Governor Scott Walker submitted a request to the federal government for a waiver that would permit changes to the state’s Medicaid policies and requirements. Because waivers can change eligibility for benefits, federal law requires that members of the public have 30 days to register their opinions. The state must respond to concerns and may then forward the revised application to the federal government. The federal government allows another 30-day period for comment. That period ends on July 15.
More than 1,000 comments were received by the state. Less than five supported the waiver. State representatives had agreed to make all comments public as a part of its application. Instead, they were released only after the state was forced to do so because of a reporter’s request through the Open Records Act. The state had submitted only an 8-page summary of comments and its responses to them. Likely the unabridged comments depict more serious concerns and potential damage than the summary.
The state resisted notifying the public about the process for involvement or its own activities. As a result, there appears to be much less protest directed to the federal government. Nevertheless, Bobby Peterson, executive director of ABC for Health, submitted an extremely well-researched and comprehensive letter to the federal Department of Health and Human Services outlining the flaws with the waiver and the state’s process. The letter includes research results from states that have implemented variations of Wisconsin’s proposals. No state has implemented any version of drug testing as a condition for receipt of Medicaid benefits.
There are other ways of stopping the waiver. The legislature’s Joint Finance Committee passed a resolution stipulating that the waiver could not be implemented without its approval. We can review any version approved by the federal government, identify flaws using Peterson’s research and analysis, and begin a campaign to lobby members of the committee.
That lobbying effort could be helped by statements from Wisconsin’s own Legislative Fiscal Bureau. It has questioned whether Medicaid programs can charge premiums for people who are under the poverty level or remove them from the rolls for non-payment. It also questioned the imposition of a time limit on benefits for enrollees who have not found work.
Lobbying efforts could also remind the co-chair of the Joint Finance Committee, John Nygren, of his own more enlightened views about the best means of combatting drug abuse. Rather than punitive measures, such as testing for drugs and denying benefits, he supported the expansion of treatment options.
He and Lt. Governor Rebeca Kleefisch, co-chairs of the Governor’s Task Force on Opioid Abuse, wrote, “We’re not talking about the ‘Just Say No’ campaign of the 80’s and 90’s…As the drugs on the street have changed, our policy and policing frameworks must catch up to shifting trends.”
Peterson identified legal grounds to challenge the waiver. In particular, he pointed out court cases in which drug testing was ruled unconstitutional when used as a condition for receipt of benefits.
It appears that the entire application is a violation of the intent of the legislation. Waivers are to be “demonstrations of innovative ways to expand eligibility and Medicaid services to improve access to care and reduce costs.” State officials claim their first objective is “ensuring that every Wisconsin resident has access to affordable health insurance to reduce the state’s uninsured rate.” But, in its waiver proposal, it projects an enrollment decrease from 150,050 beneficiaries in CY 2016 to 146,407 in CY 2018.
Finally, we can always vote. This struggle could be only a painful memory when we have a different governor.
UPDATE: The League of Women Voters of Wisconsin issued an action alert with concise talking points about the hazards of the waiver and instructions about how to comment. Click here to read it.
UPDATE: Click here to read an article from USA Today, which reports comments from organizations that challenged Indiana’s request to include work requirements in its Medicaid waiver. The federal government accepted the state’s request as complete even though time for public comments had not been allowed at the state level.
UPDATE: United Health in Wisconsin submitted a letter opposing the waiver, citing continuity of care and other issues. Click here for the letter.
UPDATE: Click here for a letter from the Wisconsin Society for Addiction Medicine.
UPDATE: Click here for a story from Politico that describes the increasing importance and popularity of Medicaid. Wisconsin is out of step in its waiver request and refusal to accept Medicaid expansion funds.