Analysis of Proposed Medicaid Reforms
The Department of Health Services (DHS) has released a list of 39 proposed Medicaid reforms to find $554 million in savings to balance the Medicaid budget as part of the Governor’s 2011-2013 budget. Disability advocates have identified four proposed reforms that could have a significant impact on people with disabilities in Wisconsin. These reforms are:
Personal care: Travel reimbursement for direct care workers will be cut in half.
- Cutting the travel reimbursement in half amounts to a rate cut and will be devastating for individuals in rural counties where direct care workers drive long distances.
- Personal care agencies will have reduced funding for wages and benefits to direct care workers. Low wages and no benefits result in costly turnover and disruption to individuals receiving services.
Family Care Cap: Maintains freeze imposed by biennial budget.
- Waiting lists have grown by over 500 people since the freeze began July 1.
- Youth in transition will graduate without supports, causing parents to become full-time caregivers, unless DHS is able to find a way to serve them with the cap in place.
- Over $24 million is available for individuals in urgent situations, however, the individual has to meet both of the following criteria:
- The individual is incapable of providing for their own care and is at risk of serious harm to themselves or others.
- There is no one to provide the needed care or supervision.
- It is unclear if transitioning youth qualify for urgent needs funds even if a parent has to quit work and stay home with the young adult.
- There are also concerns whether individuals on the wait list are informed about the urgent needs funds.
Medical Transportation – Logisticare: Logisticare is the company that serves as a centralized transportation broker for individuals on Medicaid.
- The proposal expands the use of a centralized transportation broker to southeast Wisconsin HMO consumers.
- Complaints point to consumers feeling harassed and guilty by scheduler for needing a ride.
- Complaints that individuals are missing necessary medical appointments, including children with mental health issues no longer allowed to ride unattended, and not being informed about the complaints process.
- Concern that cost savings actually result from consumers not using the broker system because it doesn’t work for them.
Medicaid Maintenance of Effort Waiver: Maintenance of effort means a state cannot spend less on Medicaid than it has in previous years.
- DHS is proposing to request a waiver from the federal government so the State can cut spending on Medicaid, with BadgerCare as the primary target.
- DHS wants to restrict eligibility for Medicaid for families with access to employer-based insurance if the premiums are below 9.5% of household income.
- Employer-based insurance may not have all the benefits families with disabilities need.
- Families with low income, many with members with a disability, could see premiums rise from $10 to $210 per month for decreased benefits.
- Young adults age 19 to 26 would be removed from Medicaid and be required to enroll in their parents’ health insurance plan.
Advocates Support Medical Home Models of Care
There has been a lot of confusion about the term “medical home.” Medical home is a model of consumer-centered services that encourages partnerships between all caregivers and the consumer and family. Medical homes can create better access to care and increase consumer satisfaction. Medical home does not have any impact on where the consumer lives.