Joint Finance Committee backs GOP Medicaid plan

June 06, 2019 11:32 AM | Sally Winkelman (Administrator)

June 5, Wisconsin Health News

The Joint Finance Committee approved a Republican plan Tuesday night that would provide around $200 million more in state money for Medicaid beyond its cost-to-continue over the next biennium.

Overall, the Republican proposal boosts state spending for health services by $588 million, which includes $356 million for the cost-to-continue for the Medicaid. 

The proposal, which passed 11-4 along party lines, would provide $60 million more in state money for disproportionate share hospital payments, which head to providers that serve a high volume of Medicaid patients. It would also provide $4 million more in state money for payments that go to rural hospitals.

Other changes include $92 million more in state money for long-term care. That breaks down to $30 million for nursing homes, $36.9 million for personal care workers and $27 million for direct caregivers in Family Care. The motion also includes $24.7 million in additional state and federal money to expand reimbursement for physicians and behavioral health services. 

Democrats criticized the plan because it didn’t take federal dollars to expand Medicaid. The money used for the motion comes at the cost of other parts of the state budget, said Rep. Evan Goyke, D-Milwaukee. 

“This motion advances, by and large, the status quo with additional investment here, and additional investment there, pick a winner here, pick a loser there,” he said. “But it isn’t a plan to bring forward the entire state’s healthcare system.”

JFC Co-Chair Rep. John Nygren, R-Marinette, pushed back against claims that expansion would cover an additional 82,000 people as those covered through expansion can find subsidized health plans through the Affordable Care Act’s exchange.

He noted that around half of those who would be covered by expansion already have insurance.

“That’s the lie of the year that has been presented before us – the lie of the year,” he said. “This motion addresses the needs of the most vulnerable in our state.”

The GOP-backed motion makes greater investments than Evers’ budget in some areas, keeps in place other parts of his plan, pared back some of his proposals and axes other provisions.

It also includes several new items, including a $2.5 million Medicaid rate increase for physical health services providers and $1 million in grants for free and charitable clinics over the biennium.

New to the proposal are $500,000 in state money for a child psychiatry consultation program and $1 million over the biennium for programs that provide clinical supervised practice to those training to become social workers, counselors, psychologists or family and marriage therapists.

Lawmakers also opted to add $100,000 for a suicide prevention grant, $100,000 for an outreach campaign on vaccinations and $250,000 for respite care.

At a press conference before the committee took up the measure, Nygren said Republican lawmakers were tripling the investment Evers put toward nursing homes, as well as making greater investments in personal care and Family Care.

Other provisions stayed in place from Evers’ budget, including providing funding for a hub-and-spoke model of care that would provide a medical home health benefit for people with substance abuse disorders. Lawmakers modified the provision so the Department of Health Services would have to ask the committee to release state funding for the proposal.

Also adopted from the governor’s budget were plans to expand funding for intake, application and screening costs for the children’s long-term care services program, $6.9 million in state and federal funding for telehealth in Medicaid and a $250,000 a year increase for grants under the minority health program. 

GOP lawmakers backed additional money for the Wisconsin Well Woman Program, which provides preventive health screenings. They set aside funds for money that would help public safety answering points comply with training requirements that dispatchers provide assistance on administering CPR. And they backed Evers’ call for DHS to reallocate five full-time positions to staff an infant mortality prevention program.

They also adopted Evers’ recommendation to eliminate the sunset date on Medicaid reimbursement for clinical consultations. And they backed $66,700 in state money to develop a plan for a mental health consultation program.

The motion opts to have the state cover a greater share of county crisis intervention share through a $13.4 million increase in state and federal money as Evers proposed. But the committee deleted a provision in his budget that would have provided $2.5 million in state money for regional crisis stability facilities. 

GOP lawmakers also scaled back Evers’ proposed investments in dental care. They opted to provide $2.5 million in state and federal funding for dental services provided to patients with special needs, half of what was included in the governor’s budget. 

They backed additional funding for dental health initiatives, including Seal-A-Smile, which provides preventative services in schools, but axed a plan to provide more money to support oral health program positions at DHS.

Gone from the proposal is Evers’ plan for $38.8 million for new dental access payments. The lawmakers left in place a program that increased Medicaid rates for pediatric and adult emergency dental services rates in Brown, Marathon, Polk and Racine Counties that Evers’ budget would have ended.

Also pared back were Evers’ plans to hire more dementia care specialists and his lead poisoning prevention initiative.

Provisions cut from Evers’ plan include his proposed funding for doula services, an extension of how long post-partum women can remain on Medicaid after giving birth and a proposed community health benefit to offer non-medical services to Medicaid members.

And lawmakers didn't include proposals for additional funding for tobacco control efforts and $500,000 over the biennium for healthy aging grants.

The adopted motion ends a proposed expansion of Birth to 3, a program offering early intervention services to children who are at risk of developmental delays. It instead directs the department to transfer, on a one-time basis, $2.3 million for the 2019-2020 fiscal year and keeps the budget level flat the following year. 

Nygren ruled a Democratic motion that would have accepted federal funding to expand Medicaid “out of order” as the committee already voted to remove the provision from the budget.