Wisconsin’s Medicaid Waiver Can Be Stopped

Wisconsin earned national headlines when state officials announced plans to request a waiver from the federal government allowing it to restrict access to Medicaid benefits in new and devilish ways.

Those officials want Wisconsin to become the first state in the country to require applicants who are childless adults to submit to a drug test and undergo treatment if results are positive.  The request would also add time limits on coverage and require co-pays and work requirements.

The severity of the proposals galvanized local advocates.  Newspaper articles throughout the state pointed out that the waiver would result in loss of access to health care for many of the state’s most vulnerable citizens.

More than 1,000 comments were received by the state’s Medicaid director during the 30-day comment period required by the federal government.   The Department of Health Services, which had planned to submit the waiver on May 26, announced a delay in order to review them.  The legislature’s Joint Finance Committee passed a resolution stipulating that the waiver could not be implemented without its approval.

The federal government offers other methods of challenging the waiver request.  The application must show that comments have been reviewed and concerns acknowledged in the request.   After the submission is accepted as complete, the federal government requires a 30-day comment period during which advocates can register opposition.

They have many sources of information from which to draw.  One of the most comprehensive is a comment letter from Mike Bare of Milwaukee’s Public Policy Institute.  He makes points rarely included in the most common critiques.  Click here to read the full letter.

Bare wrote that such waivers by law are to be “demonstrations of innovative ways to expand eligibility and Medicaid services to improve access to care and reduce costs.”  Officials claim their first objective is  “ensuring that every Wisconsin resident has access to affordable health insurance to reduce the state’s uninsured rate.” Instead, writes Bare, the health care system has large affordability gaps and the waiver would make them worse.

The second stated objective is creating “a medical assistance program that is sustainable so a health care safety net is available to those who need it most.”  Bare points out that  charging fees and premiums to low-income participants reduces enrollment.  In addition, Wisconsin is requesting permission to disenroll a participant for non-payment of those premiums.  It would be the only state to charge a premium to enrollees below 100% of the poverty line and disenroll them if they are unable to pay.

The proposal would impose a 48 month time limit on benefits if the individual is working less than 80 hours a month and is not participating in job training.  Full-time students and people who have been determined to have a disability or a mental illness would be exempt.

Bare questions the use of “job training” and “employment training” interchangeably and  points out that neither term is defined.   He argues that the exemptions from the work requirement should be expanded to include individuals with two or more chronic conditions and those who are homeless.  Bare also makes the point that access to health care enhances the capability of an individual to find work and  poor health impedes that effort.

The most notorious aspect of the waiver is the request that applicants be screened by questions about illegal drug use and tested if deemed necessary.  Refusing or failing the test and then rejecting treatment would mean the applicants go at least six months without Medicaid coverage.

That request has been challenged on many grounds.  It would unfairly target minorities, identify few people with drug abuse problems, and cause further and unnecessary stress to people who are struggling  to get by, according to a story in the Boston Globe.   Click here to read the full article.

Wisconsin Assembly member Jimmy Anderson pointed out that states that had tested recipients of other welfare benefits programs found only 200 positives out of the thousands of people who received benefits.  He wrote that the effort likely would be challenged as unconstitutional because people have a “right to be secure in their persons against unnecessary searches and seizures.”   Click here to read his op ed.

For a more academic analysis of these problems, read Proposed Medicaid Section 1115 Waivers in Maine and Wisconsin by Kaiser Health Network.  KHN cites Wisconsin’s own figures that project a decline in the number of those covered.   “Wisconsin projects that enrollment will decrease from 150,050 beneficiaries in CY 2016 to 146,407 in CY 2018, while costs will increase from $825 million in CY 2016 to over $1 billion in CY 2018.”

UPDATE:  Click here to read an article on 6/8 about Walker’s submission of the waiver.  Drug testing requirements were modified slightly.

UPDATE:  Click here to read a more comprehensive analysis of changes Walker made as a result of submitted comments.

UPDATE:  Click here to read the summary of comments and responses DHS posted on its website.  As of receipt of the application, the federal government has 15 days to determine if it is complete and to notify the state government if it is not.  A 30-day comment period begins upon a ruling that the application is complete.

UPDATE:  Click here to read an AP story reporting that less than 10 of the comments submitted supported the waiver.

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