Wisconsin Council on Children and Families

DHS Seeks Comments on Plans to Find $80 Million of Savings in Family Care

2012-01-29T22:56:00.000-06:00

The Department of Health Services (DHS) estimates that lifting the cap on Family Care (and IRIS) and allowing the program to expand into additional counties will cost $80 million in state GPR funding in the current biennium. As we noted in a previous blog post, the bill to lift the cap has no appropriation because the intent of DHS and the Governor is to find the savings within those long-term care programs.

The legislation that would remove the cap has been introduced in the Senate as SB 380 and in the Assembly as AB 477. Thus far, neither bill has been scheduled for a public hearing. A message sent Friday by the Disability Advocates: Wisconsin Network (DAWN) encourages people, especially those on the Family Care and IRIS waiting lists, to contact their legislators and ask for hearings on the bills.

DHS has now posted on its website information about its proposals for achieving $80 million of savings in long-term care, and it is accepting online comments about those plans. The department categorizes the savings in seven areas, which are listed below with the projected savings and a brief description of each category: (Click on a category for further information)

Employment Supports ($500,000) – Ensure a continuum of employment supports in Family Care, IRIS, PACE and Partnership.
Administrative and Program Efficiencies ($500,000) – Implement strategies to streamline program and administrative processes in Family Care to better align operations with current and future needs, to improve management, and to reduce program costs.
Family Care Benefits ($9 million) – Implement strategies to assure that supports and services are tailored to the needs of the individual by focusing on strength-based care plans and by maximizing the use of natural supports.
IRIS and Self-directed Supports ($1.33 million) – Strengthen program integrity and accountability of the IRIS program and ensure that self-direction in IRIS and Family Care maximize natural supports and the ability of consumers to choose the most integrated, community-based and cost-effective services.
Living Well at Home and In the Community ($54.5 million) – Increase the availability of timely and easy access to less intensive and more flexible supports to help people and their caregivers to remain healthy and safe at home and in the community without the need for more comprehensive LTC supports and services.
Long Term Care Sustainability ($14 million) – Ensure that people with long-term care needs are safe and cared for in their own homes and community settings as long as possible, with services provided in residential settings only when it is the least restrictive and most integrated location to meet the person’s needs.
Youth in Transition ($500,000) – Develop and maintain community employment and living settings for youth that transition from children’s to adult services, and address the needs of families so they can continue to work after their child graduates from school.

In his State of the State address Wednesday evening, Governor Walker seemed to be taking credit for expansion of the Family Care program. That struck me as a surprising statement, considering that the Governor’s budget bill was responsible for the freeze, which has yet to be lifted, and federal officials have ordered the state to begin enrolling people who are on the waiting lists. AARP was even more surprised than I was, and they felt compelled to respond. You can find that response, as well as the Governor's brief statement about Family Care, in AARP’s January 26 press release.

Use the department's online survey if you want to comment on any of the DHS proposals for cost savings.

Jon Peacock

Health Care Access Recommendations Fare Poorly in Legislative Council

2012-01-26T17:50:00.002-06:00

More Discouraging News Regarding Special Committee Recommendations

In a blog post last week, Sara Eskrich noted that the Legislative Council met on January 18 and recommended only 3 of the 11 bill drafts developed by the Special Committee on Infant Mortality. That same day, the Legislative Council also considered four bills developed by the Special Committee on Health Care Access, and only recommended one of the four.

Specifically, the Council recommended draft WLC: 0066/2, which would require several state agencies to jointly develop a workforce survey for health care providers (specifically the Dept. of Regulation and Licensing, now known as the Dept. of Safety and Professional Services, DHS, and DWD).

The Legislative Council did not approve any of the other three drafts that had been recommended by the committee and were reviewed last week:

WLC: 0091/1, which would expand an exemption from dental licensing requirements for dental residents or dental interns appointed by U.S.-based educational institutions and community health centers that meet certain requirements and by hospitals located outside Wisconsin.
WLC: 0096/2, which would modify duties of local health departments to require them to regularly conduct and disseminate assessments focused on population health standards and public health issues facing the community..
WLC: 0097/2, which would require graduates of the UW School of Medicine and Public Health who pay resident tuition, and graduates of the Medical College of Wisconsin (MCW), or Marquette School of Dentistry who receive state assistance as residents of Wisconsin, to practice in Wisconsin for a specified period of time.

It’s very unusual for special committee recommendations to fare so poorly in the Legislative Council because these study committees include legislators of both parties and outside experts, and they typically tackle subject areas that aren’t politically polarized. However, the composition of the special committees was determined by the Legislative Council prior to the 2010 election. The very significant shift in the makeup of the Legislature since then appears to have caused the unusually high rejection rate for committee recommendations. Also, with recall elections in the offing, the political polarization that was so pronounced in the Capitol last year appears not to have abated.

For further information about the special committee’s work, see its January 9th report.

Jon Peacock

Wisconsin Just Misses a $50 million Early Learning Challenge Grant: What Happened and What’s Next?

2012-01-25T15:36:00.000-06:00

Wisconsin barely missed receiving a $50 million federal Race to the Top- Early Learning Challenge (RTT-ELC) grant in a competitive process in December 2011. Wisconsin ranked 11 among the 37 states that applied; the top 9 were funded. If there is a 2nd round, Wisconsin could be in good shape

To see the scores and ranks by state, go to: http://1.usa.gov/tcm7mE.

In a December press release, WCCF commended the collaborative strategic planning effort by the Wisconsin grant-writing team, headed by the Department of Children and Families and the Department of Public Instruction in coordination with the Governor’s office. A significant factor in the solid proposal was strategic planning by the Early Childhood Advisory Council that served as the framework for the proposal, helping to galvanize a Wisconsin plan with crucial components of a strong early learning and development system.

Who was funded and why?
In December 2011 nine states (California, Delaware, Maryland, Massachusetts, Minnesota, North Carolina, Ohio, Rhode Island, and Washington State) were awarded four-year RTT-ELC grants ranging from approximately $44 to 70 million to improve their early learning and development systems.

The final list surprised the expectations many experts. For example, the New America Foundation’s Early Ed Watch blog projected 11 states as top contenders, based on how they ranked past performance by the states, but only 3 of those were funded: North Carolina, Maryland, and Ohio. So much for predictions.

A later analysis by Early Ed Watch found that 6 of the 9 winners had also won the K-12 version of Race to the Top. It appears that the decisions may have been made more on t what the states were proposing to do ( and how well they met the criteria) than on the state’s history of building an early childhood system.

Proposals that emphasized collaborative planning across state departments scored highly in the grant competition, according to Kathleen Sibelius, Secretary of the federal Department of Health and Human Services. She indicated that a key ingredient in the 9 winning states’ proposals was a holistic approach across government agencies and public and private sectors.

How did Wisconsin rank compared to surrounding states?
Of the surrounding states, here were the rankings:
Minnesota 7 (Got a federal RTT-ELC grant)
Wisconsin 11
Illinois 14
Michigan 18
Iowa 34

Indiana, South Dakota, and North Dakota did not apply. Wisconsin did extremely well, considering we had a new administration and we got started later on the proposal than many states.

Next steps toward an early learning system in Wisconsin
The possibility of another RTT-ELC round looks hopeful for next year, although it is hard to predict what will happen in Washington. Given Wisconsin’s ranking, it could be very competitive in a 2nd round.

In the meantime, state officials, in coordination with the Governor’s Early Childhood Advisory Council, are determining to what extent progress can be made on the state’s Race to the Top plan, which focused on the following strategies:

YoungStar: strengthening the YoungStar quality rating and improvement system,
Home Visiting: expanding evidence-based home visiting programs to better engage and support families,
Better-qualified workforce: enhancing professional development to ensure a quality early care workforce,
Data: developing an early childhood longitudinal data system,
Kindergarten assessment: establishing a assessment to measure children’s readiness at school entry, and
Public-Private Partnership: launching a Public-Private Partnership to bring more resources to local communities for quality improvement.

Already the Read to Lead Task Force, co-chaired by Governor Walker and DPI Superintendent Tony Evers, has recommended early literacy screening for all four- and five-year-old kindergartners and an early childhood longitudinal data initiative is forging ahead.

Evidence of economic benefits draw bipartisan support
Recent support for early learning investments seem to be gaining bi-partisan support across the states and in Washington, probably boosted by the evidence of economic benefits. At a press conference announcing the Early Learning Challenge awards, James Heckman, an economics professor at the University of Chicago, said: “Investments in the early life cycle of disadvantaged children, especially, have much higher economic and social returns than many later intervention programs ....”

The recent results of 2012 federal budget deliberations provide an example of support for early childhood investments, including:

Head Start increase of $424 million.
CCDBG increase of $60 million.
Race to the Top received $550 million, which is less than last year's $698 million. The Secretary will determine how much of the $550 million will be dedicated to the Early Learning Challenge. The Statement of Managers accompanying the bill says they "expect that the Secretary will include a robust early childhood component."

Let’s hope Wisconsin has a chance to compete in a 2nd round of RTT-ELC.

--Dave Edie

Budget Reductions for Juvenile Justice that Make You Go Hmmmmm

2012-01-25T10:59:00.003-06:00

As counties have developed more community-based programs and more cost-effective strategies for working with youthful offenders, we have seen a steady decline in the number of youth placed in secure confinement. Yet, another round of reductions to funding for juvenile justice programs, if approved, will hit counties hard as the legislature considers the proposals made by the Department of Administration to lapse funds for the Department of Corrections budget.

As it relates to juvenile justice funding, by far the largest single cut among the DOC lapses is from Youth Aids, which was already cut by 10 percent in the budget bill, and it has been eroded badly by inflation over the last decade. Taken together, the budget bill and new lapses reduce the 2011-12 Youth Aids funding to counties by 14 percent (without factoring in the increased loss from inflation), at a time when DOC is charging counties 3.3 percent more for youths placed in the state’s juvenile correctional institutions, a portion of which is the result of including an additional $17/day in the daily rate to help pay (over 10 years) the deficits incurred as the institution population dropped much faster than any savings could be generated.

From an outside view, what seems harder to understand is why half of the DOC lapses are coming from juvenile corrections (and mostly from Youth Aids to counties) even though juvenile programs account for one tenth of the total DOC budget.

For more detailed information, you can check out the Wisconsin Budget Project blog posting titled “Shifting the Shaft”.

Jim Moeser

Collateral Damage: Decision on Health Care Reform Funds Will Also Affect Medicaid System Upgrades

2012-01-25T07:00:00.002-06:00

By Forsaking Federal Funds, State Must Halt Effort to Develop “Real Time" Eligibility System

It was widely publicized last week that Governor Walker decided to put a halt to the state’s implementation of health care reform, including health insurance exchanges, and to stop drawing down federal funds from the $37.6 million Early Innovator grant that Wisconsin had been awarded early last year. In addition, the Governor repealed the executive order that established the Office of Free Market Health Care, and he shut down that office’s website.

What was not generally recognized last week is that the Governor’s actions will have effects that go well beyond putting a halt to health care reform implementation. DHS will also be returning a federal grant of nearly $11 million that – as Jason Stein reported on Saturday – “could have helped make cost-saving improvements to existing health programs for the poor.”

The Journal Sentinel article added:
“Supporters of the federal health law say the Walker administration let ideology and distaste for the federal law trump common sense by turning down millions of dollars that could have saved the state money in areas beyond the health care law. ‘It's really shortsighted and it's really going to hurt the state,’ Rep. Jon Richards (D-Milwaukee) said.”

The $11 million federal grant was being used to improve the state’s Medicaid enrollment system. Because the Governor has decided to forgo using any more of that funding, DHS is putting a halt to computer system changes that would have enabled the department to make some of the BadgerCare changes that are part of the cost-savings proposals submitted to federal officials in November. Specifically, DHS is pulling the plug on its efforts to develop a “real time” eligibility system. As I understand it, the indirect effects of that decision include not proceeding with the elimination of presumptive eligibility and retroactive eligibility.

Although I liked the idea of developing a “real time” process for determining eligibility, I was skeptical about whether or when it could be efficient enough to truly justify the elimination of presumptive and retroactive eligibility. Thus, I have mixed feelings about the indirect effects of the Governor’s decisions to cut off the funds for Medicaid system upgrades. On balance, however, I think it's an unfortunate choice. As I noted in the Journal Sentinel article, “We're squandering an opportunity to make upgrades to our computers that badly need upgrades - with or without health care reform."

Jon Peacock

Do No Harm should apply to juvenile justice! Some lessons from the Luzerne County (PA) scandal.

2012-01-24T10:49:00.001-06:00

Some of you will have followed the scandal that reached national notoriety in Luzerne County, Pennsylvania – where judges were ordering youth held in secure confinement in a private facility and money was being funneled back to them by the facility operators. Finally, at least some aspects of that have come to some closure with the review and expungement of over 2,200 juvenile cases and an end of the state’s oversight of that county court. The court also created a restitution fund to help reimburse some of the victims of the youth’s acts, since the expungement essentially relieved the youth of that liability. These are positive steps forward for Luzerne County, and in some ways it could be said that the scandal is over. But civil claims against Judge Ciavarella are not resolved and more importantly one can only wonder about the damage done to youth through their unnecessary incarceration and how that has a lingering effect on their lives, even if the “paper record” no longer exists.

We would all like to think that the type of abuses that occurred in Luzerne County could not occur in our own systems, and they rarely do. But, we too rarely apply the axiom of “first do no harm” to our work in the juvenile justice system.

In reality the impact of our decisions and systems is much more subtle in nature and done under the guise of “teaching him or her a lesson” or “being tough on crime” or some other adult construct that we use to justify our actions. Rarely do they rise to the notoriety or level of what occurred in Luzerne County, but that should not allow us to think “it can’t happen here”.

Every time we lock up a youth needlessly, whether in a juvenile facility or even worse in an adult facility; every time we delay court actions for reasons of convenience or set over a hearing “for good cause” when the cause is not really that good; every time we confine a youth in a facility that is poorly designed and staffed by adults who are not sufficiently trained to work with youth; every time we cut off a youth from their education or a positive relationship, even for a short time; every time we view youth only through our own cultural lens; every time we focus on blaming youth for the past without adequately supporting their future; every time we forget about the impact of a youth’s behavior on the community and on victims; every time we directly or indirectly blame a family for their failings and fail to take the extra step to really engage them in positive change; and every time we let the needs of the system supersede the needs of youth, victims, and the community we run a great risk of failing to meet the “first do no harm” test. It’s more than a risk. It’s almost a certainty.

Is the harm done more subtle? Yes. Is it often unintended? Sure. Does it get the scrutiny and media attention that it deserves? Rarely. Are our system’s actions uninformed by what we know really works? Way too often.

As you read this, today, now, somewhere in our state there is a boy or girl meeting with a social worker or facing a judge or being interviewed by police or sitting in the principal’s office – in all cases having some adult intervene in their lives and making decisions about their future that will have an impact, one way or the other. All of the adults bear the responsibility to understand that they should first, do no harm. Of course we hope for more, and in many – perhaps most – situations we get more. Unfortunately, in some we get less.

Working well with youth is hard work and it is about making tough choices, often choices that are contrary to conventional wisdom, and often choices that make the work harder - but choices that in the end deliver better results. For each of us, keeping the lessons of Luzerne County in mind as we choose which road to take as we work with youth can’t hurt! by Jim Moeser

Immigration Services Proposes to Make Some Sense out of Complex Rules to Keep Families Together

2012-01-24T09:37:00.002-06:00

This month, the U.S. Citizenship and Immigration Services (USCIS) announced a possible rule change for undocumented spouses and children of U.S. citizens who are eligible for legal permanent resident (LPR) status. Under current regulations, those seeking LPR status must leave the United States in order to file for a visa. Many of those who wish to become LPRs also qualify for a family unity waiver, but under current rules this waiver can only be filed outside of the United States, and the family must demonstrate that the U.S. citizen relative will suffer severe hardship if separated from the non-citizen relative. The family unity waiver can take months to years to process, which hardly keeps the family unified as the non-citizen must remain in his or her country of origin for this process. Furthermore, once undocumented persons leave the country they are subject to having their re-entry barred for 3 to 10 years, depending on how long they have been living in the United States without documentation. Therefore, many who are eligible to apply for LPR status make the difficult choice to remain undocumented, as the cumbersome process to become an LPR can lead to unreasonably lengthy and sometimes perilous separations.

The possible rule change means that spouses and children of U.S. citizens can file for the family unity waiver in the U.S. and can remain in the country while the waiver is being processed. These changes, however, do not eliminate the requirement that the applicants must leave the U.S. before being fully approved for LPR status, but if approved for the waiver they would know they could return to the U.S. within a reasonable amount of time.

While this proposed change is certainly not comprehensive, it could lead to a less damaging process for undocumented individuals, married to or children of a U.S. citizen, hoping to adjust their status. Family separation is traumatic, especially when compounded by the uncertainty of family unity waivers being granted and the chance of being barred from returning to the U.S. for years. This proposed change illustrates the difficult situations that arise because of current immigration regulations as it recognizes the harm these rules can cause. This proposed change is a step in the right direction for immigrant children and families.

For more information, read the American Immigration Council press release about the proposed changes and NPR Southern California’s affiliate KPCC’s coverage.

Julie Davidson

DHS Contends Wisconsin Has a Deficit (Despite Governor’s Statements to the Contrary)

2012-01-23T06:00:00.004-06:00

Certification of a Deficit Would Allow State to End or Modify BadgerCare Eligibility for 53,000 Adults

Governor Walker and many Republican legislators have said repeatedly that the biennial budget bill brought the state budget into balance. I agree with that assessment. However, the Department of Health Services (DHS) sent a letter to federal officials in late December asserting that Wisconsin’s budget is now in the red.

The matter of whether Wisconsin has a deficit is more than a rhetorical debate. The federal health care reform law contains provisions known as “maintenance of effort” (MOE) standards, which require states to maintain their current Medicaid eligibility standards and enrollment procedures. However, states that can certify that they have a deficit in either the current fiscal year or the next one may reduce eligibility of adults (specifically parents and childless adults) to 133 percent of the federal poverty level (FPL).

If Wisconsin is able to certify that it has a deficit, DHS can eliminate about 53,000 adults from BadgerCare, saving an estimated $60 million per year of state funding, beginning on July 1, 2012. Alternatively, such a certification would enable DHS to change BadgerCare for those adults (over 133% of FPL) by either increasing their premiums or by making them ineligible if they have an offer of employee-sponsored coverage where the premiums would cost less than 9.5 percent of family income.

As Jason Stein reported in an article posted online by the Journal Sentinel Sunday evening, DHS contends that Wisconsin has a $3 billion deficit based on Generally Accepted Accounting Procedures, know as GAAP. However, Wisconsin uses cash accounting, rather than GAAP. If our state employed the more conservative GAAP methodology, we wouldn’t meet the constitutional requirement to have a balanced budget.

I’m surprised that DHS chose to base its assertion of a state deficit on GAAP calculations. I had guessed the state would argue that cash accounting would put the state budget into the red if one assumed that DHS did not get federal approval to make any of the proposed changes to BadgerCare. A month or two ago that would have been a reasonable assertion. However, after lower Medicaid deficit calculations were released by DHS earlier this month, it appears that the state’s Medicaid budget could be put into balance without the proposed BadgerCare cuts that require a waiver of the federal MOE requirements. The state’s improved Medicaid budget picture may have been a factor in the DHS decision to use GAAP, rather than cash accounting, to make the case that the Wisconsin budget is in the red.

It’s not clear to me whether federal officials will approve the DHS argument that GAAP accounting illustrates that Wisconsin’s Medicaid budget has a deficit, when our state routinely uses cash accounting. The exception to the MOE requirement for adults over 133 percent of FPL was intended by Congress to apply to states who are facing significant fiscal hardship because of the recession. By switching to GAAP accounting, Wisconsin’s budget would be in the red regardless of whether the current fiscal year was a tight one or one with tremendous revenue growth.

The Journal Sentinel article notes that the Assembly co-chair of the Joint Finance Committee, Rep. Robin Vos (R-Rochester), pointed out the GAAP deficit stretches back more than a decade. That's correct, and I hardly think it was the Congressional intent to create a definition of a “deficit” so loose that Wisconsin could have met the test any time in the last decade.

Jon Peacock

New DHS Data Show Continuing Racial Disparities in Birth Outcomes

2012-01-20T19:43:00.018-06:00

Black Infant Mortality Rate Declines, But Remains Nearly Three Times the White Rate

Following up on yesterday’s blog post about the proposals of the Special Committee on Infant Mortality, it’s timely to note that today the Department of Health Services issued its annual report on “Wisconsin Births and Infant Deaths” (for 2010). The report's findings relating to trends in infant mortality are mostly positive; however, there continue to be disturbing aspects of the data, especially relating to racial disparities. Consider the following:

Wisconsin’s black infant mortality rate declined in 2010 to 13.9 (deaths per 1,000 births to black/African American women), compared to 14.3 in 2009 and 16.8 in 2000.
Although that trend is encouraging, the black infant mortality rate in 2010 was still nearly 3 times the white rate of 4.9 deaths (which has dropped from 5.6 in 2000).
The Hispanic/Latino infant mortality rate for 2010 was 4.4 (per 1,000), compared to 5.5 in 2009 and 4.7 in 2000.
Based on three-year rolling averages, the American Indian infant mortality has dropped sharply over the last two decades. The 3-year average rate was 7.3 (per 1,000) in 2008-2010, which was less than half the rate of 15.8 in the 1988-90 period.
The disparity ratio between the black infant mortality rate and the white rate increased from 2.2 in 1990-1992 to 2.7 in 2008-2010. (The disparity ratio is the black infant mortality rate divided by the white rate.)

Some of the other statistics that caught my eye in the 120-page report include the following:

Wisconsin’s teen birth rate continues to decline – falling in 2010 to 26.2 (births per 1,000 females ages 15-19), compared to 29.3 in 2009 and 42 in 1990, and it remains well below the national rate which was 41.5 in 2008 (the most current national data).
Since 1990, the birth rate for black/African American women decreased 28 percent (to about 80 per 1,000 in 2010), while the white rate fell by almost 5 percent. During that period, the Asian birth rate decreased 34 percent (to 78.5 per 1,000 Asian females aged 15-44).
In 2010, 13 percent of Wisconsin women who gave birth had not finished high school, compared to 16 percent in 2000.
The overall proportion of women who received first-trimester prenatal care finished the decade where it started, at 84 percent in 2010, which is disappointing.
The proportion of women giving birth who reported they smoked during pregnancy decreased from 16 percent in 2000 to 13 percent in 2010.
The overall percent of cesarean sections increased from 17.6 percent of births in 1990 to 26.1 percent in 2010.

Based on the continuing high racial disparities in birth outcomes, I hope that at some point in the not-too-distant future, legislators can dust off the numerous recommendations for reducing infant mortality that were not approved by the Legislative Council on January 18, and will advance a comprehensive package of measures for improving birth outcomes and reducing the stubborn divide between the races.

Jon Peacock

A Majority of Recommendations from the Special Committee on Infant Mortality Do Not Move Forward

2012-01-19T17:58:00.004-06:00

Yesterday, the Joint Legislative Council met to hear the recommendations of a number of special committees. As we discussed in Tuesday’s blog post, the Special Committee on Infant Mortality put forth particularly important legislative recommendations, which we strongly support. Unfortunately, the majority of these proposals were not recommended for introduction in the Legislature; only three of the eleven were approved by the Legislative Council.

The three recommendations of the Special Committee that moved forward were:

• WLC: 0072/2: Requiring informed consent of the woman prior to an elective caesarian section or elective procedure to induce pregnancy before 39 weeks of gestation.

• WLC: 0074/2: Requiring birth certificates to include race or ethnicity, as reported by the mother.

• WLC: 0090/1: Requiring home visiting programs to be evidence based and collaborative between DCF and DHS.

Representative Cory Mason, who spoke on behalf of the Special Committee, made clear that the recommended bills were to be seen as a package of reforms that together would help combat the infant mortality crisis in Wisconsin. There are no silver bullets to solve this public health crisis, so it is particularly disappointing that the Joint Committee did not follow the recommendation of the Special Committee and address the problem from all the angles that their expertise dictated with these recommendations.

Passage through the Joint Legislative Council would not have ensured final passage and enactment of these bills – passage simply introduces the bills to the full legislature, where they would be heard in standing committees and subject to the full legislative process. Howevr, study committee bills typically have good track records, because they are developed in a bipartisan process and are fully vetted through outside experts and the Wisconsin Legislative Council.

The Governor and members of the legislature have been speaking recently about the need for moderation and cooperation in the Wisconsin capitol. However, if yesterday's debate on these Legislative Council bills is any indication of the potential for bridging the partisan divide, we may be sorely disappointed.

Sara Eskrich

Walker’s Dilemma on the Early Innovator Grant

2012-01-18T07:30:00.004-06:00

Will the Governor Give up the Grant; Will Federal Officials End It; or Neither of the Above?

An interesting article posted online late Monday by Politico describes “Scott Walker's health care dilemma.” The topic is the question of whether the Governor will decide to forsake the Early Innovator grant Wisconsin received a year ago to cover costs associated with health care reform implementation. In recent weeks Governor Walker has been pressured to “return” the federal grant, after he said just before Christmas that the state would stop implementing the health care reform law.

As the article notes, Walker “is the lone Republican governor keeping an Early Innovator grant awarded early last year under the health reform law. ….He isn’t using the $37 million federal grant. He isn’t giving it up. And it may stay that way.” However, the Governor is under pressure from Senator Lasee and Tea Party activists to reject the federal funding.

The article does a nice job of addressing a couple of misconceptions about the Early Innovator funding. Read more in my post yesterday on the Wisconsin Budget Project’s Blog.

Jon Peacock

Joint Legislative Council Should Seriously Consider Bills Recommended by the Special Committee on Infant Mortality

2012-01-17T13:02:00.001-06:00

Tomorrow morning at 8:30am, the Joint Legislative Council will meet to consider a series of reports out of special committees. All the reports have interesting and important recommendations to consider, but one is of particular importance to families in Wisconsin – the Special Committee on Infant Mortality.

Wisconsin has one of the worst racial disparity rates with regard to poor birth outcomes in the nation. Infants born to African American women in Wisconsin have been 3 to 4 times more likely to die before their first birthday than infants born to white women. This disparity persists regardless of age, education, prenatal care, or smoking status. It is problem that we must address with a concerted effort around not only the obvious solutions such as access to good pre/postnatal care, but also by addressing the social determinants of health and the impact racism has on birth outcomes. The Special Committee on Infant Mortality recognized the importance of this multifaceted strategy, as well as working with ongoing efforts in Wisconsin to address infant mortality.

The bills recommended by the special committee include:

• Requiring cultural competency training for all UW-system and WI Technical College System students in health care or social work occupational tracks to improve patient-centered care.

• Streamlining and expanding the ACCESS (public benefits management) system to include all programs designed to assist low-income people, as well as pursue a single statewide data management system to integrate health, public health, social, and economic assistance services data and information.

• Requiring the Department of Health Services (DHS) to request a waiver from the federal government to provide services and support to pregnant women at risk of negative birth outcomes (presumably these recommendations could be tied in with the proposed healthy birth outcome medical home model of care for pregnant women in the 2011 DHS proposed Medicaid efficiencies).

• Requiring that all women being discharged from the hospital after delivery receive information on breastfeeding and newborn care, as well as a plan for postpartum care follow-up.

• Requiring DHS to prepare an annual report on infant mortality and birth outcomes.

• Allowing nurse-midwives to participate in the Patients Compensation Fund and practice with hospital staff privileges, without requiring that they collaborate in a written agreement with a physician.

• Allowing non-custodial parents, who are in compliance with court ordered support for the child, to receive the Wisconsin Earned Income Tax Credit (EITC), even if someone else also claims that child on their tax benefits.

• Requiring informed consent of the woman before an elective caesarian section or elective procedure to induce pregnancy prior to 39 weeks of gestation.

• Requiring birth certificates to include race or ethnicity, as reported by the infant’s mother.

• Requiring home visiting programs in DHS and the Department of Children and Families (DCF) to work collaboratively and be evidence-based.

• Requiring DHS to prepare an annual report related to hospital neonatal intensive care units.

WCCF urges members of the committee to move forward with the recommendations of the Special Committee on Infant Mortality. Many of these bills will require little fiscally, but have the potential to move us towards better birth outcomes for all Wisconsinites, and that ultimately saves the state in birth-related medical costs -- considering that the most recent (2008) DHS numbers show that Medicaid paid for 45% of births in Wisconsin.

This is an area where Wisconsin can and should do better. Doing what we can legislatively to require more data and more effective services will help the other efforts in communities to reduce disparities in birth outcomes.

Sara Eskrich

Update on Family Care: Bill to Lift Cap Introduced, Hearing on Audit Next Week

2012-01-12T18:14:00.004-06:00

As mentioned in our recent blog post, Healthcare Highlights of the Holiday Hiatus, Governor Walker announced on December 28th that he wants to lift the cap on Family Care (as well as IRIS and Family Care Partnership) and allow all counties to participate. Later that day, reporters discovered that the Administration had been directed by the federal government to lift the cap impopsed by the budget bill on those programs.

Just yesterday, Senator Moulton and Rep. Kaufert started circulating legislation to formally remove the cap on enrollment in Family Care and the related long-term care programs. The deadline for signing on is Friday (Jan. 13), which indicates that the co-authors hope it will be considered on a fast track. We hope so too, provided that some key questions about the assumed cost savings are answered soon.

The proposed legislation has no appropriation, which suggests that the intent of the bill is for the estimated $80 million GPR cost of lifting the cap to come from changes or “efficiencies” in the programs. That’s a concern for some advocates, who are awaiting more information about those changes. Nevertheless, a memo from the Survival Coalition of disability organizations encourages legislators to support the bill.

This coming Wednesday, January 18 , the Joint Audit Committee is holding a public hearing at 9:00 a.m. regarding the April 2011 Family Care audit and the follow-up report issued by the Dept. of Health Services (DHS) on September 1. The purpose of the hearing is to have DHS staff discuss concrete plans to address concerns raised by the audit. Advocates are hopeful that the hearing will shed some more light on the efficiencies identified by the department in Family Care.

Regardless of the Audit Committee hearing, it is critical for DHS to release more details on the seven efficiencies papers they are promoting as means to cover the costs of lifting the Family Care cap. The implications of these efficiencies should be fully examined by beneficiaries and advocates, in an open, truly transparent public process.

With recent Medicaid budget developments, including the deficit estimate being reduced by $322 million and a $24.5 million bonus payment from the federal government for successful coverage of kids, there is money to both lift the cap on Family Care and to set aside most of the proposed changes to BadgerCare.

We are very pleased that a bill to lift the Family Care cap is being introduced, and we are optimistic that it will have strong bipartisan support. However, before the bill goes much further, we are counting on DHS and legislators to ensure that interested parties understand how the changes are being financed and the implications of those choices.

Sara Eskrich and Jon Peacock

Healthcare Highlights of the Holiday Hiatus

2012-01-10T12:10:00.002-06:00

Walker Eases His Position on Two Issues, but Reverses His Support for Exchanges

Did you get out of Wisconsin for a week or two in late December or early January? Or perhaps you stayed in town over the holidays, but took a vacation from political news. Even if you only took a brief break from following the news, you may have missed some interesting and important developments on health care policy.

This blog post provides a summary of the significant news relating to healthcare policy over the last few weeks, including developments relating to BadgerCare, Family Care, the Medicaid deficit, and implementation of health care reform.

Medicaid and BadgerCare financing

Medicaid deficit – In a letter to the Joint Finance Committee released last week, the Department of Health Services (DHS) reduced its estimate of the Medicaid budget deficit by almost 60% to $93 million GPR. In a January 3rd blog post, we noted that the $127 million GPR reduction to the projected deficit could be used to avoid the proposed changes to BadgerCare (which would save $116 million GPR, if fully approved by federal officials). However, the Walker Administration appears to be resistant to using the savings for that purpose.

CHIPRA performance bonus award – On Dec. 28, federal officials announced Wisconsin was being awarded a $24.5 million bonus for the success of BadgerCare in improving Medicaid enrollment of low-income children. As we commented in a WCCF blog post that day, these funds and a similar award that the state can expect at the end of 2012 could help the state avoid the proposed cuts to BadgerCare. The Fiscal Bureau estimates that the state bonus will be about $15 million less in 2012 and 2013 (combined), if the state proceeds with plans that reduce BadgerCare participation by 29,000 children.

Lapse to General Fund – On Dec. 23, the Dept. of Administration released its recommendations for lapsing $123 million from agency budgets to the General Fund during the current fiscal year. The DOA recommendations, which will be reviewed by the Finance Committee, would lapse $18 million from the 2011 CHIPRA bonus award.

Family Care

Elimination of the cap – At a press conference in the Capitol on Dec. 28, surrounded by advocates for people with disabilities, Governor Walker announced that he wants to lift the cap on the Family Care program (imposed by his budget bill) and allow all counties to participate. The Governor said the cost of those changes would be $80 million GPR during the current biennium. It’s unclear how that will be financed, although it will probably be a combination of savings from the reduced Medicaid deficit and changes made to Family Care. Lifting the cap and providing the needed funding will require legislation, but the Assembly co-chair of the Finance Committee has expressed strong reservations. (Read more in the Dec. 28 Journal Sentinel article.)

CMS letter ordering cap to be removed – Later on the 28th, Patrick Marley of the Journal Sentinel tracked down a Dec. 13 letter from the Centers for Medicare and Medicaid Services (CMS) ordering the state to remove the Family Care cap. As Clay Barbour reported in the State Journal a day later, “good publicity turned bad for Gov. Scott Walker on Thursday when details of a letter from the federal government cast doubt on his motivations for lifting the cap on a state safety net for elderly and disabled residents.” See also the short “Fortunes” column in last Thursday’s Isthmus newspaper.

Proposed BadgerCare policy changes

Dec. 31 deadline – The budget bill says that if the state hasn’t gotten a waiver by Dec. 31, 2011, of the federal maintenance of effort requirements, DHS shall end BadgerCare eligibility of adults over 133% of the federal poverty level (FPL). That deadline has come and gone, and the state still hasn’t received such a waiver. However, in a Dec. 22nd interview with Jason Stein of the Journal Sentinel, Governor Walker said the state doesn’t necessarily have to cut off the 53,000 adults over 133% of FPL. Read more in Sara Eskrich’s recent WCCF blog post.

BadgerCare Petitions – Also on Dec. 22, John Hardin of Chetek delivered to the Governor’s office and DHS nearly 15,000 signatures he collected via an online petition – urging state leaders not to cut BadgerCare.

Senator Vinehout’s bill – On Dec. 27, Senator Kathleen Vinehout introduced a bill, SB 351, that would retroactively change the Dec. 31 deadline to March 1.

Health care reform implementation

Governor declares a halt – Jason Stein reported on Dec. 22 that “the state is suspending plans to implement the federal health care overhaul in Wisconsin while the nation's highest court considers whether to uphold that law.” This is a reversal from the Governor’s previous position that a bill to enable a health insurance exchange would be introduced in time for it to be approved before the end of the current legislative session. As the Journal Sentinel reported last week, insurance companies are unhappy with the decision because if the law is not overturned Wisconsin will probably have to have a federally designed and operated exchange, rather than a state-designed exchange.

Federal flexibility on essential benefits – On Dec. 16 the US Dept. of Health and Human Services released a somewhat surprising bulletin that outlines a state-by-state approach to defining essential health benefits (EHB) prescribed by the health care reform law for individual and small group markets, as well as Medicaid benchmark plans. This decision indicated that there will not be a strong federal minimum benefit standard, and instead EHBs will be tied to insurance offerings in each state.

In conclusion, it’s interesting that the Governor has taken a harder line on health care reform implementation, while easing his positions a bit on BadgerCare (at least with respect to the Dec. 31 deadline) and Family Care. However, the modifications of the Governor’s stance on the latter two issues might have more to do with recognition of the realities of federal law than with a moderation of his position on those issues.

Jon Peacock

2012 Brings Numerous Changes Adversely Affecting Working Families

2012-01-09T14:36:00.001-06:00

As the calendar turned to 2012, many of Wisconsin’s working families began to feel the effects of state budget cuts and policy changes made in the biennial budget bill signed into law last July. According to a new synopsis of delayed budget changes by WCCF, working families are beginning this month to be adversely affected by a number of changes, such as reduced tax credits, higher health care premiums and copays, and a new waiting period for unemployment insurance benefits.

“The range of changes that will make things tougher for Wisconsin families starting this year is startling,” said Ken Taylor, executive director of the Wisconsin Council on Children and Families. “At a time when so many working families are just starting to get back on their feet in the wake of the recession, it’s troubling to see just how many policy changes are going to make it more difficult for them to bounce back economically.”

The WCCF summary includes changes that affect tax credits for low-income households; health care costs and benefits through BadgerCare; a new waiting period for collecting unemployment benefits; and more restrictive options for workers participating in the W-2 program. Some of the changes went into effect on January 1, while others will be felt by Wisconsin residents when they file their income tax returns over the next few months.

“Low- and moderate-income families in Wisconsin are going to feel some pain as the cumulative impact of these changes sinks in,” said WCCF Research Director Jon Peacock. “These families’ loss of buying power is also going to have a negative impact on the state’s economy.”

The most significant effects for working families will probably begin at least a few months into the year, if or when federal officials allow the Department of Health Services (DHS) to implement proposed changes to the BadgerCare program.

Those changes are estimated by DHS to reduce BadgerCare participation by more than 64,000 people, including over 29,000 children. An additional 263,000 people who remain in the program would have reduced benefits and significantly higher copays.

Jon Peacock

Help Families Get the Credit They Deserve (in English, Spanish or Hmong)

2012-01-05T22:11:00.001-06:00

Each year WCCF updates a one-page brochure that helps educate people about the major refundable tax credits for low-income families -- the federal and state Earned Income Tax Credits (EITC), the state Homestead Tax Credit, and the federal child tax credit. Please help us get the flyer into the hands of low-income families who could benefit -- many of whom are unaware that they are eligible for one or more of those credits.

You can find the updated version of the tax year 2011 flyer on the WI Budget Poject website. In addition to the English version, you can also get the flyer in Spanish and Hmong.

Jon Peacock

Juvenile Crime Drops – a hope for the end of the Scapegoat Generation?

2012-01-04T12:13:00.003-06:00

Some years back Michael Males wrote a book called “The Scapegoat Generation” in which he debunked the many myths about youth, including the myth of the coming generation of super-predators. Males continues to be one of the best researchers in using actual data to talk about trends in youth behavior – and you can view a brief video and link to a recent report in California that shows a 20-year decline in juvenile arrests – similar to what we reported in our The State of Juvenile Justice in Wisconsin: What do we really know? report released in the fall.

Of particular note in California is the increased diversity in the population, along with an over 90% decrease in the number of youth confined – factors that some would suggest should have led to increases in juvenile crime, not the kind of decreases that actually occurred. Thanks to Liz Wu for posting this information on the Reclaiming Futures blog site.

Maybe we can finally get past the misperception that somehow youth are running out of control in our communities, while at the same time not getting complacent about how we invest our resources for the future.

Jim Moeser

State Announces Medicaid Shortfall is $322 Million Less than Anticipated

2012-01-03T16:39:00.004-06:00

Great News For BadgerCare, Funds Should Enable the State To Avoid Most of the Proposed Cuts

In a letter to the Joint Finance Committee, the Department of Health Services (DHS) revised estimates of a $554 million shortfall in this biennium’s Medicaid budget, down to $231.8 million all funds. This is great news for Wisconsin, especially in the midst of the debate over major eligibility, enrollment, and benefit changes (currently being reviewed at the federal level), which would result in tens of thousands losing their BadgerCare.

The changed projection comes after analyzing spending thus far in fiscal year 2012, and is lower due to several factors, including lower than expected enrollment, lower costs per enrollee, lower Medicare Part B premiums (which are paid by Wisconsin for dual enrollees), and a much lower ($18 million lower) drug rebate reimbursement to the federal government.

DHS was quick to point out that this projection represents a change of only 2% of the total program budget this biennium. However, the changes currently proposed by DHS to achieve the cost savings needed to fill the shortfall would adversely affect more than two-fifths of BadgerCare enrollees. The reduced shortfall provides the perfect opportunity for the Department to go back to the drawing board, with this money and the CHIPRA performance bonus funding, and move forward with solutions that create real cost savings for Medicaid and BadgerCare, rather than just cost-shifting.

Even if part of the savings are used to lift the cap on Family Care, as the state intends to do, the remainder and the federal bonus funding should allow the state to avoid all or most of the proposed changes to BadgerCare that would increase the number of uninsured Wisconsinites.

For more on this announcement, see Jason Stein’s article in the Journal Sentinel here.

Sara Eskrich

December 31 Has Come and Gone, So What’s the Story with the Medicaid Waiver Deadline?

2012-01-02T12:55:00.001-06:00

December 31st, 2011, was a date we heard a lot about with regard to the Wisconsin Medicaid budget; however, it has come and gone without too much commotion. Let’s backtrack and discuss the significance of this arbitrary deadline, and look ahead to what may happen now that it has passed.

To Recap: In the biennial budget, the legislature authorized $554 million in unspecified cuts to BadgerCare and Medicaid, granting unprecedented power to the Department of Health Services (DHS) to impose those changes with limited legislative oversight. Fortunately, the federal health care reform law (the Affordable Care Act, ACA) included a provision restricting states from making changes that would reduce eligibility or suppress enrollment without receiving a waiver of these maintenance of effort (MOE) provisions. Here’s where December 31st comes into play – the Wisconsin budget includes language setting an arbitrary deadline of December 31st, 2011, for the state to be granted this federal MOE waiver, or DHS is directed to remove 53,000 adults above 133% of the poverty level from BadgerCare on July 1, 2012.

In early December, the Federal government told DHS that they would likely not be able to meet the December 31 deadline. Our December 9th blog post shares more about that letter from the Feds.

Looking Forward: The Wisconsin MOE Waiver was not approved or denied by the federal government by December 31st, 2011. They are still reviewing the complex proposal, which would harm at least 168,000 Wisconsinites – WCCF is advocating, amongst others, for the rejection of this waiver. However, under state law, 53,000 adults are currently slated to lose their BadgerCare coverage on July 1. The Governor recently made statements indicating that he doesn’t see this scenario as inevitable (see Jason Stein’s Journal Sentinel story here); presumably this indicates that he is open to working with the legislature to amend this arbitrary deadline in the budget. Senator Kathleen Vinehout sponsored a bill (SB 351) which would push the deadline for federal approval back to March 1st.

Though December 31st has come and gone, we still don’t know as much as we would like about the future of BadgerCare. Hundreds of thousands of Wisconsinites health coverage is at stake with these proposals. For that reason, we hope that time is taken for thoughtful, deliberate, and transparent decisions to be made, which do not result in reduced eligibility or benefits.

Sara Eskrich

It's Not Too Late to Support WCCF in 2011

2011-12-29T17:09:00.001-06:00

For more than 130 years, the Wisconsin Council on Children and Families has been working to ensure that all children grow up in a just and nurturing family and community. No matter the year, the political climate or the state of our economy, WCCF has always put children first.

While we may not directly feed, provide child care or house people in need—we do focus on achieving lasting, long term results. WCCF works to improve outcomes for children in the areas of health, economic security, safety and education. Through research, public education and advocacy we help policy makers and government officials make changes that positively impact the well-being of children and families in Wisconsin.

The information we provide through our blog posts is just one part of our efforts to protect and support children and families, but it is a part of our work that requires the support of the people who look to WCCF to shed light on critical public policy choices.

Please join us in this important mission to protect Wisconsin’s most vulnerable. This holiday season give a gift that will touch the lives of Wisconsin’s children. Please contribute $500, $100, $50 or whatever you can afford to the Wisconsin Council on Children and Families. Your support will help us raise our voice to make every kid count.

Thank you for your support, and we look forward to working together in the coming year to assist the children and families of our state.

Confirmation of the Benefits of Being Smart on Crime

2011-12-29T09:43:00.002-06:00

The Office of Justice Assistance just released an evaluation on the costs and benefits of implementing Treatment Alternatives and Diversion(TAD) programs in seven Wisconsin counties. The evaluation is consistent with what we have seen well-researched in the juvenile system by showing that focused, strategic, and smart community-based alternatives to incarcerating many offenders not only lowers the likelihood of reoffending but is also cost-effective - in this case showing that for every $1 invested there is a net benefit of nearly $2 to the community in the long run.

Treatment courts, case processing reforms, and the use of evidence-based practices deliver benefits that far outweigh those of the too common “tough on crime” strategies that draw attention in the media.

Jim Moeser

BadgerCare Receives $24.5 Million Bonus from Feds Due to our Great Track Record Enrolling Kids

2011-12-28T17:35:00.001-06:00

Wisconsin’s success in improving access to health care for children through the BadgerCare program has qualified the state for a federal bonus of $24.5 million for 2011, federal officials announced this afternoon.

“Today’s announcement is fantastic news for families in BadgerCare because these funds could be used to avoid making proposed changes that would knock more than 64,000 people out of the program,” said Ken Taylor, WCCF’s executive director.

This blog post examines the background of the bonus awards, the total amount granted today, and the anticipated reduction in future awards if the Department of Health Services is allowed to proceed with plans that sharply reduce enrollment of children in BadgerCare.

Wisconsin is one of 23 states receiving performance bonus funding in 2011 for progress in removing red tape and administrative hurdles to enroll significantly more uninsured children in their Medicaid programs. A total of nearly $300 million was awarded to states by the federal Centers for Medicare and Medicaid Services, and Wisconsin’s $24,541.778 bonus payment is the fourth largest.

The performance bonus fund was established by Congress in 2009 to encourage states to do a better job of enrolling lower income children who were already eligible for Medicaid. To be eligible, a state must meet targeted increases in Medicaid enrollment, relative to the 2007 level, as well as meet certain policy standards for improving enrollment and renewal processes. The bonus payments will continue through 2013, with qualification based on the amount by which a state exceeds the minimum growth target, relative to the 2007 base level.

A memo by the Legislative Fiscal Bureau prepared for Rep. Cory Mason examines the question of what would happen to the anticipated bonus award in 2012 if the state proceeds with plans to implement policy changes proposed by the Department of Health Services that are expected to reduce the number of children in BadgerCare by more than 29,000. The Fiscal Bureau concluded that such changes would reduce the bonus award by an estimated $10.3 million per year, starting in the second half of 2012.

Wisconsin’s eligibility for the bonus award results partially from BadgerCare policy changes implemented in 2008, and a small change initiated in April 2010. Those policy changes include allowing families to complete one application form for both the Medicaid and CHIP programs, eliminating the in-person application requirement, streamlining the benefit renewal process, and eliminating the requirement that a family’s assets fall below a certain level for children to receive health care.

However, the size of the award is a function of the enrollment growth from January 2008 through June 2011, which resulted from numerous changes in the design of BadgerCare Plus, including the removal of premiums for kids below 200% of the poverty level. A number of those improvements would be undone if DHS gets federal approval for the Maintenance of Effort waiver that would allow the department to make sweeping changes to the program.

For further reaction to today’s announcement of the bonus awards, see WCCF’s press release and the Save BadgerCare Coalition release.

Sara Eskrich and Jon Peacock

Wisconsin Budget Project’s Top Ten Blog Posts of 2011

2011-12-27T16:23:00.000-06:00

There have been scads of interesting and important stories over the past year relating to the Wisconsin budget and the effects of budget changes on the state’s families. The Wisconsin Budget Project has blogged about many of those stories, and in today’s blog post it provides a list of and links to the project’s 10 most popular posts in 2011.

UW System and Children’s Programs Hit Hard by Lapses (Cuts) Announced Today

2011-12-23T19:11:00.001-06:00

This afternoon the Walker Administration announced its plans for lapsing $123 million to the General Fund. The biennial budget requires the Department of Administration (DOA) to allocate $174 million of lapses, and today’s announcement covers just the first fiscal year – meaning that there will be at least $51 million in additional lapses sometime during the next 18 months. (Note: A lapse is essentially the same thing as a cut, except it doesn't reduce the base level of funding used as a starting point in developing the next budget.)

The biggest hit is to the UW System, which has to give back $46 million. Several programs for children and youths are also absorbing substantial blows. The lapses include almost $18.6 million from federal bonus funding for children’s health care, $8.3 million from the Department of Children and Families (DCF), and about $4.7 million from juvenile corrections (primarily Youth Aids).

Read more below and in the Journal Sentinel coverage of the story.

According to today’s letter from DOA Secretary Mike Huebsch, “specific education exemptions were granted to school aids, higher educational financial aid and technical college aids.” In addition, there are exemptions for Medical Assistance – except for the CHIPRA bonus funding – and other direct care programs at DHS, and child welfare and certain TANF programs at DCF.

The plan also exempts “certain correctional programs and other institutions that operate 24/7.” Jim Moeser, WCCF’s deputy director, said community-based corrections programs and county juvenile justice funding are bearing a disproportionate share of the $9.4 million in cuts from the Department of Corrections budget. He noted that juvenile corrections spending accounts for less than one-sixth of the department’s $1.1 billion per year budget, but half of the lapse is coming from the juvenile programs.

“The new cut in Youth Aids funds will have a harmful impact on the ability of counties to sustain progress they have made in developing effective community-based alternatives, which get youth back on track and have helped significantly reduced juvenile crime,” Moeser said.

The Joint Finance Committee has until January 18 to review the plan.

Jon Peacock

Report Reveals Wide Disparities in Wisconsin’s Health Insurance Costs and Quality

2011-12-22T22:33:00.001-06:00

This week Citizen Action of Wisconsin released its 6th annual Health Insurance Cost Ranking. The report provides local information on cost, quality, and the rate of health insurance inflation. The study highlights a large disparity in health insurance costs between the different regions of the state, with some paying over $2,000 more per year for single health coverage.

This year's report finds the largest regional disparities yet reported. It concluded that La Crosse has the highest health insurance costs, followed closely by Eau Claire, Superior, Wausau, and Milwaukee. Citizen Action noted that because Milwaukee has a predominance of national for-profit health insurance companies, its coverage is both high cost and low quality. Madison has both the lowest health insurance costs and the highest quality, which vividly makes the point that the rest of the state’s residents are not getting the value they deserve.

The report also provides valuable insights into how to bring health care costs under control, and how Wisconsin can best implement the Affordable Care Act, the new national health care reform law. Unfortunately, Governor Walker said today that he was putting a hold on implementation of the health insurance exchanges required by that law, until the U.S. Supreme Court rules on the legal challenge to the law. (See Jason Stein’s article, posted this evening on the Journal Sentinel website.)

For some of the press coverage about the Citizen Action report, see the articles in the WI State Journal or the Green Bay Press Gazette.

Jon Peacock

A Closer Look at the Medicaid Audit, DHS Response and Senator Vinehout’s Reaction

2011-12-21T18:40:00.002-06:00

As we noted in yesterday’s blog post, the Legislative Audit Bureau issued a comprehensive audit of the Medical Assistance (MA) program Tuesday. The LAB audit recommends that DHS should report to the Legislature’s Joint Audit Committee by next July on the department’s efforts to address the following seven issue areas raised by the audit:

Ensuring adequate funding for contractual services before authorizing expenditures.
Using bids to solicit the most appropriate and effective administrative services at the most competitive price.
Reviewing existing contracted services to identify if cost savings could be achieved by using state employees.
Considering potential benefits of enrolling recipients into HMOs more quickly.
Developing separate accounting codes for administrative expenditures for the MA and FoodShare programs.
Accounting for all Medical Assistance expenditures in determining total program costs.
Developing a more detailed biennial budget request and financial reporting structure to allow for routine budgeting and accounting of all Medical Assistance costs by subprogram.

As is typically the case, the LAB publication concludes with a letter from the agency that was audited, in response to the audit findings and recommendations. In this case the response is from Secretary Smith, and most of his statements seem to support the changes proposed by the LAB. One area of apparent disagreement is that he raises concerns about the recommendation to create separate appropriations for each Medicaid subprogram. I think the concerns and questions Sec. Smith raises merit careful consideration, and I agree with him that we might not want to hinder the ability of the department to move funding between one part of Medicaid and another. However, I don't think that concern should preclude the development of more detailed budgets and enhanced DHS capacity to track expenditures by subpopulation served.

I particularly agree with the points made by Senator Vinehout today, urging additional transparency and accountability for Medicaid spending. Her press release says, “If DHS can’t answer such basic questions about program costs, how can officials make informed decisions on how to fix Medicaid?” Vinhout calls on DHS to “get its own fiscal house in order before kicking thousands of citizens off health programs.”

Note that on Wednesday the link to the complete report wasn’t working, but one could at least access the 4-page summary of the highlights.

Jon Peacock

Audit of Wisconsin’s Medical Assistance Programs Released: Suggests Improvements in Program Administration and Transparency

2011-12-20T17:28:00.002-06:00

Today, the Legislative Audit Bureau released their 100+ page report on Wisconsin’s Medical Assistance (MA) programs, including BadgerCare Plus, Medicaid, and long-term care programs. The economic downturn, as well as eligibility expansions, has increased the number of MA recipients to 1.2 million in January 2011 – boosting expenditures from $5 billion in fiscal year 2006-07 to $7.5 billion in fiscal year 2010-11. The vast majority of that $2.5 billion increase, 87%, was federally funded.

The audit report highlights a few key areas of MA, including program expenditures, administration, managing service delivery, and confirming eligibility. One particular area of interest, especially considering the national and state emphasis on managed care, was the finding that in January 2011, 61.3% of all recipients received services through managed care. Some people are not able to enroll in managed care because there aren’t HMOs serving their area, and others use fee-for-service care for things their HMO doesn’t offer. However, the audit recommends, to the extent possible, enrolling people more quickly in managed care, to control costs.

The audit also discusses the limited data systems and availability of basic information within the Department of Health Services (DHS), and the minimal use of this data in budgeting. With regard to contractual services, the audit points out that DHS has not always considered available spending authority when making contract decisions, which is important because of the increased reliance of the department on vendors for contracted services. The MA funded expenditures are also not all included in the MA budget or recorded as program expenditures. This finding relates to the overarching finding that the data systems and budget practices (including increased use of contractors) limit DHS’ ability to effectively manage and oversee the MA program.

The audit report didn’t turn up any evidence of significant fraud in Medicaid. As Rep. John Richards said in a press release this afternoon: “Today’s report debunks the myth long perpetuated by some lawmakers that widespread fraud exists in the state’s health care programs or that people are moving to Wisconsin solely to obtain Medicaid benefits.”

A press release from the co-chairs of the Audit Committee, Senator Cowles and Rep. Kerkman, doesn’t contradict that assessment, but puts more focus on fraud prevention: “Improving our Medical Assistance program should assure that only eligible Wisconsinites receive benefits from our state’s generous program and that spending can be as transparent as possible,” Rep, Kerkman said.

In a follow-up blog this week, we will take a closer look at the recommendations the audit made to DHS, as well as DHS’ response.

Sara Eskrich and Jon Peacock

From Uninsurable to Covered: ACA a Lifesaver for Those With Pre-Existing Conditions

2011-12-15T14:16:00.001-06:00

We are all familiar with the phrase “big things come in small packages.” For some, a specific provision in the health care reform law is just that.

In a blog post on Wednesday, we examined the impact of one of the better know parts of the health care reform law, which has enabled 2.5 million young adults to be included on their parents’ insurance plans. Today we’re turning our attention to a more obscure part of the law, which has created an insurance option for people who have pre-existing conditions that insurance companies typically won’t cover.

The value of the law’s implementation of a Pre-existing Condition Insurance Plan (PCIP) has garnered more attention over the past week – thanks to an op-ed column by a California woman, Spike Dolomite Ward. In her December 6 column in the LA Times, titled “Obamacare to the rescue,” Ms. Ward describes her experience after she recently found out she has breast cancer. Ward had been uninsured, but thanks to reforms to the healthcare system she was able to find coverage through a PCIP program in her state.

The Affordable Care Act, passed in March 2010, divides $5 billion among the states for creating or expanding PCIP programs. Thus far, 27 states have created or expanded programs on their own, and 23 have opted to have the federal government take the lead in operating a new program to serve people with pre-existing conditions.

Wisconsin was among the states that already had a similar program, called the Health Insurance Risk Sharing Plan (HIRSP), which has since been expanded to meet the new requirements for PCIP. In Wisconsin, the number of people currently enrolled in the expanded program is relatively small – which is true as well in most other states – but the lifesaving value that it offers to enrollees is huge. This expanded version of HIRSP – formally called HIRSP Federal – currently covers 998 Wisconsin residents, who have gained access to critical and perhaps lifesaving coverage.

Although the number of people enrolled is small, the gift it has provided is huge. Without this option, the battle for coverage by people who are branded with a pre-existing condition has been an insurmountable ordeal for far too many Americans. We are thankful that this provision can offer critically needed health care and peace of mind for the woman in California – and for many Wisconsinites facing similar circumstances.

Lacy Langbecker

The Supreme Court Takes up New Cases on Juvenile Life Without Parole

2011-12-15T12:37:00.000-06:00

The US Supreme Court has agreed to take up two new cases in which young juveniles (age 14) were involved in crimes that led to a life without parole sentence. Recall that through prior cases (Graham v. Florida, Roper v. Simmons) the court has ruled that offenders under the age of 18 cannot be executed and that youth under 18 in non-homicide cases should not be subject to life without parole. Some have interpreted the more recent decision to imply that life without parole for a youth at any age involved in a homicide is acceptable constitutionally, but the language of these decisions was not as conclusive, leaving open the possibility that there are other distinctions courts should make based on age, development, and culpability in a particular offense. After all, could the Supreme Court actually rule that someone as young as 10 or 11 or 12 – or in these cases as well as the Wisconsin v. Ninham case age 14 – should be subject to a life without parole sentence?

There is an excellent summary of these cases and the issues involved through the State Bar of Wisconsin – nice job by Joe Forward! by Jim Moeser, WCCF

2.5 Million More Young Adults Insured Because of Health Care Reform

2011-12-14T17:08:00.001-06:00

New data released today shows that 2.5 million more young adults are covered by health insurance due to health care reform, the Affordable Care Act (ACA). Traditionally, young adults have been the population least likely to have health insurance. To address this, the ACA ensured starting in September 2010, that all young adults are able to stay on their parents’ health insurance coverage through age 26.

The National Centers for Health Statistics, at the Centers for Disease Control and Prevention, analyzed the data from September 2010 through June 2011, and found that the percentage of 19-25 year olds with health insurance coverage increased from 64% to 73%, which translates to an additional 2.5 million young people.

At a time when we’re increasingly hearing about the difficult job market for young people, it helps to know that parent’s health insurance coverage is still an option. This “big policy gift” from the ACA is one 2.5 million young adults and their families are incredibly thankful for this holiday season.

Stay tuned for a blog later this week on another gift from the ACA. Also, check out our friends at the Wisconsin Alliance for Women’s Health, who are blogging about “12 Days of Gifts from the ACA.”

Sara Eskrich

Are the Proposed BadgerCare Changes an Appropriate Test of Health Care Reform?

2011-12-13T20:25:00.002-06:00

Health care advocates in the Save BadgerCare Coalition agree with the Department of Health Services (DHS) on at least one thing – that the BadgerCare changes proposed by DHS can’t be made without a waiver of the “maintenance of effort” (MOE) requirements of the federal health care reform law. Those provisions of the Affordable Care Act (ACA) require states to maintain their current eligibility standards and enrollment procedures until 2019 for children and until 2014 for adults, except that states with deficits may be allowed to reduce eligibility of adults to 133% of the federal poverty level.

Where many advocates disagree with DHS is on the issue of whether the Centers for Medicare and Medicaid Services (CMS) can or should give Wisconsin an MOE waiver. DHS contends the MOE standards can be waived pursuant to the portion of federal Medicaid statutes (sec. 1115) that allows CMS to approve demonstration waivers. A new WCCF brief explains why we strongly disagree with the DHS argument.

According to DHS, the proposed BadgerCare changes that would be authorized by a waiver are very similar to some aspects of the Affordable Care Act (ACA) that will take effect in 2014, such as the restrictions on eligibility for premium subsidies for insurance purchased through the new Health Insurance Exchanges, among families that have offers of employer-sponsored coverage. DHS argues that because of the purported similarities the waiver should be approved so Wisconsin can essentially run a pre-test of parts of the ACA.

The short paper posted on our website this week provides a side-by-side comparison of the relevant portions of the ACA and the proposed changes to BadgerCare that require a waiver. It concludes that although a few of the changes proposed by DHS bear a faint resemblance to parts of the ACA, the department’s BadgerCare proposals go in a much different direction. For example, the ACA preserves and builds upon Medicaid and CHIP, to significantly reduce the number of uninsured Americans, while the DHS proposals would erode BadgerCare eligibility and participation and would knock more than 64,000 Wisconsinites out of BadgerCare.

Comparing the DHS proposals to change BadgerCare to the provisions of the ACA is like comparing Sweeney Todd to The Sound of Music. Sure there are a few elements in common, but as you are making your entertainment plans for the holidays, would you plan to take your young children to see Sweeney Todd to test whether they are ready for the Sound of Music or the Nutcracker Suite? If Ticketmaster tells you that the Nutcracker and The Sound of Music are sold out, but suggests Sweeney Todd instead, I suspect you wouldn’t waive your parental common sense.

Jon Peacock

Fact-checking PolitiFact

2011-12-12T22:48:00.003-06:00

W-2 Costs Far Less than Article States

The Journal Sentinel ran a PolitiFact column Sunday on the subject of Tommy Thompson’s statement on December 1 (while announcing his candidacy for the U.S. Senate) that while he was governor, "we ended welfare." For what it’s worth the Journal Sentinel gave that statement a rating of “mostly true,” but that’s not what caught my attention.

The PolitiFact column states, “In October 2011, the number of people in W-2, which is budgeted to cost $626 million in state and federal funds in 2010-2011, was nearly 16,000.” The $626 million figure is actually the total budgeted in that fiscal year for W-2, child care and a variety of other programs funded from the federal block grant that replaced the old welfare program (Aid to Families with Dependent Children). The largest share, $341 million, was for child care subsidies.

The actual amount budgeted in 2010-11 for W-2 benefits was $70.5 million. (This year the amount budgeted grows to $78.8 million, but it drops to just $61.8 million in 2012-13.) If you want to count administrative costs, W-2 services (such as case management), and the relatively new Transitional Jobs program, you can tack on another $77 million, bringing the total for fiscal year 2010-11 to almost $148 million. (See Table 6 in the January 2011 Fiscal Bureau Information Paper.) There are some other amounts that one might add to the total if you use a more expansive definition of W-2, but which definitely shouldn't be counted in a sentence referencing the 16,000 households receiving W-2 cash assistance for subsidized employment benefits.

On the whole, I think the Journal Sentinel column is a well-balanced assessment of Thompson’s statement (though I might be biased because the author of the column interviewed me at length about the definition of “welfare”). The factual error in the column had little or no bearing on the assessment of whether Thompson’s statement was accurate. However, I’d hate for people to think that subsidized employment benefits for the 16,000 W-2 participants receiving them cost $626 million, which is roughly nine times the amount budgeted last year.

Jon Peacock

Feds approve a portion of DHS changes to BadgerCare, but other parts will have to wait

2011-12-09T16:56:00.003-06:00

A federal official at the Centers for Medicare and Medicaid Services (CMS) announced today that the agency probably won’t be able to act as quickly as the Walker Administration had hoped on a long and complicated waiver request that would allow the state to make sweeping changes to BadgerCare. However, the letter from CMS to Secretary Dennis Smith of the Wisconsin Department of Health Services (DHS) clears the way for the state to begin implementing some portions of its proposals.

The federal health care reform bill requires states to maintain current levels of coverage for children and for adults with income below 133 percent of the federal poverty level (FPL). On November 10, 2011, DHS submitted a 221-page request to CMS for a waiver of the federal law requiring states to maintain current standards relating to eligibility and enrollment.

The Legislature and Governor have pressured federal officials to speed up the usual deliberative process for review of waiver requests. They included language in the budget and budget repair bills directing DHS to eliminate eligibility of parents and childless adults with income over 133 percent of the poverty level if the state doesn’t get a federal waiver by December 31 of this year. However, the goal of trying to get CMS to act on the waiver proposal by the end of the year was undermined by not submitting the request to federal officials until November 10, approximately eight months after the legislature passed the bill directing DHS to seek a waiver.

The letter sent to DHS today by Cindy Mann, director of the federal Center for Medicaid and Children's Health Insurance Program Services, describes the numerous parts of the review process that will require ongoing analysis of the proposals and continued discussions with DHS, and it concludes:

“For these reasons, while we will continue to work diligently with you and your staff as we move forward in our review of Wisconsin’s proposals, we want to advise you that it is unlikely we will be able to meet the State’s requested approval date of December 31, 2011, for all of these proposed sweeping changes to its programs.”

The CMS letter does make a significant concession to the state by giving DHS a green light to apply several of its proposed policy changes to adults with income over 133 percent of the poverty level. CMS concurred with the state’s argument that federal law does not require DHS to get a waiver before making changes restricting or eliminating BadgerCare eligibility for those 53,000 adults. In addition, CMS determined that the state does not need a waiver to proceed with its proposal to speed up terminations of eligibility for people who no longer meet existing eligibility standards.

Ken Taylor, executive director of the Wisconsin Council for Children and Families, applauded the decision by CMS not to rush the agency’s consideration of all of the various portions of the state’s waiver request:

“The changes in the waiver request would harm at least 168,000 Wisconsinites. A decision this big shouldn’t be rushed through just to meet the state’s arbitrary December 31 deadline. Granting the waiver would also send the message to other states that they can drop millions of people from Medicaid. The Affordable Care Act was designed to protect people from that, and we shouldn’t encourage states to undermine this important piece of health care reform. ”

A bill introduced in the Assembly, AB 339, would return to the Legislature the authority to set Medicaid and BadgerCare policy and would eliminate the requirement that the state end eligibility of certain adults, beginning on July 1, 2012, if a waiver hasn’t been approved by December 31. AB 339 would give the state more time to work with federal officials on potential compromise plans, rather than limiting the options to just two choices: approval of the waiver request or elimination of BadgerCare coverage for 53,000 adults.

A recent WCCF publication provides a side-by-side comparison of the consequences of those two options. In addition, we commented on the letter in a press release today.

Jon Peacock

Walker Administration Vacillates on Response to Health Care Reform

2011-12-07T22:50:00.001-06:00

Continued Debate over a Slight OCI Technical Change Is Telling

Although officials in the Walker Administration have said on a number of occasions that they plan to implement the Health Insurance Exchanges required by the Affordable Care Act (ACA), we still haven’t seen the Exchange legislation that they said we could expect in the fall. Whether they still plan to carry through on their commitment to introduce such legislation is no longer clear.

One of the few visible signs of activity relating to ACA implementation has been Assembly Bill 210, which is the derailed bill that was developed by the Office of the Insurance Commissioner (OCI) and would fold into state law several health insurance industry reforms in the federal Affordable Care Act (ACA). The debate relating to that bill has taken a couple of surprising twists in recent weeks, as the Walker Administration approved and then rescinded an emergency rule to put a key part of AB 210 into place.

Over the past few months on this blog, we’ve been keeping you updated on the dialogue around AB 210 and the related emergency rule issued by OCI (see our Oct. 10 post about the bill and our Nov. 16 post about the OCI rule). After a few amendments were adopted, AB 210 passed in the Assembly with strong Republican support. However, it has been blocked in ta Senate committee because of the opposition of committee chair Frank Lasee.

As a fallback plan, the Insurance Commissioner recently approved an emergency rule that adopted the provision in AB 210 that has enjoyed the strongest support from OCI and the insurance industry – making state and federal law consistent with respect to external review (independent reviews of consumer complaints). In a conflicting move this week, Governor Walker directed OCI to withdraw the emergency rule! The Governor justified the reversal on the basis of a concern that the rule might weaken the challenge to the ACA’s constitutionality, which will be heard in the Supreme Court this spring.

Until this week’s about-face, the Governor had described his position on state ACA implementation as, follows: “States are left with a very difficult decision: do nothing and cede regulatory authority for Wisconsin’s insurance industry to President Obama and the federal government; or make very slight technical changes to preexisting Wisconsin laws, or administrative rules, to prevent the federal government from taking over our state’s insurance industry” (emphasis added). The repeal of the OCI emergency rule signals that Governor Walker is choosing the former option.

The emergency rule was simply a slight technical change to preexisting Wisconsin law, but some see it as an implicit acceptance or endorsement of the ACA. Rigid opposition to that law seems to be trumping prior judgments of the Administration, even in the case of a rule that made relatively minor changes and had strong support among insurers. The shift in the Administration’s position on the emergency rule raises questions about whether the Governor now plans not to implement further and broader health care reform provisions in Wisconsin, at least until the Supreme Court weighs in.

Sara Eskrich and Jon Peacock

Medical Loss Ratio: A Recent Win for Consumers, and Hopeful News for Wisconsin

2011-12-06T10:18:00.001-06:00

What may sound like a wonky insurance industry term is poised to have a real impact on health care consumers through the health care reform law. Recent regulations and developments around implementation of the medical loss ratio (MLR) standards have been in the news both nationally and in Wisconsin in recent weeks and months.

The Affordable Care Act (ACA) ensures that insurance companies are spending 80 to 85 percent of premium dollars on medical care and health care quality improvement – rather than administrative costs and profit. This past Friday, the final rule from the federal Department of Health and Human Services (HHS) regarding the MLR provision of the ACA was released.

Before the release of this rule, the insurance industry, agents, and brokers lobbied hard to have broker fees exempted from the calculation of administrative costs. In fact, the National Association of Insurance Commissioners took a controversial and divided vote on November 22nd, passing a resolution calling on Congress and HHS to exempt insurance agent’s commission from the administrative cost when determining the MLR. In a big win for health care consumers, the final rule issued Friday by HHS keeps agent fees and commissions in the MLR calculation of administrative costs. This will ensure that the intent of the MLR provision is realized - so premium growth slows and consumers receive rebates from insurers who do not bring down administrative costs. The rule also ensures that rebates to consumers are tax-free.

The remaining concern about MLR rests in a provision allowing states to request waivers or phase-ins of the MLR 80 and 85 percent standards. States may be granted a waiver if they can show that immediate implementation of this provision would hurt consumers. Wisconsin’s Insurance Commissioner has requested an exemption from the MLR regulation, with a three year phase in – 71% in 2011, 74% in 2012, and 77% in 2013. However, nearly two-thirds of the insurers in Wisconsin are well above the necessary 80% MLR, with the average rate for Wisconsin HMOs at 88.7%. Even though most insurers in our state won’t be affected, Wisconsin consumers are estimated to receive about $14 million in rebates under the full implementation of the MLR provision – which would be in jeopardy if a waiver were granted. The request for a waiver suggests that Wisconsin’s Insurance Commissioner seems to be more concerned with the profits of a select few insurance companies, and not the general welfare of Wisconsin consumers.

Rejection of Wisconsin’s MLR waiver is looking more likely after HHS decided in late November to reject MLR exemption waivers requested by Indiana and Louisiana. HHS said that the states were able to meet the MLR standard, and that consumers would be better off if the exemption were not granted. The HHS decision appears to be good news for Wisconsin consumers because it allows the health care reform law to perform the intended function of ensuring that an unreasonably large share of our insurance premiums isn’t being swallowed up by administrative costs and profits.

Sara Eskrich

Fifty Groups Sign Letter Opposing Waiver for Proposed BadgerCare Changes

2011-12-05T20:53:00.003-06:00

Fifty Wisconsin organizations sent a letter to HHS Secretary Kathleen Sebelius late last week urging her to deny the recent request from the Wisconsin Department of Health Services (DHS) for a waiver of federal maintenance of effort (MOE) requirements. As WCCF explained in a short summary of the DHS proposals, the proposed waiver is expected to adversely affect more than 168,000 Wisconsinites, including more than 64,000 who DHS expects to lose their BadgerCare coverage.

According to the December 1 letter:

“The effects of the changes proposed by DHS are clearly at odds with congressional intent to significantly reduce the number of uninsured Americans by building on the Medicaid and CHIP coverage that states already have in place. …Approval of the DHS waiver request would be very damaging for Wisconsin and a dangerous national precedent.”

The letter makes numerous arguments for rejecting the waiver. The following list is a brief synthesis of some of those arguments:

Approving the waiver would cost more than 29,000 children their BadgerCare coverage.
The waiver would have disproportionate impact on people with disabling conditions.
The DHS proposals don’t meet the requirements for approval of research and demonstration waivers.
Approving the waiver would harm many extremely low-income families.
The proposed changes would increase red tape and reduce enrollment efficiency.
Contrary to the department’s assertions, many of the proposed changes are inequitable.
The waiver would result in cost-shifting, not cost savings.
Detail on the DHS proposal was not made available to the public to allow meaningful input.
The budget can be balanced without making the proposed cuts to BadgerCare.

The Save BadgerCare Coalition has posted the letter online, including the list of 50 groups that endorsed it and background documents prepared by WCCF.

Jon Peacock

New Study Finds Copays Are Harmful for Heart Patients

2011-12-04T22:48:00.002-06:00

Just as Wisconsin was submitting proposals to federal officials to significantly increase BadgerCare premiums and copays, a new study added to the evidence that increased cost-sharing can be counterproductive.

The study published in the November 14 New England Journal of Medicine examined the effects of drug copays for patients who have been discharged from a hospital after experiencing a heart attack. The study found that eliminating copays had the following effects:

The patients who didn’t owe copays for their heart medication were more likely to take the drugs they were prescribed.
They experienced “fewer heart attacks, strokes, and other vascular events.”
The improved outcomes were achieved without a significant change in spending by the insurer.

The Department of Health Services (DHS) has submitted a request to the Centers for Medicare and Medicaid Services (CMS) for approval of an alternative Benchmark Plan that would reduce covered services and significantly increase copays. The new plan would impose copays of up to 5 percent of income for families between 100 percent and 150 percent of the federal poverty level (FPL), and there would be no limit on the cumulative copays that could be charged for families over 150 percent of FPL.

The increase in copays would be on top of an increase in premiums to 5 percent of income for all families or individuals above 150 percent of FPL, if the state is granted the maintenance of effort waiver it has requested from CMS.

Jon Peacock

Number of Uninsured Kids Drops by About One Million since 2008, but Wisconsin Doesn’t Share in that Improvement

2011-11-29T18:34:00.002-06:00

The recession has significantly increased poverty and unemployment, and with those changes there has been a large increase in adults without health insurance. Yet despite those trends, the number of uninsured children in the U.S. dropped by 1 million from 2008 to 2010 (from 6.9 million to 5.9 million), according to a report released today by Georgetown University.

Experts attribute that remarkable improvement to several factors, including federal funding provided to states by the Children’s Health Insurance Program (CHIP) and steps states have taken to expand eligibility for, and simplify access to, Medicaid and CHIP funded coverage. Another significant factor is federal health care reform (the Affordable Care Act), which requires states to maintain income eligibility levels and discourages other barriers to coverage. (Wisconsin’s Department of Health Services is currently seeking a waiver of those requirements.)

The analysis by the Center for Children and Families at Georgetown found that 34 states had a statistically significant decrease in the percentage of uninsured children. Wisconsin was one of only three states with an increase in the number of uninsured children – joining Minnesota and Kansas in that regard – although the apparent growth in our state, from 4.8 percent of children to 5.0 percent, was not statistically significant. For most of the last decade, Wisconsin had one of the lowest rates of uninsured kids, but since 2008 a number of other states have climbed ahead of us in the rankings, and we have slipped to having the 13^th lowest percentage of children lacking health insurance.

When one looks at recent trends, Wisconsin compares much more favorably to other states if one measures back to 2007, the year before BadgerCare Plus was implemented. (That is why we fought hard as the CHIP Reauthorization Act was being developed to ensure that federal bonus funding for states with large improvement in enrollment of low-income children is calculated from a 2007 base year, rather than 2008.) BadgerCare Plus enrollment has continued to grow since 2008, as it has picked up the slack while access to employer sponsored insurance shrank – offsetting the gains in public coverage.

The success of other states that have been passing Wisconsin in progressing toward the goal of covering all kids can probably be attributed to more aggressive outreach efforts and the adoption of reforms like 12-months continuous eligibility to reduce churning of children on and off the program.

Wisconsin’s ranking would almost certainly fall far more if the state gets a waiver from federal maintenance of effort requirements. The waiver proposal submitted by DHS is projected by the department to result in more than 29,000 children dropping off the BadgerCare program (which we think is a very conservative estimate). If about two-thirds of those children became uninsured (which we also think is a conservative assumption), there would be about a 30 percent increase in the number of Wisconsin kids without health insurance. That would probably drop us to or perhaps a little below the national median in the percentage of uninsured children.

Massachusetts, which is the model for the national health care reform law, has by far the lowest rate of children without health insurance, at just 1.5 percent.

Jon Peacock

Just in time for Thanksgiving - Congress Declares Pizza a Vegetable?

2011-11-23T14:34:00.002-06:00

Well, no, not exactly. But the Republican controlled House of Representatives did bring a whole new meaning to the phrase “you say tomato…”

As we’re sitting down with family and friends this week, we are thankful for so much – including a delicious Thanksgiving meal. For many in Wisconsin, meals that are both healthy and filling are far too difficult to come by these days. This point is considered further in the following post.

Earlier this year the U.S. Department of Agriculture (USDA) released proposals –based on recommendations by the Institute of Medicine – which would limit the amount of starchy foods and sodium, and would increase the amount of whole grains and vegetables served to children in schools. Last week, the food industry declared a big win when Congress blocked the new proposals and voted to allow tomato paste on pizza to be counted as a vegetable, among other proposed changes. In a time when children need healthy meals the most, pizza and French fries are two of the unhealthy foods offered in school lunch lines that the proposed guidelines would have limited.

Are starchy and salty foods on school menus a threat to Wisconsin’s health? We certainly think so. Families in poverty (13% of Wisconsin residents and 19% of children in Wisconsin) rely much more heavily on school meals, and their children are more likely to be obese or overweight. Contributing to the problem is inadequate access to healthy fruit, veggies and whole grains. Families that live either in inner city areas or rural areas are more likely to be caught in food "deserts", defined by the Center for Disease Control (CDC) as “areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk, and other foods that make up the full range of a healthy diet.”

Children in poverty are more likely to be facing food insecurity and decreased access to healthy foods, putting them at risk of adverse health outcomes. The federal Supplemental Nutrition Assistance Program (SNAP) – formerly “food stamps” – is an entitlement program meant to ensure that children and families receive the nutrition necessary to remain healthy and promote healthy growth and development. However, a recent study shows that SNAP benefits aren't suficient for many families to actually afford the items recommended by the Thrifty Food Plan (i.e., the recommended food purchases by U.S. Department of Agriculture, which are low cost and nutritious). Although an increase in maximum benefits by the American Recovery and Reinvestment Act in 2009 brought SNAP recipients closer to being able to afford items recommended on the Thrifty Food Plan, the study shows the shortfall is still prevalent. One factor contributing to these findings is that many people living in food desert areas rely on “corner stores” for a significant portion of their food shopping. These small stores are likely to lack fresh produce and to be much more expensive than larger, more robust grocery stores.

By allowing children to be served high-fat, high-sodium foods (e.g., pizza and French fries), Wisconsin’s healthcare system will also suffer. The Department of Health Services (DHS) estimates that the yearly cost of obesity-related medical expenses in our state is more than $1.5 billion. This is, in part, because high sodium intake increases the likelihood that an individual will suffer from a chronic disease such as diabetes, heart disease, or hypertension. Children who are obese at ages 2 to 4 are up to 40% more likely to be obese in adulthood. Furthermore, 60% of obese adolescents will face the same fate.

On average, children receive 50 percent of their daily calorie intake from schools, making reform in what we serve our children increasingly important. With more children and families living in poverty, the need for school lunches – for some children, the only meal that they are guaranteed – to be healthy is vital. In Wisconsin, the changes in acceptable vegetables and decrease in sodium are imperative, as one in four of children are overweight or obese by the time they reach high school. The numbers are greater (37%) in the Milwaukee area where kids are more likely to be facing food insecurity and poor diet than in other parts of the state – one out of two children in this area are living in poverty.

Consequently, with new research showing the low probability of SNAP recipients receiving all of the nutrition that they need, and with 20% of Wisconsin families with children reporting food hardship, the need to provide children with nutritious school meals is critically important. Unemployment remains high in Wisconsin, and the state's food stamp participation level has increased by 9% - with areas like Milwaukee seeing their highest ever participation rates. In light of those facts, as well as the adverse health outcomes associated with poor diet, we need to protect children from unhealthy school meals.

Lacy Langbecker

Giving thanks for government programs holding down poverty

2011-11-22T23:12:00.002-06:00

When we give thanks on Thursday, let’s remember that there are many public programs providing critically important assistance to people who aren’t as fortunate. Among them are a number of government programs that are working as intended to keep low-wage Americans and unemployed workers out of poverty. Unfortunately, some of those programs are under assault.

A recent New York Times article outlines data from a special Census Bureau report that was requested by the New York Times – an analysis of those that are not considered to be poor, but have slightly greater incomes between 100-150 percent above the poverty line. Using the Supplemental Poverty Measure that we describe in our other blog post today, the Census Bureau calculated that fifty-one million people fell into this category. They aren’t categorized as being poor, but are precariously close to being so – the “near poor.”

The Census Bureau noted this was a larger number than expected. Nearly 20 percent, however, were kept above the poverty line because of programs that supplement income. Conversely, they were kept out of higher thresholds because of factors like out-of-pocket medical expenses, and work-related expenses like child care.

The NY Times article does a nice job of providing the stories of some of the people in that income range. And it points out another surprising fact – that 28 percent of the near poor work full-time.

Unfortunately, many state and federal budget cuts that have been made this year or are under consideration target the near poor. One example is the extended federal unemployment benefits for the long-term unemployed, which may be coming to an end this year if Congress doesn’t come up with a plan to continue them. In addition, low-wage workers in Wisconsin who fall in the “near poor” category could pay a heavy price if the Department of Health Services is able to get federal approval for its proposed changes to BadgerCare. Those changes include much higher co-pays for families over the poverty level, and excluding some of those families from BadgerCare if they have offers of employer coverage – even in cases when the combined premiums, co-pays and deductibles for that coverage would consume a huge share of their income.

Let’s give thanks on Thursday that successful government programs have been keeping out of poverty tens of thousands of low-wage Wisconsinites, and let’s also be thankful that it’s not too late to preserve and protect those programs.

Jon Peacock and Julie Davidson

Supplemental Poverty Measure Provides a More Comprehensive Picture of Poverty, the “Near Poor,” and the Role of Public Policy

2011-11-22T18:37:00.004-06:00

Earlier this month the Census Bureau released a new way of measuring poverty: the Supplemental Poverty Measure (SPM). This measure revealed higher rates of poverty nationally for most groups, but a lower rate for children.

The Census Bureau also released an analysis of those with incomes slightly above the poverty line which illustrates that 51 million people are not considered poor, but are nonetheless struggling to make ends meet. Among this group, referred to as the “near poor,” 20 percent are kept from slipping below the poverty line by government programs like housing subsidies and school lunch programs. The new data reveal the importance of such programs, which are keeping millions of Americans out of poverty.

The Census Bureau stresses that the SPM is an “experimental poverty measure” and it will not replace the official poverty measure. The official poverty measure was developed in 1960 and implemented in 1969 after a few minor changes. Criticisms have arisen about the official poverty measure, which was developed based on the estimation that families of 3 or more spend one third of their after tax income on food. This calculation was conducted only once in 1963 and has been updated only by using the Consumer Price Index. Therefore, the federal poverty thresholds do not account for significant factors, such as expenditures on child care and transportation, the rising costs of out-of-pocket medical expenses, and differences in prices among geographic regions. Moreover, the official measure does not consider government policies like Supplemental Nutritional Assistance (SNAP), Earned Income Tax Credit (EITC), school lunch, and housing subsidies that help the near poor to stay out of poverty.

The SPM, on the other hand, does address many of those factors. The thresholds are based not just on food expenditures, but also clothing, shelter, and utilities. Household size includes not only all related individuals living at the same address, but also co-residents like foster children. Geographic adjustments are made to recognize the fluctuation in prices based on region. Furthermore, family income is calculated by adding tax subsidies as well as cash and in-kind benefits that families use to cover food, clothing, shelter, and utilities expenses. Taxes, work-related expenses, and out-of-pocket medical expenses are subtracted from this total.

According to The Research Supplemental Poverty Measure: 2010, including the EITC in the calculation of family resources results in significantly lower poverty rates. Without EITC the poverty rate for all people would be 18 percent rather than 16 percent. Other benefits like SNAP, housing subsidies, school lunch, and energy assistance also result in lower poverty rates. Conversely, when subtracting child support payments, income and payroll taxes, work-related expenses and medical out-of-pocket expenses results in higher poverty rates. These data illustrate the positive effects of government assistance programs, and show that more individuals would be considered poor without them.

Most groups showed an increase in poverty rates using the SPM, but some groups, including children had a lower rate. The reduction in the rate of poverty measured among families with children can be attributed primarily to the fact that the SPM takes into account programs like the EITC.

Closer to home, the Institute for Research on Poverty at UW-Madison has developed the Wisconsin Poverty Measure, which uses parameters set out by the SPM for a more comprehensive method to measure poverty in our state. They released a report in the spring based on 2009 data. You can read about their report in a May 4th blog post by the Wisconsin Budget Project.

A follow-up WCCF blog post will take a closer look at the near poor and how they are helped by current programs, but may be adversely affected by proposed policy changes relating to programs for low-wage workers and the unemployed.

Julie Davidson

Wisconsin still below average in food stamp participation, but gaining ground

2011-11-21T22:11:00.000-06:00

The US Census Bureau released a report late last week regarding the number and percentage of households in each state who received food stamps in 2009 and 2010. Wisconsin’s participation rate of 11.0 percent last year was well below the national rate of 11.9 percent. However, Wisconsin has been rapidly gaining ground on the national average. From 2009 to 2010, the number of Wisconsinites receiving food stamps grew by 30.1 percent, which was the 6th highest percentage increase and compares to average growth last year of 16.2 percent nationally.

The rapid growth in Wisconsin reflects several different factors. First, it’s part of the national trend of increasing poverty rates. Second, it results in part from the fact that Wisconsin’s poverty rate has been growing slightly faster than the national average. Finally, Wisconsin has improved food stamp enrollment processes and for several years our participation rate has been gaining ground on the national average.

Jon Peacock

MJS editorial: “DHS should go back to the drawing board on Medicaid”

2011-11-20T22:34:00.004-06:00

An editorial in the Milwaukee Journal Sentinel Sunday urges federal officials to deny Wisconsin’s current request for a “maintenance of effort” waiver that would result in more than 64,000 people losing their BadgerCare coverage:

We urge the federal Department of Health and Human Services to hold off on that waiver until the state does more to ensure that fewer of the poor are affected.

The editorial discusses a number of specific parts of the plan, including one that would disqualify from BadgerCare many families who have offers of employer sponsored insurance:

The department estimates that nearly 28,000 people no longer would be eligible for BadgerCare Plus after enactment of this particular rule change, including more than 11,000 kids. The administration of Gov. Scott Walker argues that many of those families will find a way to cover their kids.

We think that's a fantasy. It's far more likely that families on the edge of poverty will forego insurance in order to pay the rent or put food on the table. And that means that some of them will end up using emergency room care - some of the most expensive medical care in the business - when they or their kids get sick.

The Smith plan may save taxpayers money now, but it's built on an illusory foundation. Those same taxpayers will pay for the more expensive care of the poor through their health insurance premiums as providers shift the costs onto those who can pay.

We urge HHS secretary Kathleen Sebelius to deny the state's request for a waiver until the state amends its proposal so that fewer of the poor - especially kids - are affected.

To learn more about the DHS recommendations, see WCCF’s recent 3-page paper. In an easy to read table, it summarizes the substance and projected effects of the proposed changes that require an MOE waiver and compares those with the anticipated effects of the Walker Administration’s fallback plan if the waiver isn’t granted.

That fallback plan, which could end BadgerCare coverage for 53,000 adults with income over 133% of the federal poverty level, wouldn’t go into effect until July of next year. In the meantime, there’s plenty of time to heed the Journal Sentinel’s advice and "go back to the drawing board" to devise a better plan.

Jon

Advocates surprised by Supreme Court announcement that it will review Medicaid’s expansion

2011-11-18T20:43:00.003-06:00

Case might pivot on studies relating to state costs and savings

Is it unconstitutional for Congress to enact a law expanding Medicaid coverage to everyone below 133% of the federal poverty level? About half the states (via their Attorneys General or Governors) contend that making them participate in a large expansion of Medicaid, which is slated to be part of health care reform in 2014, amounts to an unconstitutional coercion of state governments. The U.S. Supreme Court surprised many people early this week when it announced that its review of the federal health care reform law will include consideration of the constitutionality of compelling states to participate in the broadening of Medicaid coverage.

That expansion, which is expected to add about 17 million people to the Medicaid rolls, is probably the single most important component of the Affordable Care Act’s strategies to make quality, affordable health insurance accessible for nearly all Americans. That’s one of the reasons why advocates are very concerned that the Walker Administration is seeking waivers that would harm Wisconsin’s Medicaid coverage (especially BadgerCare and Family Care), and why many people are worried that the Supreme Court is entertaining the argument that the Medicaid expansion violates states’ rights.

A very good article in the Washington Post on Thursday reports on the surprise announcement by the Court that its review of the ACA will include the Medicaid expansion. The article quotes Ron Pollack, executive director of Families USA, who said “The decision on this issue is probably the most important the Supreme Court will be making on the Affordable Care Act.”

The states' concerns are rooted in the fact that they help pay for Medicaid – with state match rates currently between 20% and 50% of total costs (40% in WI). However, from 2014 through 2016 the ACA will reimburse states for the entire cost of newly eligible Medicaid recipients. Beginning in 2017, the 100% federal reimbursement rate for the newly eligible will slowly decline until it becomes 90% in 2020 and thereafter. The ACA also provides other direct and indirect fiscal relief for states.

A study last December by Stan Dorn of the Urban Institute concluded that the ACA would yield total net savings for states in the range of $40.6 billion to $131.9 billion (depending on different assumptions about Medicaid growth) from 2014 through 2019, after one takes into account reduced government spending for uncompensated care and for mental health services.

Some states come out ahead even if one doesn’t look at the less direct savings. Wisconsin is likely to be one such entity because the ACA offers a carrot to states that have fewer newly eligible adults to cover. For states that already provide Medicaid coverage to at least a portion of the childless adult population, the ACA will provide an 80% reimbursement rate in 2014 for the already eligible childless adults below 133% of FPL (compared to the 60% match rate in WI now), and that rate will gradually increase to 90% in 2020. A paper by the Legislative Fiscal Bureau summarizes an analysis last fall by the Doyle Administration, which concluded the ACA would save Wisconsin between $745 million and $940 million between 2014 and 2019. (See also WCCF’s Feb. 7 blog post.)

The constitutional challenge to the Medicaid expansion seems like a long shot, considering that states aren’t forced to participate in Medicaid. Nevertheless, advocates will continue to worry because the Medicaid expansion is such a crucial part of the ACA, and because the Court might also directly or indirectly undermine the law’s maintenance of effort requirements. If so, that wouldn’t merely negate the potential gains in insurance coverage through the ACA; it could unleash an onslaught against current Medicaid coverage.

Jon Peacock

OCI Emergency Rule Implements a Portion of the Health Care Reform Law

2011-11-16T23:04:00.000-06:00

We’ve reported a couple of times this fall on a bill that would have put several important health care consumer protections from the Affordable Care Act (ACA) into state law. The bill, AB 210, has had strong backing from the Office of the Commissioner of Insurance (OCI) and from insurance companies who have been worried about potential problems that might result from having inconsistent state and federal laws. They were particularly concerned that the state’s failure to have a consistent state law would mean that consumers would be able to take their grievances to two different independent appeal boards – one at the state level and one at the federal level – and could get conflicting rulings.

Progressives have had reservations about the bill, mostly because it sunsets (repeals) the new consumer protections being put into state law if the ACA is struck down by the U.S. Supreme Court. AB 210 was approved by the Assembly on Oct. 18, by a vote of 57-39, with only 5 Republican legislators voting against it. Notwithstanding the bill’s vigorous support from the Insurance Commissioner and its endorsement by the vast majority of Assembly Republicans, Senator Frank Lasee (R., De Pere) announced on Nov. 1 that he wouldn’t schedule the bill for a vote in his Senate committee, where the bill currently resides.

On November 11, to the consternation of Senator Lasee, the Insurance Commissioner issued an emergency rule that adopts some of the provisions of AB 210 and the federal law.

Lasee, who is running for the US Senate seat held by retiring Senator Herb Kohl (and is jockeying for position with several other conservative Republicans for Tea Party support), is opposed to any state action that arguably helps implement the ACA. This week he criticized the Walker Administration for working on the emergency rule even before he announced that the bill would not emerge from his committee.

According to today’s Wisconsin Health News, J.P. Wieske, the spokesman for the Insurance Commissioner, responded to the criticism by stating that, "we felt that it was important for the state to continue to regulate the appeals process rather than have the feds take it over.” Wieske added that OCI is still deciding whether it will propose additional rules related to AB 210.

Jon Peacock

Public Input and Sharing Stories on the BadgerCare Waiver

2011-11-15T14:13:00.002-06:00

As we’ve been sharing on this blog, the Wisconsin Department of Health Services (DHS) recently submitted a proposal for federal approval that will result in tens of thousands of working Wisconsinites losing BadgerCare and Medicaid coverage.

Despite attempts from the public and advocacy groups to call on DHS for a transparent process and adequate public input, they held only two public hearings on the proposals prior to Thursday’s vote by the Joint Finance Committee (JFC). In addition, those hearings were held before DHS answered basic questions about what they were proposing and how many people would be affected. We didn't get the answers to many of those questions until the Fiscal Bureau analysis of the proposals was released two days before last week's JFC meeting. The proces has left many unanswered questions on how the proposals will be implemented as well as their overall effects.

Democratic members of the legislature have organized public hearings to brief their constituents about the proposals and take public testimony. (We shared those dates in a previous blog post.) Here’s some great coverage of the hearings in La Crosse and Eau Claire.

I have been lucky enough to attend both the Eau Claire and Wausau hearings. The response from members of the community has been tremendous. Yesterday in Wausau, constituents were shocked after I shared a brief presentation on the changes-based on this Save BadgerCare overview sheet. As these changes are complex, and we have not had access to an adequate level of detail, it is understandable that the public is unfamiliar with the extent to which the program would be changed under the waiver proposal.

One young woman in Wausau shared that she is avoiding treatment for depression, because she is worried that just when her body becomes used to anti-depressants she will become ineligible for BadgerCare, and be unable to afford the prescription. She is a hard working college graduate in the childcare field, without access to employer sponsored insurance. Beyond concerns about needed mental health care, BadgerCare allows her to go to the doctor when she’s sick, so she can return to work quickly after kids bring germs with them to her workplace (as we all know they do).

An advocate in Eau Claire, who works with people enrolling in BadgerCare, spoke about the importance of express enrollment for kids (a provision this waiver would remove). She told a story about a family she worked with last week, who called when their child had a 103 degree fever. She was able to help the mother to enroll the child in BadgerCare through express enrollment immediately, printing the card to take to the father, who took the child directly to urgent care. This family was eligible for BadgerCare, and was able to access services when their child needed them because of express enrollment.

If you live in near one of the upcoming hearings – please come to listen and share your story. I guarantee you’ll be inspired by the activism and engagement of your fellow community members. If you can’t make it to the hearing, but would like to add your story, please email me at seskrich@wccf.org. The next hearings are in:

Oshkosh: Friday, November 18th 4pm-6pm
UW Oshkosh Reeve Memorial Union, Room 202
800 Algoma Blvd, Oshkosh, WI
RSVP

Green Bay: Monday, November 21st 4pm-6pm
Central Library Auditorium
515 Pine Street, Green Bay, WI
RSVP

Sara Eskrich

MOE Waiver: What's the Difference Between Approval and Denial for the Future of BadgerCare?

2011-11-14T16:44:00.001-06:00

The Wisconsin Department of Health Services (DHS) recently submitted a request to federal officials for approval to make sweeping changes in the BadgerCare program. Most of those changes conflict with provisions in the federal health care reform law requiring states to maintain current standards relating to eligibility and enrollment. So DHS is seeking a waiver of these so-called “maintenance of effort” (MOE) requirements in order to implement it's plan for dramatic cuts to BadgerCare spending.

Here's the catch: If Wisconsin is not granted an MOE waiver by federal officials by December 31, 2011 (an arbitrary, self-imposed deadline), the state budget bill directs DHS to lower the BadgerCare income limit for adults from 200% of the federal poverty level (FPL) to 133%. That would result in 53,000 adults losing their BadgerCare coverage. So it's important to understand what's at stake in the federal government's decision regarding the DHS waiver request. Neither outcome is appealing. Regardless of whether or not the waiver is granted, tens of thousands of people in Wisconsin are going to lose their health insurance. But there are significant differences between how the two decisions would affect participants, such as who will lose their coverage, how coverage will change, how much less money the state will spend, and how much more it will cost families to stay covered.

Based on analysis from the nonpartisan Legislative Fiscal Bureau, approval of the MOE waiver will result in nearly 65,000 Wisconsinites losing their BadgerCare coverage. Nearly half of those (over 29,000) would be children. As noted above, if the waiver is not granted and the income limit is lowered to 133% of the poverty level, about 53,000 people--all of them adults--would lose their BadgerCare coverage.

Another key difference is in the total number of people affected. If the waiver is rejected, those 53,000 adults would be the only people affected for the time being. The impact of a successful waiver would be felt by more than triple that number (over 168,000), in the form of higher premiums and copays, reduced services covered, and a variety of other changes.

These are just a few of the differences between what will happen if the waiver is granted and what will happen if it not. The Legislature could also choose to push back the self-imposed December 31 deadline in order to work out a better solution, but that does not seem to be a likely scenario. We have posted to our website a more complete comparative analysis of the waiver /no waiver impacts in handy, easy-to-read table form.

Finance Committee Approves Plan to Reduce BadgerCare by 65,000 People

2011-11-10T22:58:00.004-06:00

The Joint Finance Committee met today to consider the Department of Health Services plan to cut the state’s Medicaid spending by making changes to BadgerCare that will result in tens of thousands of Wisconsin families becoming uninsured. The DHS plan was approved on a party-line vote of 11 to 4, with one of the Republican committee members absent.

A Journal Sentinel article does a nice job of summing up the debate and the effects of the committee’s action. (But I’m biased because I was quoted in the article; so check it out for yourself.) The proposals approved by the committee today will now be forwarded to federal officials, who must review proposed Medicaid plan amendments and waivers of provisions that conflict with federal law.

One of the arguments DHS has been making is that the proposed BadgerCare changes requiring federal waivers of “maintenance of effort” (MOE) requirements (which restrict the power of states to reduce eligibility) are preferable to the fallback plan in the budget repair bill. That plan, which can be implemented without a federal waiver, would cut off BadgerCare for 53,000 adults with income over 133% of the poverty level. However, more than 8 months after the budget repair bill passed we finally learned that the proposals requiring waivers are expected to lower BadgerCare enrollment even more. According to the Department’s own estimates, which we think are conservative, the changes to BadgerCare approved today will reduce enrollment by nearly 65,000 people, including more than 29,000 children!

Our memo to the committee urging them to reject the plan explains why we think the projected savings ($90 million in state funding from the Maintenance of Effort changes alone) will result in cost shifting, rather than true cost savings. Some of the other points made in that memo include the following:

A huge increase in uninsured children – If, as we believe, two-thirds or more of the 29,000 children who lose BadgerCare coverage become uninsured, that would increase the number of uninsured children in our state by almost 30 percent, moving Wisconsin from having one of the lowest percentages of uninsured kids to a state that is average or even falls a bit short of the national median.

Loss of federal bonus funds – The large drop in enrollment of children in BadgerCare will significantly reduce the performance bonus funding Wisconsin receives for the substantial growth in the number of Medicaid-funded children participating in BadgerCare. Wisconsin received $23 million in performance bonus funds last December. To the best of our knowledge, the reduction in that funding hasn’t been factored into the DHS fiscal analysis of the proposed changes.

Unreasonable cost-sharing requirements – Parents making $10 per hour and living paycheck to paycheck shouldn’t be expected to pay as large a share of their income for health care costs as middle income families. Yet Attachment 5 at the end of the Fiscal Bureau analysis shows that the increased premiums, co-pays and deductibles would add up to a total in the range of 10% - 12% of income for low-income families in BadgerCare who are at or above 150 percent of the federal poverty level. (DHS has subsequently released information indicating a slightly lower amount of cost-sharing, which will still be out of reach for many low income families.)

More than 350,000 people adversely affected – Our review of the Legislative Fiscal Bureau analysis indicates that more than 350,000 people in BadgerCare will be adversely affected because of the proposed changes, including 263,000 who will be moved into a new "alternative benchmark plan" that covers fewer services and requires much higher co-pays and deductibles.

Inadequate time for public input – The two public hearings held by DHS were hamstrung by the lack of sufficient information about their proposals and the real effects. It’s extremely disappointing that the sort of information that the public needed for meaningful comment on the proposals wasn’t available until Tuesday – via the Fiscal Bureau analysis. Before today's vote, there should have been additional public hearings to help affected parties understand the changes and respond based on solid information about the proposals and the tradeoffs. However, as we reported yesterday, Democrats plan several public forums over the next week or two to discuss the DHS plans and take public testimony.

You can watch a video of today’s JFC meeting on Wisconsin Eye.

Jon Peacock

Finance Committee Meeting Thursday on Proposed BadgerCare Changes, and Concurrent Public Hearing

2011-11-08T23:02:00.001-06:00

The Legislature’s Joint Finance Committee (JFC) will meet this Thursday (Nov. 10) to consider the proposals by the Department of Health Services (DHS) to make dramatic changes to the BadgerCare Program. Although the JFC is not taking public testimony, Democrats are hosting a public hearing in the Capitol Thursday at about the same time (beginning at 10:30 a.m. in Room 400 NE), as well as several other hearings over the next couple of weeks.

According to a lengthy (51 page) analysis released by the Legislative Fiscal Bureau today, DHS estimates that the proposed BadgerCare changes will reduce enrollment by more than 64,000 people, including more than 29,000 children.

The JFC meeting is scheduled to begin at 10:00 a.m. in Room 412 Northeast. The BadgerCare proposals are the fourth and last item on a substantial agenda.

The JFC co-chairs and the chairs of the Senate and Assembly health committees haven’t been willing to hold public hearings on the proposals, as requested by the Save BadgerCare Coalition and other advocates. However, Democrats have scheduled several hearings to provide an opportunity to brief their constituents about the proposals and to take public testimony from the people who are likely to be affected by the proposed changes.

The following is the current schedule of public hearings:

Thursday, November 10th 10:30am-1:30pm - Madison Public Hearing
State Capitol Room 400NE
Madison, WI

Friday, November 11th 4pm-6pm - Eau Claire Public Hearing
Chippewa Valley Technical College, Business Education Center – Room 30A
620 West Clairmont Avenue
Eau Claire, WI

Monday,November 14th 4pm-6pm - Wausau Public Hearing
Location TBD
Wausau, WI

Friday, November 18th 4pm-6pm - Oshkosh Public Hearing
UW Oshkosh Reeve Memorial Union, Room 202
800 Algoma Blvd
Oshkosh, WI

Monday, November 21st 4pm-6pm - Green Bay Public Hearing
Central Library Auditorium
515 Pine Street
Green Bay, WI

Jon Peacock

Wisconsin Among Six States Joining Federal Pilot Project to Streamline Approval of Affordable Housing

2011-11-07T22:02:00.001-06:00

Federal and state officials announced at a press conference Monday (Nov.7) that Wisconsin will be one of six states taking part in a new federal pilot program to expedite the approval of affordable housing projects.

Developers of federally subsidized multifamily housing complexes typically rely on multiple sources of state and federal funding, and each funding agency currently has its own inspection requirements and other procedural checks. The pilot program removes the need for redundant inspections and other repetitive regulatory practices.

The initiative announced today, which is part of the Obama Administration's commitment to better coordinate federal rental policy, is being piloted in Wisconsin, Michigan, Minnesota, Ohio, Oregon and Washington. Read more in an article today in Housing Wire.

Jon Peacock

The Harmful Consequences for Kids from the Sweeping BadgerCare Changes Proposed by DHS

2011-11-06T13:39:00.001-06:00

Sweeping changes to BadgerCare have been proposed by the Department of Health Services (DHS) and are expected to be reviewed this week by the Legislature’s Joint Finance Committee (probably on Thursday). A new WCCF issue brief examines how the proposed BadgerCare changes would have very negative consequences for Wisconsin’s children.

The new WCCF issue brief explains the numerous ways in which the DHS proposals would result in tens of thousands of children and parents becoming uninsured and would reduce the scope of BadgerCare services for those who are able to remain in the program. It also explains several factors that make the DHS proposals even more harmful for kids than for parents.

If the DHS plans are approved, we expect at least a quarter of a million children and parents to be adversely affected by the following changes:

Raising premiums, co-pays and deductibles, to the point where health insurance is priced out of reach of thousands of Wisconsin families.
Making many children and parents ineligible for affordable coverage in a variety of other ways, including: a) eliminating Transitional Medicaid, b) creating a 12-month suspension of eligibility for missing a BadgerCare premium, and c) counting as part of family income the income of unrelated adults living in the household (even though those adults aren’t counted for purposes of family size and financial need!).
Reducing the scope of health care services covered by BadgerCare for families over the poverty level.
Creating additional red tape that will slow applications, substantially increase administrative workload and costs, and make it much more difficult for applicants or participants to get timely assistance from caseworkers.

In most respects the proposed changes will have the same effects for kids and their parents, but there are a few ways in which the adverse consequences will be greater for children:

Premiums will be extended to children between 150% and 200% of the poverty level, which will negatively affect families who have access to employer coverage that does not include dependents. (Currently, the premiums only apply to the parents in that income range, not to their kids.)
Children between 150% and 200% of the poverty level will be suspended from BadgerCare for 12 months if their parents miss a premium. (Now the suspension is for 6 months and doesn’t apply to children in that income range.)
The state will no longer use express enrollment to expedite coverage of children, which will deny BadgerCare coverage for urgently needed care to kids whose applications are held up by the increased red tape from the DHS proposals (such as the new requirements to provide documentation of state residency or to verify the income of non-related adults living in the household).

If the Joint Finance Committee (which is comprised of 12 Republicans and 4 Democrats) approves the DHS recommendations, those changes can be implemented without the approval of the full Legislature, even though they conflict with state statutes. However, many of the key changes will also require waivers of federal law from the Obama Administration, because those changes conflict with federal statutes.

There is a chance, however, that the federal review process and restrictions will be eliminated – if Congress repeals the requirement to maintain children’s coverage, as the Walker Administration and many GOP members of Congress have proposed. Whether Congress allows Wisconsin and other states to significantly reduce health care coverage for children may depend on the deal, if any, struck by the “super-committee” developing a plan for cutting at least $1.2 trillion from the federal budget. We’ll follow up on that issue over the next couple of weeks.

Jon Peacock

Eau Claire Area Legislators Plan Nov. 11 Hearing on Proposed Medicaid Changes

2011-11-03T22:39:00.004-05:00

Joint Finance Committee Meeting Also Expected Next Week on the DHS Halloween Package

Senator Kathleen Vinehout (D-Alma) announced this week that she will host a public hearing to invite comments on Governor Walker’s proposed cuts to the Medicaid and BadgerCare programs. The hearing will be next Friday, November 11, from 4:00 to 6:00 p.m.

WHERE: Chippewa Valley Technical College

Eau Claire Clairemont Campus

Business Education Center – Room 30A

620 West Clairmont Avenue

Eau Claire, WI 54701

The Eau Claire hearing is part of a series of events being hosted by Democrats in response to the Department of Health Services’ plans to make $554 million in cuts to the state’s health care programs for eligible seniors, children, families and people with disabilities. The Nov. 11 hearing will be hosted by Representatives Chris Danou and Mark Radcliffe, as well as Sen. Kathleen Vinehout.

Also this coming week (perhaps on Thursday, Nov. 10) we expect the legislature’s Joint Finance Committee to meet and review portions of the DHS plans that conflict with state laws, but we don’t expect that meeting to be a hearing with public testimony (though it will definitely be open for the public to observe).

The “budget repair” allows DHS to make sweeping changes that supersede state statutes, subject only to the review of the Joint Finance Committee. Late on Monday, Halloween eve, DHS formally submitted its plans that require JFC review. On Tuesday morning, WCCF issued a press release with our reaction to the department’s 238-pages of Halloween-delivered documents.

For a summary of all of the department’s 39 different cost-cutting proposals unveiled on Sept. 30, see WCCF’s 6-page synopsis. On Friday we expect to post on our website a new WCCF analysis of what the latest DHS proposals will mean for health care access for Wisconsin children. Watch this new section of the WCCF website for that analysis and for subsequent updates by WCCF and the Save BadgerCare Coalition.

Under the provisions of the budget repair and budget bills, DHS is required to eliminate BadgerCare eligibility for 53,000 adults (those over 133% of the poverty level next July, if the state doesn't get a federal waiver by the end of the year to make other changes that will have devastating effects for children and lower-income families. It's extremely unlikely that CMS can act on the DHS proposals that quickly, considering that DHS has made little or no effort yet to begin pitching their ideas to federal officials. See the very interesting article in Wednesday's Capital Times.

There will be a brief presentation on the proposed cuts at the start of the Eau Claire hearing. The public is then encouraged to share comments and personal stories.

The Senate Takes Action on FY2012 Juvenile Justice Funding

2011-11-02T14:52:00.000-05:00

This is a text of a message that worked its way through from others related to the Senate’s action related to juvenile justice funding. Sen. Kohl voted in favor of this bill – Sen. Johnson voted against, presumably because he thinks it should be essentially zero. Even at this level of funding, there will be reductions in the amount of funds available for grants to counties, system reform efforts, and perhaps even compliance.

Moments ago (now yesterday) , the U.S. Senate passed H.R. 2112 as amended which, among other things, provides federal funding for juvenile justice programs in FY 2012 at the following levels:

• Title II at $45 million
• Title V at $33 million (entirely earmarked for non-JJDPA programs)
• JABG at $30 million
• Mentoring at $55 million
• Violence prevention at $8 million

The bill passed on a vote of 69-30 (Senator McCain didn't vote), with 14 Republicans voting yes. That gives us some good momentum heading over to the House.

H.R. 2112 is no where near the bill that states need to maintain and advance their delinquency prevention and juvenile justice reform efforts. We remain very concerned about the impact these dramatically reduced amounts will have on youth and community safety. Without the collective efforts of CJJ members and allies, however, the outcome thus far could be worse. by Jim Moeser

The bill now moves on to the Conference Committee, which will include 3-6 Members of the Senate and 3-6 Members of the House. The word on the street is that the Conference Committee will try to complete its work within the next week or so.

Contradictory Releases: Walker Administration Releases Comments Pushing for ACA Repeal, while Families USA Releases Report Outlining Benefits of the ACA for WI Families

2011-11-01T15:20:00.000-05:00

Wisconsin households will save an average of $1,467 per year after full implementation of the Affordable Care Act (ACA), yet the Walker Administration continues to push for repeal. Yesterday, the Walker Administration released copies of their comments to the U.S. Department of Health and Human Services (HHS) on the ACA Health Insurance Exchange regulations. Their comments, and corresponding press release, continue to push for repeal of the ACA. However, today, Families USA released a report, “The Bottom Line: How the Affordable Care Act Helps Wisconsin Families," which outlines the significant health care cost savings in store for Wisconsin families (as noted above).

The Families USA report looks at a range of health reform benefits, including protections against high deductibles and copayments, elimination of lifetime and annual limits on covered benefits, and improvements to the health care delivery system itself. It finds that Wisconsin households, both with insurance and uninsured now, win big with the ACA – through direct financial relief in premium tax credits, expanding affordable insurance options, and reforms of the health care system which will slow the growth of underlying health care costs.

The Health Insurance Exchanges are a crucial part of this affordable coverage expansion through the ACA. WCCF submitted comments on the proposed regulations from HHS, focusing on the positive elements of the regulations—like the “no wrong door” approach to enrollment in Exchange or public programs like Medicaid—as well as places where the regulations could be strengthened—like the conflict of interest rules and affordability test of employer sponsored insurance. The WI Department of Health Services and Office of the Insurance Commissioner’s comments emphasized that 95% of Wisconsinites have access to health care, and attribute that high rate to our insurance market alone. What Administration officials are forgetting is that in recent years of severe economic depression, the private and employer sponsored insurance markets have had declining rates of insurance coverage, while BadgerCare has picked up the slack. Read more about this in WCCF’s analysis of the Census insurance coverage numbers. The ACA helps push us further towards access to affordable coverage for all Wisconsinites – and not remaining satisfied when 5% of kids and around 10% of adults in Wisconsin are uninsured.

Our friends at Citizen Action of Wisconsin called out the Walker Administration for failing to recognize the need for the ACA in their press release here.

Sara Eskrich

La Crosse Hearing Friday on Proposed Medicaid Cuts

2011-10-27T07:00:00.009-05:00

Many questions still unanswered, but more details expected this week

As we reported previously, the Department of Health Services held hearings last Wednesday and Friday in Milwaukee and Madison on their proposals for cutting more than $500 million from Medicaid and BadgerCare. We appreciate that DHS held two hearings, although their proposals are still sketchy in many areas and leave so many unanswered questions that it has been impossible for many participants in the programs to know how they will be affected. (See WCCF's 3-page list of key questions.)

Thus far, the chairs of the Senate and Assembly health committees haven’t agreed to hold any public hearings on the controversial proposals, but some Democrats are beginning to make plans for their own meetings to inform and involve the public. The first of those hearings will be hosted in La Crosse this Friday, October 28, by Senator Jennifer Shilling. It will be from 4:00 p.m. to 6:00 p.m. and will be held in Room 337 in the Cartwright Center at UW La Crosse (1725 State Street).

Additional hearings are being considered in a number of other communities, including Eau Claire, Green Bay, Oshkosh and Wausau. We’ll follow up with information on those hearings or other public forums as they are scheduled.

In the meantime, DHS has yet to formally submit to the Joint Finance Committee (JFC) the proposed policy changes that conflict with current state law. However, the DHS plans are likely to be submitted to JFC members later today or tomorrow, and the committee will then have up to 14 days to decide whether it wants to hold a meeting to review the proposals that are inconsistent with current state statutes and rules.

For a summary of the department’s 39 different cost-cutting proposals, see WCCF’s 6-page synopsis. The Save BadgerCare Coalition has prepared a one-page summary that focuses specifically on the portions of the DHS proposals that affect BadgerCare. Watch this new section of the WCCF website for additional analysis and updates as DHS releases more detailed information about the substance of their proposals.

After JFC completes its review of the proposals, DHS will need to seek waivers from the federal Department of Health and Human Services (HHS) for any changes that conflict with federal statutes and regulations, and that includes most of the changes relating to BadgerCare. Many of the other changes require federal approval of Medicaid "plan amendments," which are usually easier to get okayed than waivers. Although state officials want to get the federal waivers by the end of the year, that is now extremely unlikely -- in part because of substantive issues, but especially because the waiver process typically takes many months and DHS has yet to formally submit its proposals to HHS.

Stay tuned for further updates on both the substance of the DHS proposals and the review process.

Jon Peacock

Sound Familiar? – Illinois struggling with decisions related to juvenile correctional institution while federal cuts proposed endanger the progress that has been made

2011-10-26T08:36:00.002-05:00

While Wisconsin made the leap to consolidate its juvenile correctional institutions, Illinois is struggling with similar issues. Throughout the nation, approximately 50 secure juvenile centers/programs have closed in 18 states, and the state of Illinois and some counties are facing the tough decisions about how best to deploy resources when there has been a significant decline in youth arrests and incarcerations.

This is being played out at the state level as well as the local level, as the DuPage County Juvenile Center has been the focus of debate now for months – a declining population and the potential to save money has placed one of the premier juvenile detention programs in jeopardy.

At the same time, cuts being proposed in Congress for juvenile justice funds endanger the progress that has been made in states and counties in developing successful prevention and intervention programs that have contributed to the decline in youth arrests and victimization. It is problematic when the rhetoric about what does not work (investing in prisons and incarceration) seems to outweigh the evidence about what does work (strategic, evidence-based, community-based programs) for almost all youthful offenders.

Jim Moeser

Good News on Teen Birthrates and Abortion Rates – and Bills that Could Aid or Harm that Progress

2011-10-18T11:02:00.001-05:00

Teen birthrates have been dropping in Milwaukee, and abortion rates have also been decreasing statewide. These two positive outcomes point to policies that have increased adolescents’ awareness about how to prevent unplanned pregnancies and increased access to contraception and reproductive healthcare through BadgerCare’s Family Planning Only Services (FPOS). Although progress is being made, recent actions in the Legislature threaten to reverse these positive trends. According to 2011-2013 budget stipulations, the Department of Health Services (DHS) is requesting a federal waiver to lower the income eligibility for and bar men from FPOS. Additionally, a new bill, SB 237, has been introduced and is moving in the Legislature to reinstate abstinence-only education in Wisconsin schools, repealing the Healthy Youth Act which provides comprehensive sex education to students. However, there are also better alternatives in the Legislature, particularly the Healthy Women, Healthy Families bills, a set of measures restoring FPOS to its eligibility standards prior to the 2011-2013 budget.

In Milwaukee, the teen birthrate spiked in 2006 at 52 per 1,000 teens, well above the state rate. By 2010, the rate dropped to 35.68 per 1,000. A combination of preventive measures were introduced through a collaboration between the United Way and the City of Milwaukee, which included a media campaign; comprehensive sex education in elementary, middle, and high schools in the Milwaukee Public Schools; and distribution of condoms through school nurses for those who asked.

In addition to this progress, abortion rates have also been on the decline. A recent report by DHS shows a decrease from 8,299 abortions in 2009 to 7,591 in 2010.

Both the decrease in the teen birthrate in Milwaukee and the statewide abortion decrease correlate with policies implemented in Wisconsin in the last several years. The expansion of FPOS has been crucial to increasing access to reproductive healthcare and contraception. Before the 2011-2013 budget, men and women ages 15 and older and with income no more than 300% of the federal poverty level (FPL) were eligible for this BadgerCare program, which covered breast and cervical cancer screenings, STD testing and treatment, and contraceptives. As stipulated in the 2011-2013 budget, however, DHS is currently seeking federal permission to discontinue coverage for men and change the income eligibility to no more than 200% of FPL. The budget also eliminates funding from Title V of the Maternal Child Health block grant for any organizations that are affiliated with or make referrals to abortion providers. Many clinics fall into this category, and over 30,000 patients access health services through these clinics annually. If funding is cut and clinics have to close their doors, consequences such as increased unintended pregnancies could occur.

Within the last few weeks, SB 237 has been introduced, and it has a hearing scheduled this Wednesday, October 19. Abstinence-only education has been shown to be ineffective. Conversely, comprehensive sex education programs, like those demonstrating their effectiveness in Milwaukee, have been shown to increase contraceptive (including condom) use, delay the initiation of sex, and reduce frequency of sex.

Providing Wisconsin youth with correct information about preventing unplanned pregnancies is vital to reducing teen birthrates, and correlates with the reduced number of abortions. Unplanned pregnancies among adolescents are also tied to poor outcomes that reach across generations. Not only do adolescent mothers have a decreased chance of graduating from high school but they are at greater risk of living in poverty. Their children, in turn, are also at greater risk for adverse outcomes like behavioral problems, cognitive deficits, high school drop out, and incarceration.

It is important to focus on measures that work. Comprehensive sex education is evidence-based and effective and threats to the Healthy Youth Act, such as SB 237, undermine efforts to disseminate accurate, age-appropriate information to aid in the prevention of unplanned pregnancies. Fortunately, more supportive bills have been introduced. The Healthy Women, Healthy Families bills work in two parts, by restoring funding to healthcare providers that offer family planning services and by returning FPOS eligibility to no more than 300% of FPL. In considering the health and safety of Wisconsin youth and families, reproductive health is imperative to positive outcomes. The encouraging data of dropping teen birthrates in Milwaukee and the falling numbers of abortions statewide correlate with policies like the Healthy Youth Act and the expansion of FPOS. Repealing these measures might only serve to destroy the gains that have been made.

Julie Davidson

New Report on the State of Juvenile Justice in Wisconsin

2011-10-17T12:37:00.001-05:00

The State of Juvenile Justice in Wisconsin: What do We Really Know?” released today examines recent trends in juvenile arrests and incarceration in the state, as well as the success of recent community-based alternatives to secure confinement of youth offenders and includes these highlights:

• The number of juvenile arrests in Wisconsin has declined by 42% over the last decade, and the juvenile arrest rate has gone down by 37% over that span.
• The number of arrests of juveniles in the state for violent offenses has declined by 17.5% over the past five years.
• The average daily population in the juvenile correctional facilities has declined by 70% over the decade.
• Racial disparities remain significant at all stages of the juvenile justice system.
• The number and effectiveness of community-based alternatives to incarceration and the use of research-based practice throughout the juvenile justice system have increased

Check out the report and keep in mind the WCCF recommendations to:

• Return 17-year-olds to the juvenile system, since the juvenile system is proving to be effective, has the capacity to handle it, and would avoid the unnecessary harm youth experience from being in the adult system;
• Reaffirm what is working with youthful offenders, such as local approaches that keep youth in their own communities; and
• Reinvest savings from reduced use of incarceration to support the continued expansion of evidence-based, cost-effective community alternatives to confinement by Jim Moeser

DHS Schedules Two Town Hall Meetings on Medicaid & BadgerCare Cuts

2011-10-15T11:41:00.001-05:00

Forums Set for Oct. 19 in Madison & Oct. 21 in West Allis

The Department of Health Services announced Friday that it is holding two town hall meetings this week on the 39 initiatives the department outlined in late September for cutting a projected $554 million from Medicaid and BadgerCare. To learn more about the proposed cost-cutting measures, see WCCF’s new webpage, which provides links to the DHS proposals and to our analyses of those proposed changes, including our concerns about some of the likely consequences for BadgerCare.

The two hearings that were announced Friday will be in Madison and Milwaukee (West Allis).

Madison: Wednesday, October 19th from 1:00 PM to 7:00 PM

Goodman Community Center -- Evjue Community Room D

149 Waubesa Street

Madison, WI 53704

Milwaukee: Friday, October 21st from 10:00 AM to 3:00 PM

Wisconsin State Fair Park.

Tommy G. Thompson Youth Center – Multi-Purpose Room

640 South 84th Street, West Allis

(Use Gate 5 – directly off Hwy 94/84th Street)

Individuals who are interested in speaking will have up to three minutes to share their comments at this forum. Those who would like to share their ideas and do not wish to speak are encouraged to submit their written feedback at the meeting. Those unable to attend the town hall meeting can provide comments on the DHS website.

A recent WCCF blog post provides an overview of the review process for the DHS proposals.

Jon Peacock

What’s the Process for Implementing $554 Million of Medicaid Cuts?

2011-10-12T23:29:00.009-05:00

Seven months ago, the Wisconsin Legislature hurriedly passed a bill giving the Department of Health Services (DHS) sweeping authority to rewrite the laws governing Medicaid and BadgerCare. On September 30, DHS finally unveiled a lengthy outline of its plans for cutting $554 million from the state’s Medicaid programs. Those plans include 39 initiatives, and you can find our preliminary summary of those plans and some of the likely consequences on the WCCF website.

The most frequent questions I get about the department’s proposals concern the procedural steps that lie ahead: Do some of the proposals need to be reviewed by the legislature? If so, what will that timetable be? Will there be any public hearings? Do any of the changes require rulemaking? What’s the role of the federal government in reviewing and approving the proposed changes? Unfortunately, I can’t answer all of those questions, but I take a stab in this blog post at summarizing what we know at this point about the process for review and approval of the DHS plans.

The Legislature’s role – One thing that we know for sure is that the full Legislature does not need to review and approve any of the DHS proposals. That isn’t to say they couldn’t do so, or shouldn’t at least have meetings to hear the concerns of the people they were elected to represent, but the budget repair and budget bills give the decision making authority to unelected state officials. (See WCCF’s issue brief about the sweeping shift in power.)

The Joint Finance Committee’s role – The budget bill does provide one small check on the unprecedented delegation of policy-making authority to the executive branch. It gives the Joint Finance Committee (which is comprised of 12 Republicans and 4 Democrats) the option of reviewing any DHS proposals that conflict with current statutes. From the date when the Finance Committee formally receives the proposals (and that hasn’t happened yet), the committee has 14 days to request a meeting on proposals that conflict with the statutes. If the committee notifies DHS within that time period that it wants to hold a meeting to review those proposals, DHS may submit the proposals to federal officials only with the approval of the Committee. We don’t know yet whether the committee will hold a meeting.

Public hearings (Updated Oct. 15) – On Friday (Oct. 14) DHS announced the dates, times and locations of two town hall meetings about the proposed Medicaid and BadgerCare cuts. (See our Oct. 15 blog post for the details on those Madison and Milwaukee hearings.) Also, DHS held a town hall meeting Wednesday on one particular proposal relating to long-term care (see Monday’s blog post), and plans a couple of more forums specifically on that proposal. It’s still unclear if there will be any public hearings in legislative committees on the DHS proposals. The Save BadgerCare Coalition has asked the chairs of the Assembly and Senate health committees (as well as DHS) to hold hearings on the proposed BadgerCare and Medicaid changes.

Commenting online – People who are unable to attend one of the public meetings to express their opinions about the proposals, or who are unable to say all they would like in the 3 minutes per person allotted at those forums, may provide comments on the DHS website, and we strongly encourage you to do so.

The federal role – The vast majority of the proposals require federal approval, but for most of them the federal role is just to approve Medicaid “plan amendments.” At the risk of over-generalizing, approval of such amendments is typically pretty routine if the proposals don’t conflict with federal statutes or rules. However, proposals that do conflict with federal law require federal waivers of the conflicting statutes or rules, and getting waivers can be a lengthy process and is much more difficult than getting a plan amendment approved. Most of the changes relating to BadgerCare require a waiver of federal “maintenance of effort” (MOE) requirements, which are part of the federal health care reform law and which prevent the state from reducing coverage of adults below 133 percent of the federal poverty level. The MOE standards also preclude making other policy changes that restrict program participation (including such things as increasing premiums), or any reduction in child eligibility prior to 2019.

Reducing eligibility of adults – The budget bill says that if the DHS waiver request isn’t approved by federal officials by Dec. 31, 2011, then the department shall reduce eligibility of parents and childless adults to 133% of the poverty level (from 200% now), effective on July 1, 2012. That change would end BadgerCare coverage for an estimated 53,000 adults. The state’s self-imposed Dec. 31 deadline provides relatively little time for federal review of the waiver request, making it unlikely that it will be approved by the end of the year. If the Legislature and Governor don't move the Dec. 31 deadline, it appears very likely that the state will end coverage for at least 53,000 adults next July. (Unfortunately, we think the changes that would result if the state gets the waivers are even worse; we'll elaborate on that in a later post.)

We’ll provide updates as we learn more about the DHS timetable and whether the agency, the health committees or the Finance Committee plan to hold any hearings.

Jon Peacock

Check out our analysis of the proposed Medicaid and BadgerCare cuts

2011-10-11T18:21:00.003-05:00

Sara Eskrich and I have been busy analyzing and summarizing the long list of proposals recently unveiled by the Department of Health Services (DHS) to cut $554 million from Medicaid and BadgerCare. We have completed a preliminary analysis, which you can find on the WCCF website. It outlines the changes relating to eligibility, benefits, payment reform, and service delivery, and includes some preliminary thoughts about the consequences of these changes. Check it out!

Unfortunately, there are scores of unanswered questions about details of the DHS proposals. We will update our 6-page analysis as DHS answers some of those questions and as people like you send us your perspectives on the proposals. Check our website for revisions.

We worked with the Save BadgerCare Coalition (SBC) to help produce a condensed, one-page document that summarizes the BadgerCare portions of the DHS proposals, including potential effects of those changes, and we’ll put a link to that on our website soon. In the meantime, you can find that summary attached to a Save BadgerCare press release issued yesterday.

Jon Peacock

Committee Vote Tuesday on Bill Remedying Wisconsin’s Noncompliance with Part of the Health Care Reform Law

2011-10-10T22:34:00.005-05:00

The Assembly Committee on Insurance will hold an executive session Tuesday (Oct. 11) to vote on AB 210, which would put into state law a number of health insurance reforms in the federal Affordable Care Act (ACA) – at least on a temporary basis. The bill was introduced by the committee chairman, Rep. Petersen, and is being pushed by insurance companies.

Insurers are concerned that Wisconsin’s failure to comply with the federal law means that consumers will be able to take their grievances to two different independent appeal boards – one at the state level and one at the federal level – and could get conflicting rulings. An article in this morning’s Kaiser Health News says that Wisconsin is one of 16 states that don’t meet new requirements under the federal health law for consumers to appeal health plans’ decisions to a third party, according to the Centers for Medicare and Medicaid Services, and it helps explains why insurers are concerned.

Rep. Pedersen plans to offer a substitute amendment Tuesday that addresses a couple of the concerns raised by advocacy groups, while still appeasing conservative legislators who are leery of being involved in any way in appearing to endorse the ACA. For that reason, the substitute amendment retains a slightly amended version of a provision that advocates hoped would be deleted – the section that blocks the new consumers protections being put into state law if the ACA is struck down by the U.S. Supreme Court.

From the perspective of advocates for health care consumers, the substitute amendment makes at least a couple of small improvements:

It deletes a provision that would have allowed the Insurance Commissioner to issue emergency rules without a finding of an emergency.
It precludes establishing a Health Insurance Exchange in Wisconsin without the approval of the legislature. In other words, an Exchange can’t be set up by executive order. (That’s a change that is likely to be supported by liberals and conservatives alike, though for somewhat different reasons.)

It will be interesting to watch the debate on this bill. Insurers will be pushing hard for it because they are worried about inconsistencies between current state and federal law, and because being out of compliance means we will soon have two different systems of independent reviews for consumer complaints. Progressive legislators are likely to have a lukewarm reaction because the bill is such a weak endorsement of the consumer protections in the ACA. Some conservatives will be reluctant to support it for a similar reason -- because it’s an endorsement (of any sort) of portions of the ACA.

We’ll follow the bill with great interest.

Jon Peacock

DHS Plans First Hearing on One Part of Proposed Medicaid Changes

2011-10-10T19:15:00.001-05:00

Oct. 12 Town Hall Meeting in Madison on “Virtual PACE”

It’s still unclear if there will be any public hearings on the proposals recently unveiled by the Department of Health Services (DHS) to substantially change BadgerCare for low-income Wisconsinites. (A WCCF summary of the proposed BadgerCare and Medicaid changes was posted online today.)

However, there will be public forums on at least one part of the long list of proposed Medicaid reforms. The department announced last Thursday that it plans to hold several town hall meetings on the proposal known as “Virtual PACE,” beginning with a town hall meeting in Madison on Wednesday afternoon, starting at 2:00:

Wednesday, October 12, 2011

2:00 P.M. – 5:00 P.M.

WHERE: Goodman Community Center

149 Waubesa St., Evjue Community Room D

Madison, 53704

Virtual PACE is a proposed pilot program for a coordinated care system for elderly and disabled adults who wish to receive services in the community. It would serve up to 20,000 adults who require a nursing home level of care and are eligible for both Medicaid and Medicare (“dual elibgibles”). The current PACE program is only available in parts of the state, is limited to people age 55 and older, and to services provided through adult day settings. The Virtual PACE pilot program envisions serving a broader age range, more counties, and with greater flexibility in the location where care is provided.

The department’s summary of the Virtual PACE demonstration proposal and the federal grant that is facilitating its development can be found on the DHS website. Their website also contains information on the department’s full list of cost-cutting proposals.

Individuals who are interested in speaking will have up to 10 minutes to share their ideas at this forum. Those who would like to share their ideas and do not wish to speak are encouraged to submit their written feedback.

Additional meetings on Virtual PACE are being planned in La Crosse, Milwaukee and Stevens Point and will be announced by DHS as details are finalized.

Jon Peacock

DHS Unveils New Webpage to Solicit Comments on Medicaid Cost-Cutting

2011-09-27T19:31:00.007-05:00

The Department of Health Services (DHS) unveiled a new webpage Monday that contains descriptions of some of their Medicaid cost-cutting plans and provides an online mechanism for the public to submit comments on the department’s proposals. Thus far, most of the measures described there are the ones approved by the Legislature in the biennial budget bill, such as capping enrollment in the Family Care program.

In addition to containing specific cuts like the Family Care cap, the biennial budget bill directs DHS to cut at least $444 million in state and federal funding from Medicaid and BadgerCare. The three new measures posted on the webpage Monday would save an estimated $15 million (including $6 million of GPR funding). As an Associated Press article by Scott Bauer notes, that amounts to just 3 percent of the additional (“unspecified”) cuts that the department must find. We’ll be checking the new website frequently for updates that reveal how DHS proposes to achieve the other 97% of the unspecified cuts.

I have somewhat mixed feelings about the new DHS webpage. My quote in the AP article captures that: “I'm glad they've acknowledged that they're interested in public comments, but it's not a very meaningful gesture until we see the meat of their plans." That observation reflects a feeling of consternation that I think is shared by many other advocates who are anxious to see the DHS proposals and to ensure that BadgerCare and Medicaid participants have an opportunity to learn about the potential effects and to raise any concerns they may have. My frustration stems from the following factors:

The original emergency rationale for the Medicaid power shift – When the Walker Administration proposed in February, as part of the “budget repair” bill, that DHS should be allowed to make changes to Medicaid that conflict with state statutes, advocates and many others argued that the unprecedented shift in policy-making authority should be handled in the budget bill, so there would be more time to debate it. DHS insisted that handling the cuts and/or the power shift in the budget bill wouldn’t be soon enough to achieve the savings needed. Now almost 7 months after the legislature approved the budget repair bill’s provisions, which give unelected officials in DHS sweeping power to rewrite Medicaid and BadgerCare policy, we have only seen a tiny fraction of the department’s plans for how they will achieve nearly $450 million of cuts.
The department’s self-imposed December 31 deadline – The measures approved in the budget repair bill (and subsequently made a little more problematic by the budget bill) include a December 31 deadline, which was proposed by the Governor, for federal action on the state’s request for waivers of federal laws that conflict with the DHS proposals. If the state doesn’t get a waiver from federal officials by that self-imposed deadline, the bill directs DHS to reduce the income eligibility cap for parents and childless adults to 133% of the poverty level. Reducing that eligibility ceiling from the current 200% level is expected to eliminate coverage of about 60,000 Wisconsinites. Since waivers often require many months of review, and the DHS proposals conflicting with the statutes have to be referred to the Finance Committee before being submitted to federal officials, the fact that it has taken DHS so long to develop its plan makes it unrealistic to expect federal approval before December 31.
The diminishing opportunities for public input – Advocates believe very strongly that Medicaid and BadgerCare enrollees and potential program participants should have an opportunity for meaningful input – at both the state and federal level. As the process of developing and unveiling the department’s proposals drags out, the opportunity for robust public involvement is greatly diminished by the looming December 31 deadline set by the state legislation. Our hope is that there will be public hearings, as well as the new opportunity to comment online about the proposals.

For information on some of the very detrimental changes that could be proposed in the waivers, see WCCF's short September 9 paper. We will follow up this blog post over the coming weeks once we finally learn what DHS has in mind for achieving about $450 million of additional cuts to Medicaid and BadgerCare.

Jon Peacock

Stable for Years, Poverty Skyrockets in Wisconsin

2011-09-26T10:52:00.005-05:00

The number of Wisconsinites living in poverty jumped significantly between 2008 and 2010, new figures from the Census Bureau show. Between those years, the poverty rate in Wisconsin increased from 10 percent to 13 percent, and an additional 163,000 Wisconsinites slid into poverty. To put that number in perspective, the number of additional people living in poverty represents a population greater than the entire city of Green Bay. For a family of four, the 2010 poverty line was $22,050.

Wisconsin’s overall poverty rate (13 percent) is still lower than the U.S. average (15 percent), as shown in the chart below. But both the state and national poverty rates have climbed precipitously since 2008. This trend is especially troubling considering that the recession officially ended in June of 2009. Given that the economy made modest gains in 2010, one would hope that the number of people living in poverty in 2010 would level off at a rate similar to 2009. Unfortunately that didn’t happen.

There was a great deal of regional variation in poverty rates among Wisconsin counties. Milwaukee County, where more than one in five residents were poor, had the highest poverty rate among the 23 Wisconsin counties for which there were figures. (The sample size used by the Census Bureau does not permit it to report on poverty figures for counties with relatively small populations.) Surprisingly, in 2010 Eau Claire County had the second highest poverty rate, at 18 percent. Other counties with high rates of poverty were Racine (15 percent), Rock (14 percent) and Kenosha (13 percent).

Last week, we posted an analysis of the increase in child poverty in Wisconsin, which is even more dramatic than the increase in the overall poverty rate. Between 2008 and 2010, Wisconsin’s child poverty rate rose from 13.3 percent to 19.1 percent, and the number of children living in poverty increased by 43 percent. Household income in Wisconsin also plummeted during the recession, decreasing faster than the national average.

Given these trends, it’s especially important that the state adopt policies aimed at mitigating the effects of the recession. Instead, just the opposite has happened, as the state has raised taxes on working-class families and slashed investment in the public education system, while cutting taxes for the wealthy.

For additional analysis of income and poverty figures, see the WCCF press release.

Tamarine Cornelius

Household Income in Wisconsin Plummets During Recession

2011-09-23T16:42:00.000-05:00

Since the recession, Wisconsin household income has plummeted, according to new figures released yesterday by the Census Bureau. Between 2006 and 2010, median household income in Wisconsin dropped by about $3,600, or 7 percent.

In yesterday’s blog post, we discussed how child poverty rose faster in Wisconsin than it did nationally. The same trend is played out in the median household income statistics. Back in 2006, Wisconsin’s median household income was actually about $250 higher than the national average, and we ranked 19th among the states.

But during the recession, Wisconsin’s income dropped faster than the national average, a trend illustrated in the chart below. In 2010, Wisconsin’s median household income was about $1,000 lower than the national average and we ranked 22nd among the states. In comparison, Minnesota ranked 12th among the states and had a household income $2,100 higher than Wisconsin in 2010.

Some Wisconsin counties were particularly hard hit by the recession. Residents of Wood County saw their median household income drop $9,600 between 2007 and 2010 (adjusted for inflation), a dismaying 18 percent decrease. Five other Wisconsin counties saw double digit percentage decreases in their median household income since 2007: Jefferson (-14 percent), Marathon (-12 percent), Washington (-12 percent), Sheboygan (-10 percent), and Milwaukee (-10 percent).

Many of these counties with especially significant drops in income also had big increases in overall poverty and child poverty. Jefferson County seems to be especially hard hit, with a child poverty rate that increased from 4 percent in 2007 to 20 percent in 2010.

Yesterday’s Milwaukee Journal-Sentinel included an article on the loss of income for Wisconsin households, which profiled workers who had experienced a drop in income and explored the resulting hardships. The article quotes a University of Wisconsin researcher saying, “The pain is out there…the middle class is taking a beating.”

Tamarine Cornelius

Health Care Cuts in the President’s Deficit Reduction Plan

2011-09-23T08:00:00.001-05:00

The deficit reduction plan unveiled by President Obama on Monday would cut health care spending by an estimated $320 billion over the next 10 years. About $248 billion of that total would come from Medicare, and $72 billion would be cut from Medicaid. This blog post summarizes the major aspects of those spending cuts and attempts to put them in a broader perspective.

Although a number of the proposed changes are very worrisome for health care providers and advocates (see, for example, the Families USA statement opposing the Medicaid cuts), there are some positive aspects of the plan as a whole -- atl least when it is analyzed relative to other options that have been on the table or are likely to emerge. Those more positive aspects include:

The President said he would only approve cuts to Medicaid and Medicare if they are coupled with tax increases on the wealthy, in order to prevent low-income and vulnerable Americans from bearing a disproportionate share of the burden of deficit cutting.
Coupling entitlement cost-savings with additional revenue will help over the longer haul to protect Medicaid, Medicare and the health care reform initiatives.
The proposed Medicaid cut is about $22 billion less than the President recommended as part of his budget in April.
The significant Medicaid proposals are delayed and generally won’t affect Wisconsin until 2014 or later, after the state should start to realize savings from the health care reform law’s more generous matching rates.

Looking more closely at the specific aspects of the proposed cutbacks, here are some of the key health care cost savings:

The proposal would allow Medicare to benefit from the same rebates that Medicaid receives for brand name and generic drugs provided to beneficiaries who receive the Medicare Low-Income Subsidy beginning in 2013. This part of the plan is estimated to save $135 billion over 10 years.
Another of the larger health care cost reductions would come from the so-called post-acute health providers – nursing homes, long-term care hospitals, rehabilitation facilities and home health facilities – which would face $42 billion in cuts over 10 years.
An estimated $26.3 billion in proposed savings would come from limiting the state practice of imposing taxes on health care providers. (We're anxious to get more details on that part of the plan.)
Higher income Medicare beneficiaries would pay higher premiums for Medicare Part B and Medicare prescription drug plans, raising $20 billion over 10 years.
$14.6 billion in savings would be achieved by changing the modified adjusted gross income (MAGI) formula used to calculate eligibility for Exchange premium tax credits and cost sharing reductions, Medicaid and CHIP. The President proposes using a formula that is consistent with current Medicaid practice by including Social Security benefits in the definition of income.
Starting in 2017, new beneficiaries who buy a Medigap policy that leaves them with little out-of-pocket costs would pay a 15 percent surcharge on that policy. Critics have argued such Medigap plans lead to excess use of health services and raise health spending. The change would net the feds $2.5 billion over 10 years.
The deductible for Medicare Part B (physician costs) would increase for new beneficiaries by $25 in 2017, and again in 2019 and 2021, raising $1 billion over the next decade.

Some of these proposals will shift costs onto states or onto families enrolled in Medicaid, and we will continue to oppose those sorts of cost-cutting measures. However, as we evaluate the changes, we need to look at the whole package and the implications it will have for the ability of the federal government to avoid deep cuts in Medicaid and Medicare in future years.

For additional information see the White House’s fact sheet on health care aspects of the plan.

Jon Peacock

Child Poverty Spikes in 2010

2011-09-22T17:33:00.002-05:00

The number of children living in poverty rose dramatically in Wisconsin in 2010, according to new figures released today by the U.S. Census Bureau. In 2010, a quarter of a million Wisconsin children lived below the poverty line, about 36,000 more than in 2009.

Unfortunately, the increase in child poverty in Wisconsin is nothing new. It’s part of a troubling longer-term trend dating back to 2008. Between 2008 to 2010, Wisconsin’s child poverty rate rose from 13.3 percent to 19.1 percent. The number of children living in poverty increased by 43 percent between 2008 and 2010. The chart below shows the significant increase in the number of children in poverty in recent years.

Wisconsin’s child poverty rate remains below the national rate (19.1 percent vs 21.6 percent), but child poverty is growing considerably faster in Wisconsin than in the nation as a whole. In 2008, Wisconsin had the 12th lowest rate for the number of children in poverty. Just two years later, Wisconsin’s ranking has slid to 24th, putting us squarely in the middle of the states, and far behind our neighbor Minnesota, which had the 10th lowest rate of child poverty in 2010.

In Wisconsin, there is substantial regional variation in the proportion of children living in poverty. Across the state, slightly less than one out of every five children in Wisconsin lived in poverty in 2010. But in Milwaukee County, more than one out of three children lived in poverty. That’s much higher than the child poverty rate in wealthier counties like Ozaukee County, where only one out of twenty children lived in poverty.

Unfortunately, we’re not likely to see a dramatic turnaround in recent child poverty trends in the near future. The economy is still stuck in neutral, the recent pace of job creation has been – at best – anemic, and recent policy decisions at the state level have exacerbated the effect of the recession for families and children.

Keep tuned as we post additional analysis of new Census Bureau figures for Wisconsin, and address recent trends in overall poverty, household income, and health insurance coverage.

Tamarine Cornelius

Did DCF Violate State Law by Overriding Administrative Rules?

2011-09-21T12:47:00.000-05:00

Last month the Department of Children and Families (DCF) made an abrupt and significant policy change to the Wisconsin Shares payments to licensed family child care providers. But in doing so, according to the non-partisan Wisconsin Legislative Council, they neglected to follow legal procedure. The new policy was released as an "operations memorandum" even though it directly "contradicts the current rule." In order to comply with the law, DCF needs to make such changes through promulgating an administrative rule.

Rep. Tamara Grigsby points this out in a press release dated 9/20/11. She argues that the Department should "cease its implementation of an illegal policy change". The above rule that is affected by DCF's policy change states that a provider may be paid on an attendance basis "if the agency has documented three separate occasions where the provider significantly overreported the attendance of a child" or “if the schedule of child care to be used is expected to vary widely.” However, the new payment scheme applies to ALL family child care, not just in instances of serious and repeated fraud or a widely varying child care schedule.

WCCF and the Early Learning Coalition agree that the new policy, implemented without hearing or consultation with the child care community, is unfair and damaging to licensed family child care providers and to the families they serve. We encourage the Department to reconsider this legally questionable and unnecessary policy change. We fear that in the Department’s zeal to address fraud they are punishing honest, conscientious child care programs serving the low-income families in Wisconsin Shares.

Daithi Wolfe

New Census Bureau Data Shows Poverty Holding Steady in WI Amid Big National Increase, But Household Income Continues to Shrink

2011-09-13T15:15:00.001-05:00

Today the U.S. Census Bureau released data from its Current Population Survey (CPS) on poverty, household income, and health insurance coverage. Nationally, more people are living in poverty--46.2 million in 2010--than at any other time since the federal government began estimating poverty 52 years ago. The national poverty rate jumped from 14.3% in 2009 to 15.1 last year, the highest national poverty rate since 1993 and the fourth consecutive yearly increase. The child poverty rate rose from 20.7% in 2009 to 22.0% in 2010.

Wisconsin’s poverty rate remained stable in 2010. The overall poverty rate in Wisconsin in 2009-10 was 10.3%, which does not represent a statistically significant change from the 10.6% rate recorded in 2006-07. However, the picture with regard to median household income in the state is much bleaker. Wisconsin’s median household income in 2009-10 was $51,303, a statistically significant decrease of $3,608 from 2006-07. But this downward trend has been taking place since long before the recession kicked in. Median income in Wisconsin has fallen $7,119 since 1999-2000 (in 2010 dollars, adjusted for inflation). (Note: For state-level analysis of CPS data, two-year averages are used to increase reliability. Even with the two-year averaging, state-level CPS figures are considered “preliminary.”)

The Census Bureau will provide more penetrating estimates of poverty at the state and local levels on September 22, when it releases data from the American Community Survey (ACS). The ACS uses a much larger sample of the population, allowing for more reliable estimates at the state level and more localized estimates of poverty and other key indicators.

Our press release with WCCF’s analysis and reactions to the new CPS data is at http://www.wccf.org/pdf/cps_poverty_2011.pdf.

Bob Jacobson

Census Data Shows BadgerCare Has Filled the Gap for Many Families and Individuals Who Lost their Job-Based Coverage Due to the Recession, However 504,000 Non-Elderly Wisconsinites Still Lack Insurance Coverage

2011-09-13T12:49:00.007-05:00

As WCCF noted in a press release today, the U.S. Census bureau released the Current Population Survey (CPS) data this morning, showing that more Americans are living in poverty -- 46.2 million in 2010 -- than at any other time since the federal government began estimating poverty 52 years ago. The national poverty rate jumped from 14.3% in 2009 to 15.1% last year, the highest national poverty rate since 1993 and the fourth consecutive yearly increase. The child poverty rate rose from 20.7% in 2009 to 22.0% in 2010.

Though we mention it at the end of the release, the health insurance coverage data from the CPS is not insignificant. The recession and its aftermath have also reduced the number of people who are covered by employer-sponsored health care insurance. An estimated 504,000 non-elderly Wisconsinites (10.6%) lacked health insurance in 2009-10, according to the new CPS data, an increase of about 31,000 since 2007-08, when 9.8% were uninsured. (The Census Bureau averages two years of CPS data in order to make the estimates more reliable.)

Low-income families with incomes below $25,000 were hit especially hard. Nationally, an estimated 846,000 more people in these low-income households were uninsured in 2010 than in 2009 (part of the story here is that the number of people with households incomes below this level increased by nearly 2 million). One of the goals of the Affordable Care Act (ACA) is to increase access to affordable coverage for these families, though the Health Insurance Exchanges and Medicaid expansion. In fact, one of the bright spots in the data was the decline in the number of young people (ages 18-24) without access to health insurance. This was likely due to the ACA’s expansion of coverage for this group in 2010.

In Wisconsin, BadgerCare Plus has filled the gap for many families and individuals who have lost their job-based coverage due to the recession. According to the CPS data, approximately 162,000 Wisconsinites under the age of 65 lost their employer-sponsored coverage from 2007-08 to 2009-10, but 102,000 gained Medicaid or BadgerCare Plus coverage, largely offsetting the loss of job-based coverage. This shows the importance of public coverage options like BadgerCare in difficult economic times.

As the Wisconsin State Journal reported yesterday, the state has yet to make public their plan to cut nearly $500 million in BadgerCare and Medicaid, as passed in the state budget. A WCCF paper outlines some of the potential implications of these changes; however, the CPS data shows that it will be particularly important to go through a robust public input process, to ensure that changes will not cause a further increase in the number of uninsured Wisconsinites.

Sara Eskrich

Wisconsin Scores 5th in the Nation on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers

2011-09-12T17:57:00.000-05:00

A first of its kind report by AARP, The Commonwealth Fund, and The Scan Foundation measured state-level performance of long-term services and support (LTSS) systems providing assistance to older people and adults with disabilities. The report is called “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers.”

Across the four dimensions, Wisconsin scored 5th. However, the report emphasizes that all states have room for improvement and that public policies play an important role in those improvements. If Wisconsin were to improve to the level of the top performing state, 9,542 more low- or moderate-income adults with activity of daily living disabilities would be covered by Medicaid and 6,057 more new users of Medicaid LTSS would first receive services in home and community based settings, instead of nursing homes.

Overall, the report examined state performance based on:
   1. Affordability and access;
   2. Choice of setting and provider;
   3. Quality of life and quality of care; and
   4. Support for family caregivers.

Wide variation existed within each indicator, and support for family caregivers went hand in hand with other dimensions of high performance. One reason why Wisconsin ranked high is that the scoring gave preference to services in community and home-based care settings. Medicaid, as the primary sources of public funding for LTSS, plays a key role in determining the extent to which low-income people can receive their care through home and community based supports.

Innovative programs like Family Care help Wisconsin lead in this area. However, Family Care enrollment is currently frozen. For more on advocate’s efforts to lift the limit on Family Care in Wisconsin, see the August 8th article in the Appleton Post-Crescent.

Sara Eskrich

A Wisconsin Patients’ Bill of Rights

2011-09-07T17:01:00.004-05:00

This afternoon, WCCF was pleased to participate in the announcement of the WI Patients’ Bill of Rights. Sponsored by Rep. Jon Richards and Sen. Jon Erpenbach, this bill looks for common ground around health care reform by addressing the pro-consumer measures from the Affordable Care Act (ACA), on which there is very broad public support, and on which there should be broad bipartisan agreement in the Legislature.

The bill would fold those measures into the state statutes. Some of the key provisions of this bill for children in Wisconsin include the following:

Immediately, insurers in all new health plans will not be able to deny coverage to kids under 19 because of a pre-existing condition, and in 2014 this benefit will be extended to all Wisconsinites.
All new health plans will be required to cover preventive services for children, like immunizations, vision screenings, and depression screenings for teens, without a co-pay.
The bill ensures that women and their newborns are covered for their hospital stay for no less than 48 hours after delivery and 96 hours after a cesarean section.
Insurers are prohibited from imposing a lifetime limit on the dollar value of coverage, and in 2014 plans will not be able to impose an annual limit on coverage.

WCCF believes these popular and sensible measures from the ACA should be incorporated into state statutes, so they have the force of law regardless of how federal judges rule on the Constitutionality of the federal law.

Another bill, AB 210, which was introduced by Rep. Petersen and relates to the “implementation of health insurance reform, providing an exemption from emergency rule procedures, and granting rule-making authority,” would repeal these consumer protections if the ACA was found unconstitutional. Additionally, though AB 210 is being described as implementing the Affordable Care Act (ACA), it includes numerous provisions not required by health reform and contrary to consumer protections, including:

granting emergency rule-making authority to the Insurance Commissioner without finding of emergency,
repealing the WI statutes related to internal and external appeals (which are more generous than those required by the ACA), and
allowing the Insurance Commissioner to refuse to disclose rate filing information if it’s determined to be proprietary.

For a more detailed analysis of AB 210 see ABC for Health’s HealthWatch Wisconsin newsletter here, and the full bill text with a Legislative Reference Bureau summary here.

There will be a public hearing on AB 210 on September 15th at 10:45 AM in room 328 Northwest of the Capital. We encourage advocates to attend and share their concerns with the extraneous elements of this bill.

Sara Eskrich

New Report Examines Joblessness in Wisconsin

2011-09-05T19:12:00.000-05:00

The Center on Wisconsin Strategy (COWS) has released a report called The State of Working Wisconsin -- Update 2011, which examines the increased rates of unemployment and underemployment in Wisconsin and the disparate impact those problems on particular sectors of the workforce. Read more in the Wisconsin Budget Project’s Labor Day blog post.

Jon Peacock

Health Care Advocates Call for More Balance on Health Reform Working Groups

2011-09-02T19:12:00.002-05:00

Two consumer advocacy groups issued a press release this afternoon calling Insurance Commissioner Ted Nickel’s newly identified membership of the health insurance exchange work groups “unacceptable.” Under the Affordable Care Act, states are required to establish health insurance exchanges as an important tool for consumers of all abilities to get health insurance and certain Medicaid/BadgerCare Plus services.

To help plan and build the exchange, the Office of the Commissioner of Insurance (OCI) yesterday announced the new “working groups” composed overwhelmingly of insurance industry members. A blog post today by the Wisconsin Alliance for Women’s Health describes the composition of these advisory committees:

“In all of the eight working groups, meant to provide feedback and recommendations to the Commissioner on Exchange development, consumers are greatly outnumbered by industry representatives. The representation is on average, 8:1 in each group. In total, 90% of those on the working groups represent insurers, agents, businesses, or employers.”

The press release this afternoon from Citizen Action of Wisconsin and ABC for Health calls on Commissioner Ted Nickel “to go back to the drawing board” in setting up the working groups and involving the public. They noted:

“An exchange built without meaningful consumer input on rights and protections will do nothing to help consumers and it is no substitute for a strong health plan marketplace that supports consumers in their decisions.”

WCCF shares the concerns that there should be increased public involvement in the state-level implementation of the Affordable Care Act, including meaningful input from working groups that aren't dominated by represenatives of the insurance industry.

Jon Peacock

GOP Governors Renew Push for More Authority to Restrict Medicaid

2011-09-01T12:57:00.004-05:00

The Republican Governors Association (RGA) released a report Tuesday (Aug. 30) detailing 31 recommendations for loosening federal Medicaid standards, in order to give states far more autonomy in determining who is eligible and what they are eligible for. The report, titled A New Medicaid: A Flexible, Innovative and Accountable Future, has been endorsed by 30 GOP governors and territorial leaders, including Governor Walker.

As an Associated Press/ Washington Post article reported Wednesday, the RGA report says that “Medicaid should be custom-designed by each state to best provide care to children, the poor and disabled without federal rules and the waivers required to get around them.” The recommendations include longtime GOP priorities such as repealing the health care reform law's “maintenance of effort” requirement that places restrictions on the ability of states to cut their Medicaid rolls.

Advocates are concerned that giving states broad authority to change Medicaid will be very detrimental for the low-income families, seniors and people with disabilities that the program serves. The Georgetown Center for Children and Families (CCF) released a brief earlier this year detailing what’s at stake for children and families if stability provisions such as the “maintenance of effort” requirement were repealed. They found that more than a third of Medicaid and CHIP beneficiaries would be at risk and more may face red-tape barriers to coverage.

The RGA report was submitted to Congress just as GOP appointees to the new “super committee” were getting together to discuss their priorities for achieving the goal of cutting $1.2 trillion from the federal deficit. Mississippi Governor Haley Barbour said the report should be "helpful" for the super committee, since giving states broader options for cutting Medicaid spending will also reduce the federal matching dollars for that spending. Previous GOP efforts this year to give states broad power to rewrite their Medicaid programs have been blocked by the Senate, so the best chance to enact such recommendations is to get them included in whatever deficit reduction package is developed.

As Georgetown CCF discussed, broad authority to change Medicaid could quickly unravel the nation’s progress in covering children and families. In addition, advocates argue that such changes will significantly increase the number of people who are uninsured and underinsured, which will have the effect of increasing uncompensated care and shifting additional cots onto the insured.

Jon Peacock and Sara Eskrich

On the Path to Becoming a C Student

2011-08-30T16:15:00.000-05:00

How do Wisconsin's schools compare to those in other states? A new Wisconsin Budget Project analysis asks this question, and finds that Wisconsin, once a national leader in educational performance, now ranks close to the national average in many measures of support for education.

Here's an excerpt from the analysis:

Wisconsin schools have long been an engine of our state’s economic growth. We have depended on a well-educated workforce, grounded in high quality public schools supported by state dollars, to lay the foundation for our state’s economy. But that may all be changing.

Over the last few years in Wisconsin, growth in support for classroom learning has not kept up with the national average, state support for schools has declined, and student/teacher ratios have increased. The massive cuts to schools in the 2011-13 budget will likely exacerbate these troubling trends.

For more about trends in state support for schools and student/teacher ratios, see the analysis here.

Tamarine Cornelius

What Would Walt Disney Think of Beyond Scared Straight?

2011-08-29T17:09:00.002-05:00

Just read a very interesting and provocative letter from Leonard Witt of the Center for Sustainable Journalism to the CEO of Disney related to the inconsistency between the Disney vision and the latest season of Beyond Scared Straight showing on the A&E Network, owned in large part (one-third) by Disney.

In his letter, Mr. Witt points out that the gut-wrenching, verbally abusive, and harassing behavior shown in the most recent Beyond Scared Straight airings is in direct contrast to the stated “Three core principles that guide our daily decisions and actions” at Disney as well as being contrary to all evidence about what works effectively for at-risk and delinquent youth.

What a tragedy that Beyond Scared Straight is again even showing – and although it seems to make for decent ratings, perhaps it’s time those that can make a difference step up to the plate and do so. So, to the Disney Corporation – make a difference! Thanks Mr. Witt.

Jim Moeser

Public Employees Take Pay Hit Starting Today

2011-08-25T15:49:00.002-05:00

The paychecks that public employees get today will be quite a bit smaller than the ones they’ve gotten in the past. That’s because this is the first paycheck that takes into account a provision in the budget repair bill that requires public employees to pay more for their fringe benefits.

Beginning teachers, janitors, workers in school, and other working-class public employees could lose thousands of dollars per year, the equivalent of as much as six months of grocery costs.

A WCCF analysis of the compensation cuts and other budget changes found that:

• Workers earning the least will take the biggest hits to their budget – as much as 15% in lost income and increased costs.

• The impact on low-income public sector workers, in terms of monetary impact, will be far greater than that on workers in the private sector.

• Working-class families with children will be hit especially hard, as the state rolls back tax credits for working families with children and support for child care.

If you’re interested in seeing the impact of these changes at the local level, the Institute for Wisconsin’s future has county-by-county information on the effect of the compensation cuts and other budget changes.

You can find WCCF's analysis here.

Most people nonplussed about changing demographics

2011-08-25T10:54:00.000-05:00

Census Bureau data on population trends indicates that by midcentury, people of color will be in the majority. Interestingly, a new opinion survey by Colorlines.com, finds that most people are ambivalent about this demographic shift. However, the research by the Applied Research Center (Colorline’s publisher) did find that among those concerned about the change, political ideology, race, education and age were factors in their opinion. See the Colorlines article on the survey and all its findings. A People of Color Majority? Meh, So What?

New DCF Ops Memo Outlines Switch to Attendance-Based Payment for Wisconsin Shares

2011-08-19T16:08:00.002-05:00

The Department of Children and Families just released an operations memo dated 8/11/11 on the subject "Authorizations to Licensed Family Providers to be Attendance Based Only". "Attendance Based" means payment is based solely on hours attended, unlike private child care, Head Start, and public and choice schools, where everything is enrollment based--i.e. payment is for a slot. Under their new authority granted by the 2011-13 Budget, DCF has decided to implement this cost cutting (or cost shifting) measure that amounts to a substantial financial hit to family child care providers who are part of Wisconsin Shares. This comes on top of inadequate reimbursement rates that remain frozen at 2005 levels and have already negatively impacted the quality and availability of care for Wisconsin's low-income working families.

There are several problems with this policy change:

Attendance based only payments unfairly punish family providers who care for Shares children with an immediate 7-8% compensation cut (based on average attendance figures).
In licensed child care, payments should mirror the market, where payments are made based on child enrollment, not on hours attended.
If the payment system does not provide fair, reasonable reimbursement to providers, many providers will choose not to serve low-income families.
DCF is exercising their authority unilaterally, with no input from legislators, consumers, providers, or experts in the field.
It is extremely unfair to only apply this policy to family providers (this is bad public policy for ALL providers).
The WI Shares program is actually UNDER budget, so there should be no immediate need for cost saving measures.

Prices in the child care market have generally risen 3-5 percent per year, but Wisconsin Shares reimbursement rates have now been frozen for over 5 years. If payment rates do not reflect cost increases, programs will have to absorb the difference, or pass the additional cost on to already struggling low-income families. This ongoing trend is likely to mean less access for families and lower quality child care for their children, as well as financial hardship for a fragile child care industry, where the average teacher earns only about $11.00 per hour.

A large percentage of Wisconsin’s young children in poverty or close to poverty are in child care settings that receive subsidy payments. These are the same children that are potentially at risk of not being ready for school. We hope that Wisconsin can find a way to assure that Wisconsin Shares remains a strong program providing an essential support to low-income working parents and a solid start for their children. Changing to an attendance only system is taking us in the wrong direction.

For another angle on the problems with the policy change, see the WI Budget Project's blog post on the issue.

Daithi Wolfe

ACA – Helping Us to Actually Understand What’s in Our Private Health Insurance Plan

2011-08-17T21:53:00.001-05:00

Many of us have frustratingly tried to decide which insurance plan to choose – and it’s like comparing apples to bananas to oranges, all in a foreign language. Thankfully, a preliminary federal rule announced on August 17 by the Department of Health and Human Services – implementing part of the health care reform law – will ensure that all consumers of private insurance are provided clear, consistent, and comparable information about their health plan benefits and coverage.

The proposed regulations clarify the implementation of the ACA provision ensuring that consumers have access to two forms to help them understand and evaluate health care choices, specifically:

An easy to understand summary of benefits and coverage; and
A uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “co-pay”.

Much of the discussion of the Affordable Care Act (ACA) focuses on the provisions that help expand access to insurance – by expanding eligibility for Medicaid and subsidizing coverage purchased through the new Health Insurance Exchanges (for people who don’t have access to affordable care through an employer). However, there are also many parts of the health care reform law, such as the rules proposed today, that provide valuable assistance to the more than 180 million health insurance consumers with private coverage.

It is especially important that the ACA moves forward with these common-sense improvements, helping people to make educated decisions about the best health plan for themselves and their families, because state policy choices in Wisconsin this year have been moving in the opposite direction. As we previously blogged, the WI Insurance Commissioner has issued and extended an emergency rule suspending improvements to readability and electronic access to private insurance plans made last November. The ACA rule would help mitigate the effect of that setback to the development of a more consumer friendly market for purchasing insurance.

During the 60-day public comment period, we look forward to delving into the proposed regulation and the examples it provides, to make sure they fully address the needs of Wisconsin families considering their private health insurance options.

Sara Eskrich

“BadgerCare Plus: Who’s Eligible, for What, and at What Price?”

2011-08-16T17:41:00.002-05:00

Back by Popular Demand

Shortly after BadgerCare Plus began in 2008, I wrote a paper providing a detailed description of the income eligibility criteria, what people are eligible for, and how to calculate the premiums for families of different sizes and incomes. We recently got a couple of requests for an updated version of that report, and this seemed like a good time to make it current – before DHS unveils its proposal for how to change premiums and/or various other aspects of BadgerCare Plus.

A new version of “BadgerCare Plus: Who’s Eligible, for What, and at What Price?” has been completed, and can be found on the WCCF website. Appendix 1 provides a table comparing the benefits available in the Standard Plan and the Benchmark Plan. Appendix 2 provides a number of examples of how to apply the tables for determining eligibility and the premiums, and how those hypothetical families might be affected if the state raises cost-sharing for low-income enrollees to 5 percent of family income.

Jon Peacock

Real Deficit Reduction Will Take Real Health Care Reform

2011-08-15T11:53:00.002-05:00

Raging debates about reducing the federal deficit, as well as state spending, have reiterated a common point – health care costs are too high. Medicare and Medicaid make up about 23 percent of federal spending, and their costs are growing faster than the overall economy. Because of this, the new "super committee" will likely be looking at health spending as part of deficit reduction. However, real deficit reduction will take real, systemic health care reform.

On this note, recent news of success in the Medicare shared savings demonstration project at Marshfield Clinic shows a glimmer of hope. Ten physician groups from across the country, including Marshfield, recently completed a five-year demonstration project with the federal Centers for Medicare and Medicaid Services and signed on for another two years. The goal of the project was to improve quality of care and reduce costs in order to achieve shared savings – central to this was paying for quality of care, not for quantity. Already, Marshfield Clinic has earned $56.2 million in shared savings payments from the project. This was 80% of the savings; the other 20% was kept by Medicare. Guy Boulton wrote about the pairing of savings and quality in the Journal Sentinel, and Jake Miller in the Wausau Daily Herald shared that, “Marshfield Clinic Impresses with Savings Success.”

Various aspects of the Affordable Care Act (the health reform law) attempt to build on these sorts of reform initiatives to improve quality while lowering the cost of health care. Specifically, Marshfield clinic’s successful demonstration project has laid the groundwork for Accountable Care Organizations (ACOs). ACOs, expected to launch in early 2012, will be patient-centered providers and suppliers of services working together to coordinate care for Medicare patients. This is intended to create incentives for providers to work together across care settings (including doctor’s offices, hospitals, and long-term care facilities), where the amount of shared savings will be determined by the quality of care. Though there are still questions about the feasibility and risks of ACOs, Marshfield Clinic’s experience leads us to believe that success is possible. (For more about ACOs, see healthcare.gov’s factsheet here.)

These sorts of real, quality reforms to the health care system will make the difference in health care costs. Merely reducing payments to states and providers without reforming systems will lead to cost-shifting, doing nothing to actually reduce health care costs. For this reason, we look forward to implementing and assessing the innovative approaches to health care reform in the Affordable Care Act – recognizing that effective deficit reduction can only be accomplished by reforming health care, not just cutting.

Sara Eskrich

New Affordable Care Act Rules Get Mixed Reviews

2011-08-12T20:36:00.004-05:00

Three new sets of proposed federal regulations relating to the Affordable Care Act (ACA) were issued today by the Department of Health and Human Services (HHS) and the Treasury Department. I haven’t reviewed them carefully, but I was pleased to read that Tricia Brooks at the Center for Children and Families (CCF) at Georgetown University said the proposed rules “take a number of positive steps forward to remove administrative barriers to coverage and reduce churning.”

In a CCF blog post, Brooks explained that the draft rules incorporate lessons learned from the Children’s Health Insurance Program (CHIP) about the importance of streamlining eligibility, coordinating enrollment in Medicaid and CHIP, and improving retention. She said that, “the ACA's vision for seamless, coordinated coverage is reflected in the details of the regulation,” which she said answers “a number of questions states have as they move forward in building the important IT systems that will support these goals.”

Although Brooks’ comments are heartening, child advocates also have a significant concern about the Treasury Department proposal because they think it interprets the law in a way that will significantly reduce the number of families eligible to purchase subsidized insurance through the new health insurance exchanges, thereby increasing the number of people who remain uninsured.

The ACA bars individuals from purchasing coverage through an exchange if they are offered “affordable” coverage through an employer. The law defines a health plan as unaffordable if an employee would have to spend more than 9.5 percent of household income. The preliminary IRS interpretation in the proposed rule is that the affordability requirements apply only to the coverage of the employee, not to the cost of family coverage. The result is that far fewer people will be eligible to participate in the exchanges, despite the fact that their employer's family coverage costs more than they can afford.

The Obama Administration was caught in a bind on this issue because even though many people thought the intent was to look at the affordability of family coverage, apparently the Joint Committee on Taxation and the original cost projections for the law assumed otherwise. Thus, basing affordability on family coverage would boost the law's cost -- perhaps significantly (though the amount is still in dispute). We’ll review the issue more carefully in a future post.

The full regulations can be found here. There is also a 4-page overview of the rules and fact sheets explaining each of the three proposed rules:

HHS and the Treasury Department are soliciting comments on the proposed rules.

Jon Peacock

“Will Wisconsin’s Scott Walker Implement Health-Care Reform?”

2011-08-11T13:00:00.003-05:00

Seems Likely He’ll Implement a Heritage Foundation Supported Exchange

This morning, the Washington Post’s article, “Will Wisconsin’s Scott Walker Implement Health-Care Reform?”, noted that of the seven early innovator state grantees, Wisconsin is the only state with a GOP Governor holding onto the money. Oklahoma returned its grant in April, and just this week Kansas Governor Sam Brownback returned $31 million. These early innovator grants are intended to help states develop the Health Insurance Exchanges, a key element of the health care law.

Some conservatives speak dismissively of Exchanges as part of “Obamacare,” and much of the recent discussions of Exchanges seems to have forgotten their original proponents, which included the conservative Heritage Foundation. As a PolitiFact article noted, “On numerous occasions, Heritage scholars wrote approvingly of the exchange system in Massachusetts, known as the Connector.”

The PolitiFact article referenced the work of Edmund Haislmaier, a Heritage fellow in health care policy, who wrote in an April 2006 paper about the Massachusetts plan, of the "truly significant and transformative health system changes that the legislation would set in motion." Haislmaier went on to say:

"this concept of organizing a state's insurance markets around a central clearinghouse represents a dramatic departure from recent state health insurance reform proposals. States have spent the past 15 years trying to expand health care coverage to small-business employees, with virtually no positive results. The Massachusetts legislation represents a bipartisan commitment to move away from the policies that have largely failed to make progress in covering the uninsured for the past 15 years."

Though the original Exchanges supported by the Heritage Foundation, including the Massachusetts Connector model, will be implemented somewhat differently in the Affordable Care Act, Heritage and other conservative leaning policy groups have been advocating for similar ideas for years. As PolitiFact reported, Heritage scholar Robert Moffit wrote in an October 2006 paper ("The Rationale for a Statewide Health Insurance Exchange") that "the best option is a health insurance market exchange." He said it "would expand coverage and choice" and would represent "a revolutionary change in the health insurance market."

It is important to note that after leaving the role of Medicaid Director under former U.S. Health and Human Services Secretary Tommy Thompson, the current WI Department of Health Services Secretary, Dennis Smith, was a senior fellow at the Heritage Foundation. We hope and expect that he understands the potential in Health Insurance Exchanges to create a strong market of private insurance plans for individuals and small businesses to shop for health insurance coverage, and for the Exchanges to set in motion what Edmund Haislmaier called "truly significant and transformative health system changes.”

Sara Eskrich and Jon Peacock

States Struggling to Comply with Federal Law on Sex Offender Registration - the Adam Walsh Act

2011-08-08T14:54:00.005-05:00

The Adam Walsh Child Protection and Safety Act was signed into law on July 27th, 2006 by President George W. Bush with the intention of keeping tabs on sexual offenders. The Adam Walsh Act organizes offenders into 3 tiers. Tier 3, the most serious tier, mandates that offenders update their whereabouts every 3 months, with lifetime registration requirements. Tier 2 offenders must update their whereabouts every 6 months, with 25 years of registrations. Tier 1 offenders must update there whereabouts every year for 15 years. Failure to register and update information is a felony under law.

States had until last week to be submit a compliance plan, in order to avoid receiving a 10% decrease in federal justice assistance funding. Most states have found it be difficult to be in strict compliance with the law, but the process does include that being “substantially compliant” may be sufficient.

The ultimate focus for any law should be directed towards preventing more victims by reducing recidivism among offenders, which the Adam Walsh Act doesn’t really provide. There continues to be a tension between the good intentions of the Act to better inform community members of potential dangers vs. the reality of whether these kinds of notification have a long-term benefit. On one hand, it would be nice as a parent to know where the offenders are living, but on the other hand does it ensure community safety? This tension has been most evident when planning for how to comply with the Act as it relates to youthful offenders.

An article on CNN, Alisa Klein, Public Policy Consultant for the Association of the Treatment of Sexual Abusers and coauthor of the report, “A Reasoned Approach: Reshaping Sex Offender Policy to Prevent Child Sex Abuse”, said “that public notification creates barriers to successful sex offender management and treatment and supervision....offenders reentering the community need strong support to prevent them from reoffending through family, faith communities, and a steady job.” Going on a public registry would do the exact opposite. A stigma would be attached to the offenders and prevent employment, prevent them from living with families, get them thrown out of faith communities; it has the consequence of putting someone in an emotional state that may make them more likely to reoffend, she said.

Another criticism of the act is that it uses an offense-based registration approach instead of using an approach based on risk-assessment. States like California and Texas already use a risk-assessment approach because they agree that that truly dangerous offenders like pedophilias and rapists should be heavily watched, but the act does the opposite. By using the offense-based approach it pulls too many offenders onto the registry and overburdens law enforcers, preventing them from keeping a close eye on the riskiest offenders.

Imposing public reporting and/or a lengthy reporting period on a youth before their brain is fully developed doesn’t make sense. We know that youth respond better to rehabilitation versus incarceration, and if the latter happens we know that there is a higher chance of recidivism, which makes our communities less safe. If we know this why make it a mandate to put kids on a registry? Since taking over beginning in 2009, the Obama Administration demonstrated a willingness to be more flexible in reviewing state’s compliance plans (Wisconsin’s was submitted about 10 days ago) and to be more proactive in looking at what works when confirming if states are or are not compliant with the law.

And, simple economics is playing a role, as more states are having trouble finding the resources to really be compliant. For many states, it may cost more to be fully compliant with the new law compared to the 10% decrease in justice funding they would lose. In an article on the Bangor Daily News website, “Maine one of many states failing to comply with federal sex offender laws” reported that Maine would be one of the states that would actually save money by not being compliant with the law. Representative Ann Haskell said that “I understand that a percentage of grant money could be withheld, but full compliance would be much more expensive for Maine.”

As of July 28th, 14 States, 9 tribes, and one territory have implemented the new requirements, WI not being one of them. Wisconsin’s plan does include some reasonable flexibility in how youthful offenders are treated, so time will tell whether it will be approved.

by Allan Goetsch

Effective School Discipline Practices – Some Parameters for Good Practice

2011-08-05T13:55:00.001-05:00

The National Juvenile Justice Network has just released a policy platform on Safe and Effective School Disciplinary Policies and Practices.

Sparked by concerns about school safety, in the 1990’s and into the last decade, schools implemented a variety of “get tough” policies and practices that led to a steady rise in the number of school suspensions and expulsions of youth – too often reinforcing or putting them on a downhill track toward further delinquency and ultimately jail or prison. Some of these policies created a “zero tolerance” approach that scooped in youth who could benefit by more creative, informed, and productive efforts to successfully reengage them in school.

This policy platform recognizes the need for safety in our schools but more strongly urges that districts avoid a “one size fits all” approach – instead working to prevent school-based problems and then, when the do occur, intervene effectively so that troubled youth have the opportunity to become successful. Wisconsin schools, large and small, can struggle with how best to approach the needed balance, and this platform provides some guidance on what advocates should expect in terms of discipline policy and practice.

Jim Moeser

World Breastfeeding Week: Good News As Well As Challenges

2011-08-04T12:30:00.009-05:00

Part way through World Breastfeeding Week (this week), child advocates have seen a major victory as well as a challenge. On Monday the Department of Health and Human Services (HHS) released guidelines on preventative services to be available to women with no additional co-pay under the Affordable Care Act. These eight requirements, recommended by the Institute of Medicine, include comprehensive lactation support and counseling and the costs of renting breastfeeding equipment. The necessity of those particular provisions was quickly re-affirmed when the Centers for Disease Control and Prevention (CDC) released a new study Wednesday, showing that most hospitals do not adequately encourage breastfeeding.

Childhood obesity is an epidemic in our country; a CDC fact sheet for Wisconsin shows that 25% of children in the state are either overweight or obese. Breastfeeding for 9 months reduces a baby’s odds of becoming obese by more than 30%. Stopping breastfeeding too early also increases risk of diabetes, as well as respiratory and ear infections. Women who breastfeed are also less likely to develop breast and ovarian cancer. According to the CDC report, low breastfeeding rates add an estimated $2.2 billion to national health care costs annually.

Hospitals are a critical place for women and infants to either be helped or hindered in breastfeeding. The report from the CDC showcases the Baby-Friendly Hospital Initiative, which encourages supports to help mothers breastfeed. Unfortunately, fewer than half of US hospitals follow recommended practices to encourage breastfeeding. In Wisconsin, only 10-19% of births in 2011 took place in “baby-friendly facilities.”

Encouraging breastfeeding -- both by eliminating co-pays for lactation support and counseling and encouraging hospitals to follow the recommendations of the Baby-Friendly Hospital Initiative -- will improve the health and well-being of women and children throughout the country in a cost-effective and relatively easy way. What better time to recognize this than World Breastfeeding Week?

Sara Eskrich

DHS Declines to Seek $9 Million of Potential Health Care Grants (though WI Ranks 47th in Public Health Spending)

2011-08-04T09:00:00.005-05:00

A Journal Sentinel article posted late Wednesday afternoon reports that Wisconsin’s Department of Health Services (DHS) “has declined to make or back applications for federal public health grants that could have totaled more than $9 million over the next five years.” Most of that total represents two grants for combating alcohol and drug abuse, which could have amounted to up to $8.6 million over 5 years.

In addition to the potential health care funding, the article by Jason Stein notes that DHS decided not to apply for a grant of about $9 million “to update the system for providing food assistance benefits to pregnant women, infants and children through the WIC program from a voucher coupon to an electronic debit card.”

The article quotes Bevan Baker, the City of Milwaukee’s commissioner of health, who said, "I for the life of me cannot understand why at a time when there is a proliferation of illicit drugs and documentation of binge drinking and drunken driving in the state . . . Wisconsin would put its head in the virtual sand and not go after this funding."

The DHS response is that it doesn't pursue grants that duplicate existing efforts, aren't needed, haven't received enough planning, or might lead to ongoing programs that would later require state funding. The department’s Deputy Secretary, Kitty Rhoades, defended the decision not to back a grant for $1.6 million a year for five years to expand alcohol and drug screening by primary care health workers, with the goal of providing brief interventions and referrals to treatment for patients in need of it. According to the article, “Rhoades said the five-year substance abuse grant wasn't needed because the state had already prepared to implement the screening and referral efforts to reach drug and alcohol abusers.”

Commissioner Baker took issue with that argument, noting that Wisconsin ranks high in statistics on drunken driving and binge drinking, and he questioned whether current efforts to remedy the problem are adequate. He pointed out that a March report (Investing in America’s Health) by the Trust for America's Health found that Wisconsin ranked 47th or lower per capita among states for both federal and state spending on public health. (WI appears to be 47th in per capita federal funding for public health, and 49th in state support for public health.)

The current controversy follows one that surfaced in late June, when the Journal Sentinel reported that Secretary Smith had decided not to support applications by the city of Milwaukee, University Health Services in Madison and other groups who wanted to apply for about $30 million in federal grants to fight obesity and reduce chronic diseases such as diabetes. (Even when non-state entities can apply for federal grants, the relevant federal statutes often require them to line up the backing of state officials.) After taking a fair amount of criticism from legislators, community leaders, and the media (see Joel McNally’s article, Walker Administration Hazardous to Health), DHS reversed its position and signed on in support of the grant proposals. (See the follow-up article from the Journal Sentinel.)

Wednesday’s article also reports on the DHS decision in April not to provide a letter of support for ABC for Health, which is seeking the renewal of a two-year $380,000 federal grant to sign up people who qualify for BadgerCare Plus. ABC for Health also lost federal grant funding earlier in the year, when the state Insurance Commissioner, Ted Nickel, canceled a $238,000 contract with the Madison-based group. Nickel’s office has returned to the federal government the grant that was supporting the ABC contract, which had been awarded to Wisconsin as part of the funding provided to states under the Affordable Care Act to help consumers navigate the complexities of health insurance and file complaints and appeals. (Read more about that issue and ABC's recently-filed lawsuit against the state on their website.)

Jon Peacock

WCCF Issues Year-End Review of Juvenile Detention Data

2011-08-02T10:56:00.001-05:00

WCCF has just posted a 2010 Report on the use of Juvenile Detention that indicates a slowing but continued decline in the number of youth held in temporary juvenile detention centers – from as many as 14,000 admitted in 2007 to approximately 9,600 youth admitted in 2010. Highlights of interest include:

• Consistent with earlier years, there is a continuing decrease in average daily population with juveniles being held in detention. In the beginning of 2009, there were 224 juveniles being held in detention on an average day and by the end of 2010 there were 214. This is not a huge decrease but a dramatic decrease from the beginning of 2008 when there were over 300 juveniles being held in detention on an average day.
• The disproportionality of youth being admitted and held in detention is still a problem. 79% percent of Wisconsin’s juvenile populations (aged 10-16) are White, but Whites only represent 47% of the juvenile detention population. While Black juveniles are only 9% of the juvenile population they make up 40% of detention admissions.
• There is a wide gap in the average length of stay across the 17 juvenile detention facilities in Wisconsin. It ranged from as short as 4 days in Lacrosse to almost 13 days at Racine.
• Girls were 22% of all 2010 admissions, consistent with the 2009 report.
• State and Federal laws discourage holding juvenile status offenders in secure detention facilities. Facilities admitting status offenders range from over 8% of their admissions at Marathon to 0% at Dane.

To check out more data on juvenile detention in 2010 and prior years check out the reports here.

By Allan Goetsch

Extended Jobless Benefits Approved; Repeal of UI Waiting Period Rejected

2011-08-01T19:15:00.001-05:00

The state Senate wrapped up work today on a bill enabling Wisconsin to use an estimated $88 million of federal funding to extend unemployment insurance (UI) benefits for up to 13 weeks for the long-term unemployed. The bill, SB 147, could benefit as many as 40,000 Wisconsinites between now and the end of the year. Once the bill is signed, Wisconsin will no longer be one of the small handful of states who are eligible for the extended benefits but choose not to implement the federally-funded extension.

Today’s vote ended an impasse between the Senate and Assembly over the issue of whether newly laid-off workers must wait a week before they become eligible for UI benefits. The Senate voted about two weeks ago for an amendment to SB 147 to repeal the one-week wait that was created by the state budget bill. However, the Assembly rejected that amendment, and today the Republican Senators all decided to side with the Assembly, thereby completing work on SB 147 and allowing it to be sent to the Governor for his signature. (We examined the waiting period issue in a recent blog post in our “31 Ways” series.)

Read more about the vote today in a new WI Budget Project Blog post.

Jon Peacock

31 Ways in 31 Days – Way #31 Some Other Things That Will Have a Significant Impact But Didn’t Quite Make the List

2011-08-01T09:54:00.001-05:00

For the past month, we’ve been using this series of blog posts, “31 Ways in 31 Days,” to draw attention to some of the ways the recently passed 2011-13 biennial state budget stands to affect children and families in Wisconsin.

But let’s be clear: 31 is a rather arbitrary number we picked simply because it coincides conveniently with the number of days in the first month of the new fiscal year. The state budget’s impact on kids and families goes far beyond what we have outlined in this series.

In this final installment, we will take a very brief look at a handful of ways the budget affects kids and families that didn’t quite make the final cut for inclusion in the series—not because they are insignificant, but simply because we had to draw the line somewhere. Think of this segment as sort of an “honorable (or dishonorable, as the case may be) mention” category of ways the budget affects children and families.

Cuts to local assistance: The budget includes large cuts to Shared Revenue, which provides aid to counties and municipalities to help pay for services they deliver to residents in order to keep local property taxes in check. Local governments will receive $76.8 million less in this biennium compared to the previous one.

Gov. Walker and legislative leaders justified these cuts by arguing that local governments would be able to offset this loss of support via the new “tools” they were given to deal with public sector union employees; but county and municipal officials, like public school districts, contend that those savings do not come close to filling the gap. The budget also contains substantial cuts in transportation assistance to local governments.

Shift of dollars from the general fund to the transportation fund: The budget shifts 0.25% of general fund tax revenue to the transportation fund, beginning in 2013. That amount must be at least $35.1 million. It also separately transfers $125 million from the general fund to the transportation fund during the 2011-13 biennium.

This shift of GPR dollars into the transportation fund comes at a time when nearly every critical GPR-funded program that benefits children and families is seeing large cuts.

Reinstatement of the “job ready” classification in W-2: Case managers are once again able to classify W-2 participants as “job ready,” meaning they can receive job search assistance and other services but will receive no cash assistance even though they meet all eligibility requirements for the program and are not currently employed.

This classification—which was nowhere to be found in the original W-2 legislation -- was struck down by the courts several years ago (to the great relief of advocates), but now returns as an option for W-2 case managers.

Tax breaks for the wealthy and corporations: Rather than adopt a balanced approach to solving the budget deficit, this budget actually magnified the problem by creating additional tax breaks for corporations and the state’s richest residents, thus deepening the hole that had to be filled through spending cuts.

Those breaks include an exclusion from the income tax for capital gains reinvested in Wisconsin businesses within 180 days; a new credit for business income generated by qualified production activities in Wisconsin; and a change to combined reporting that will allow corporations to share losses generated before loopholes were closed a couple years ago.

In addition to these items, there were a number of other policy changes in the budget that tend to favor business at the expense of the environment and consumer protection, a pattern that has continued beyond the biennial budget bill and into the regular legislative session.

We hope you have found the “31 Ways in 31 Days” series useful, and will refer back to it as the impact of the budget continues to make itself felt. Please help disseminate this information to a broader audience by posting links to it (bit.ly/k0LBCp) on your social media sites and wherever else you see fit.

And be sure to check back regularly, subscribe, "like", and follow as many of these as you can stand for similar information in the months ahead:
Wisconsin Council on Children and Families
http://www.wccf.org/
http://www.wiskids.blogspot.org/
www.facebook.com/wiskids
www.twitter.com/wiskids

Wisconsin Budget Project:
http://www.wisconsinbudgetproject.org/
http://www.wisconsinbudgetproject.blogspot.org/
www.facebook.com/wisconsinbudgetproject
www.twitter.com/wibudgetproject

Bob Jacobson

About the series: “31 Ways in 31 Days” is a series of posts to the WCCF blog exploring the recently-passed biennial budget’s impact on children and families in Wisconsin. Each day in July, we are posting a description of one way the budget will affect kids and families, with an eye toward what should be done going forward to help improve outcomes and move us closer to the goal of making Wisconsin a place where every child has the opportunity to grow up, learn, and thrive in a safe, healthy, economically secure home and community.

31 Ways in 31 Days – Way #30 Reducing the Ability of School Districts to Raise Money at the Local Level

2011-07-30T09:00:00.009-05:00

Earlier in this series, we noted that the state budget is reducing general aid to schools by nearly $750 million over the biennium (see Way #1: Massive Cuts to School Funding Threaten Wisconsin's Tradition of High-Quality Education), and withdrawing more than $45 million in state support for specific programs in Wisconsin school districts (Way #18: Cuts to K-12 Education Jeopardize Educational Opportunities for Future Workforce). The state budget also limits the amount of money districts can raise at the local level through the property tax.

To do so, the budget reduces the revenue limit for school districts, which restricts the amount of money schools can receive from general school aids and property taxes combined. The revenue limit will decrease by 5.5% in 2011-12 and stay at that same level for 2012-13.

The decrease in revenue limits means that not only will many school districts receive less in state aid, but they will also have to reduce the amount of revenue they raise at the local level (unless voters approve a referendum increasing the revenue limit). For example, if a school district loses $350 in general aid per pupil, but the revenue limit decreases $500 per pupil, the district will have to decrease property taxes by $150 per student to comply with the lower revenue limit. A study by University of Wisconsin professor Andrew Reschovsky projected that the majority of districts will need to decrease their levy to stay under the revenue limits.

The restriction on districts’ ability to raise money at the local level could have serious consequences for our public education system, especially when coupled with steep cuts in state aid. Some districts are finding that the ability to unilaterally require higher employee contributions to fringe benefits – a power given by the controversial Act 10 – has helped control costs and mitigate the cuts in aid and levying ability. But the extent to which other districts—for example, those with multiyear contracts already in place--will be able to take advantage of Act 10 powers in the short-term remains unclear. The longer-term effects on schoolchildren are also unclear, but very worrisome, particularly since many districts will have to make even deeper cuts in 2012 (as federal Recovery Act funds dry up).

Here's what the Wisconsin Association of School Boards has to say on this issue:

"Deep, historic cuts to general school aids of nearly $800 million is one of the more prominent features of the 2011-13 biennial budget adversely affecting Wisconsin’s public schools. But, less visible and talked about, a 5.5 percent cut to revenue limits further exacerbates an already difficult situation. Revenue limits restrict the amount of resources local school board members are allowed to take from the local tax levy.

According to the Department of Public Instruction the resources lost by local school districts will exceed $1.6 billion over the biennium – an average cut of $550 per student – compared to the law governing revenue limits after passage of the 2009-11 budget. After 18 years of state imposed revenue limits that required many school districts to make annual cuts to cost-to-continue programming, the evidence is overwhelming that the school funding formula needs re-writing."

Instead of balancing the budget on the backs of students, we should recognize that public schools are one of the cornerstones of our state’s economy. Going forward, we should work to provide the resources necessary for Wisconsin’s children to receive a high-quality education. Let’s make investments in today’s education system to help insure that we have the well-educated workforce and citizenry we’ll need for the future.

Tamarine Cornelius

Tomorrow—Way #31: The Budget and Beyond

About the series: “31 Ways in 31 Days” is a series of posts to the WCCF blog exploring the recently-passed biennial budget’s impact on children and families in Wisconsin. Each day in July, we are posting a description of one way the budget will affect kids and families, with an eye toward what should be done going forward to help improve outcomes and move us closer to the goal of making Wisconsin a place where every child has the opportunity to grow up, learn, and thrive in a safe, healthy, economically secure home and community.

31 Ways in 31 Days – Way #29 Making it More Difficult to Succeed on W-2

2011-07-29T09:00:00.001-05:00

It’s a difficult time to get a job, especially a good job. So it’s not surprising that participation in the Wisconsin Works program, W-2, has risen. W-2 helps low-income parents develop a self-sufficiency plan that can include job placements, other work activities, and education and job training. The program works in tandem with employment supports like child care, transportation assistance, and health care through BadgerCare Plus to help families become independent and successful.

The biennial budget makes major changes to W-2, making it more difficult for families to participate and be successful in the program. A few of those changes were discussed in “Way #8, W-2 Changes Reduce Mother-Baby Bonding Time and Cripple Education and Job Training." Other changes include reducing payments for W-2 placements, removing the oral notice requirement before reduction or elimination of payment, and removing the “good cause” test and conciliation period.

People engaged in work activities in the W-2 program get paid up to $673 per month for Community Service Jobs and $628 for transitional placements. Those amounts have been frozen since 1997; they would now be $930 and $870 respectively if they had increased with inflation over the past 14 years. On top of that loss of buying power, the 2011-13 biennial budget lowers payments by $20 per month. $20 may not seem like very much, but it adds up when your kids need new shoes or it’s extremely hot out and your electric bill is higher than usual.

Low-income families on W-2 will also see penalties imposed more quickly and with less transparency under this budget. Though many nonfiscal policy items were removed from the budget, these changes remained. Currently, before a 20% reduction in monthly payment or termination of payments, the W-2 agency must provide the participant with written notice followed up by oral notice of the impending action. The notice must explain the basis of the action and provide the participant time to remedy the failure or behavior that caused the reduction or termination. These requirements were eliminated.

Currently, when a W-2 participant does not participate in required activities, she faces potential payment sanctions and a three-month penalty. Before the penalty, the W-2 agency determines if there is good cause for her non-participation, and if there is not, she is offered a conciliation period to “make up” the failure and avoid the penalty. The good cause determination and conciliation period are eliminated in this budget. The repeal of these provisions is significant because they made decisions more transparent and gave participants the benefit of the doubt and fair treatment to help them succeed in the program.

If we want W-2 to work for Wisconsin families, the program must work with them, not against them. For more on the changes to W-2, see this Milwaukee Journal Sentinel article.

Sara Eskrich

Tomorrow—Way #30: Reducing the Ability for School Districts to Raise Money at the Local Level

About the series: “31 Ways in 31 Days” is a series of posts to the WCCF blog exploring the recently-passed biennial budget’s impact on children and families in Wisconsin. Each day in July, we are posting a description of one way the budget will affect kids and families, with an eye toward what should be done going forward to help improve outcomes and move us closer to the goal of making Wisconsin a place where every child has the opportunity to grow up, learn, and thrive in a safe, healthy, economically secure home and community.

31 Ways in 31 Days – Way #28 10% Cut to Public Health Programs

2011-07-28T09:00:00.001-05:00

As noted in “Way #7: Mixed News for Community Health Centers and Dental Health Care” and “Way #9: Extra Cut to Tobacco Use Control Grants”, the budget bill contains cuts to a broad range of public health programs, some of which were lessened by the budget process and some worsened. However, in today’s post we will be discussing the general 10% cuts to public health programs.

The budget cuts about $7.7 million per year from 47 different programs. The largest of these cuts are: $1,062,800 General Purpose Revenue (GPR) from mental health treatment services; $959,200 Program Revenue (PR) from Department of Health Services (DHS) licensing and certification activities; $638,700 GPR from HIV/AIDS services; $610,000 GPR from community health centers; $417,500 GPR from Community Support Programs and psychological services; $316,000 GPR from services and operations for congenital disorders; $300,500 GPR from funding for dental services; $217,800 GPR from emergency medical service aids; $99,500 GPR from rural health dental clinics; and $99,400 GPR from lead poisoning and exposure services.

The 10% cut was restored to one program, the Wisconsin Well Woman Program. In the Administration’s letter requesting modifications to the Governor’s budget, the Joint Finance Committee was asked to restore full funding to this program, which provides breast and cervical cancer screenings and diagnostic services to uninsured or underinsured women ages 45-64 with incomes below 250% of the Federal Poverty Level. This is a valuable program, and while we are relieved that funding was restored, many other programs deserved full funding as well.

Other programs of particular concern to kids and families include the Emergency Food Assistance Program; the Statewide Poison Control Program; the Supplemental Food Program for Women, Infants, and Children (WIC); Pregnancy Outreach and Infant Health; and programs targeted to the Native American community.

Health programs in our communities, often prevention-focused, have a huge impact on people’s everyday lives. When cuts are made to these sorts of programs, they should be targeted to inefficiencies, and not arbitrary general cuts that impact Wisconsinites’ access to care, health, and well-being.

Sara Eskrich

Tomorrow—Way #29: Making it More Difficut To Succeed on W-2

About the series: “31 Ways in 31 Days” is a series of posts to the WCCF blog exploring the recently-passed biennial budget’s impact on children and families in Wisconsin. Each day in July, we are posting a description of one way the budget will affect kids and families, with an eye toward what should be done going forward to help improve outcomes and move us closer to the goal of making Wisconsin a place where every child has the opportunity to grow up, learn, and thrive in a safe, healthy, economically secure home and community.

31 Ways in 31 Days – Way #27 Wisconsin Students Who Are Undocumented Immigrants Must Now Pay Three Times the UW Tuition of Their High School Peers

2011-07-27T11:00:00.005-05:00

In a move that saves very little money, the budget bill eliminates the ability of undocumented but otherwise qualified Wisconsin students to attend college and pay in-state tuition. The change could have a huge impact on students’ ability to attend school. In Wisconsin, undergraduate students residing in the state pay about $8,900 per year to attend UW-Madison, while out-of-state students pay more than $24,200 per year.

The number of undocumented students taking advantage of in-state tuition rates is relative small. According to the Legislative Fiscal Bureau, in the 2010-11 school year about 100 undocumented students applied for in-state tuition at the University of Wisconsin System four-year institutions, up from 70 students in the previous year.

Undocumented students first qualified for in-state tuition rates in 2009, a change that finally acknowledged that for all intents and purposes, these children are American. Raised in the United States, they share more in common with their U.S.-born peers then with their parents' generation. They tend to be bicultural and fluent in English. Each year, these kids graduate from Wisconsin high schools, often at the top of their classes. Many have the potential to be future scientists, business owners, doctors, nurses and teachers, if they can afford higher education.

Christine Neumann-Ortiz, executive director of Voces de la Frontera, described the situation by saying, “These are Wisconsin families. They contribute to our tax base. They are not receiving anything they haven’t paid for or contributed to.” In fact, in 2010, Wisconsin households headed by unauthorized immigrants paid $94.5 million in personal, property and sales taxes.

This policy change will have a negative impact on undocumented students like “Stacy.” Now a junior at the UW, she was a high school honor student who volunteered and played sports. She set her sights on attending UW, where she was accepted. In an email to the Badger Herald prior to the change in the budget, she says “UW-Madison was far beyond my reach for many years. Even though money remains as the biggest barrier to continuing my education, in-state tuition has made it possible for me to attend at all.” The change in the budget will make it more difficult for Stacy to complete her studies.

The end to in-state tuition for Wisconsin undocumented students is also bad news for high-achieving undocumented students like Christian Pacheco. Christian, 18, graduated this spring from St. Catherine's High School in Racine. He hoped to enroll at UW-Parkside in Kenosha, but he is unsure whether he'll be able to afford tuition at the out-of-state price. His family moved to the U.S. from Mexico when he was 5 years old. Pacheco said he may try to take classes at Gateway Technical College while he works. Although he will still have to pay out-of-state tuition, the cost per credit is much less than the four year university campuses. "I've stayed out of trouble and gotten the best grades I can," he said. "I don't want to fall behind and then not do anything with my life."

Instead of blocking access, let’s work to make higher education more affordable to all students living in Wisconsin.

Martha Cranley

Tomorrow—Way #28: 10% Cut to Public Health Programs

About the series: “31 Ways in 31 Days” is a series of posts to the WCCF blog exploring the recently-passed biennial budget’s impact on children and families in Wisconsin. Each day in July, we are posting a description of one way the budget will affect kids and families, with an eye toward what should be done going forward to help improve outcomes and move us closer to the goal of making Wisconsin a place where every child has the opportunity to grow up, learn, and thrive in a safe, healthy, economically secure home and community.