More Medicaid Reimbursement Woes

Providers of services for children with autism are the latest group to describe the harm caused by the state’s low Medicaid reimbursement rate.

Wisconsin Health News (9/22) includes an interview with Jackie Vick and Mike Miller, the president and treasurer of the newly formed Wisconsin Autism Providers Association.  One of the five goals of the WAPA is to “Increase reimbursement rates for Medicaid treatment.  Low reimbursement rates are the primary cause of client demand exceeding the supply of providers…”

Miller and Vick conducted a survey to see if other providers shared the problem of “putting families in a holding pattern” because of an inability to take more Medicaid clients.  The answer was “yes across the board for all of those providers.”

Miller estimated that over 500 children in the state are waiting for treatment under Medicaid funding.  The lists are growing by 15 to 20 children a week and could total 1,000 by the end of the year.

Vick said that providers have responded to the challenges of the reimbursement rate in different ways.  Some limited the number of Medicaid clients in order to maintain fiscal stability.  A related problem, she said, is the difficulty of hiring therapists and technicians because of the low rate of pay.

She pointed out that access to treatment for young children pays off for them and for  taxpayers.  Vick said, “…the research shows that they make great gains and the lifetime costs of care for a child on the autism spectrum go down.”

The low Medicaid rate affects children with other behavioral health problems.  Here is an excerpt from the Kids in Crisis/Legislative Action Tracker article that was part of a series by USA Today-Wisconsin (June 2016)

There is evidence that Wisconsin’s Medicaid reimbursement rates – among the lowest in the country – are shutting children out of accessing outpatient behavioral health care and leading to higher costs associated with emergency psychiatric care.

A report by Milwaukee’s Public Policy Forum found that in Milwaukee County, low reimbursement rates were stopping mental health providers from accepting Medicaid patients. A 2014 survey by the Wisconsin Statewide Medical Home Initiative found that only 20 percent of Wisconsin pediatricians said they could find therapists when needed for their patients on Medicaid, and just 5 percent could find psychiatrists for patients on Medicaid.

Check out “Voices from the Front Lines: NAMI’s Lindsay Wallace” on this blog for a report on how people with mental illness in Dane County are affected by the rate.

Click here to read a study by Pew Trusts that reports experiences of states that supplemented Medicaid rates for primary care doctors.





Look for the Tiny Rays of Sunshine in Walker’s Budget

Wisconsin Health News (9/22) offered comments by advocacy organizations about small steps forward in this year’s budget.  Here are excerpts.  WHN is a subscription service.

“The Survival Coalition of Disability Organizations said the budget would help eliminate long-term care wait lists for 2,200 children with physical, developmental or emotional disabilities. And they called a 2 percent increase in Medicaid personal care rates “an important first step in addressing the workforce crisis.”

“Wisconsin Health Care Association and Wisconsin Center for Assisted Living Executive Director John Vander Meer lauded the budget for including a 2 percent increase for skilled nursing facilities and a $60 million increase for Family Care over the biennium.”

“Linda Hall, executive director of the Wisconsin Association of Family and Children’s Agencies, said the budget makes a “significant investment” in student mental health by providing $3.25 million in new grants along with Medicaid-funded consultation services.”

On the other hand, WHN also reported that Walker vetoed a resolution passed by the Joint Finance Committee stipulating that the state’s requested Medicaid waiver could not be implemented without its approval.  The requested waiver is the most Draconian in the country.

What Will Happen to Long-term Care as Wisconsin’s Population Ages?

Wisconsin Health News offers monthly luncheons with terrific speakers.  The May 2 event features the escalating problem of financing long-term care for an aging population.  Here is WHN’s description of the event.

“Wisconsin’s population is aging and healthcare care costs for the elderly and those needing long-term care are growing along with it. Gov. Walker’s budget increases Medicaid reimbursement for nursing homes and provides more money for direct care workers. Is it enough to address workforce shortages? And what’s next for Family Care? After pulling back its plans to overhaul the program, the administration is pushing forward with a statewide expansion. Will they incorporate other proposed program changes?”

Lynn Breedlove, Co-Chair, Wisconsin Long Term Care Coalition
Curtis Cunningham, Assistant Administrator of Long-Term Care Benefits and Programs, Department of Health Services,
Tim Garrity, Chief Innovation Officer, Community Link
John Vander Meer, Executive Director, Wisconsin Health Care Association

The luncheon will take place on May 2 from 11:30 to 1:00 at the Madison Club, 5 E Wilson St., Madison.  Wisconsin Health News is a subscription service providing daily updates on health news and exclusive interviews.  The lunch is $30 for subscribers and $40 for non-subscribers.  Click here to register and to learn about WHN.


Walker Requests Federal Grant To Address Opioid Epidemic, but Continues to Refuse Dollars from Medicaid Expansion

At the direction of Governor Walker, the Department of Health Services submitted an application to receive up to $15.7 million in federal funding over the next two years to curb opioid abuse and misuse.  The money is available under the 21st Century Cures Act, a massive bill recently passed by Congress with bipartisan support and signed by then-President Obama.

The funding will support community coalitions focused on reducing the non-medical use of opioids among teenagers and young adults, establish a hotline on treatment and recovery services and create opioid-specific treatment programs to reduce travel distance for those in need.  The grant would also create a network of individuals in long-term recovery from opioid abuse who are trained to help people through the process

The above report comes from the Wisconsin Health News.

WHN also reported on a recent presentation by Dr. Aleksandra Zgierska, a UW professor, and president of the Wisconsin chapter of the American Society of Addiction Medicine.  Her data show that deaths per thousand people from opioid addiction have more than doubled since 2003 in both Wisconsin and Dane County, with Dane County’s increase being greater until the last two years.

WHN quotes Madison Police Dept. Capt. Cory Nelson as saying, “For 28 years I’ve seen drugs come and go on the streets of Madison.  I have never in my life seen what’s going on with heroin currently.”

Click here for slides from the presentation.

It is certainly good news that Gov. Walker is willing to accept federal dollars to address this escalating crisis.  He has also called a special session of the state legislature to consider nearly a dozen bills addressing the problem.   What he has refused to do is accept federal dollars available through Medicaid expansion to increase treatment and prevention options for those who badly need them.

Click here to read “Americans with Mental Health and Substance Abuse Disorders: The Single Largest Beneficiaries of the Medicaid Expansion.”

UPDATE:  If Republicans have their way, mental health and substance abuse benefits will be stripped from the Medicaid expansion.  Even if governors were enlightened enough to accept the expansion, those benefits would no longer be available.  Click here to read the Post’s story about the loss of benefits for 1.3 million Americans in states where governors accepted Medicaid expansion funds.

UPDATE:  Click here for an account of the latest figures on deaths from the opioid epidemic and the success story of an woman who received treatment.

UPDATE:  Click here for a letter to the editor advocating for the ACA and parity requirement to address the opioid epidemic.