In an agreement reached with federal officials, Gov. Scott Walker's administration will seek a second legislative change for the state BadgerCare Plus health plan as part of an ongoing adjustment to problems with the federal health care law.
Less than two weeks after Walker signed legislation to adjust timelines for changing the Wisconsin Medicaid program, the administration told lawmakers it needs a second tweak to those deadlines to start implementing Walker's plans for BadgerCare Plus two months earlier.
In addition, the Walker administration also informed lawmakers Monday that the state's overall Medicaid programs faced a projected shortfall of about $93 million in state tax dollars through June 2015 — about 1.9% of the total Medicaid budget. More than half of that is due to an improving state economy leading to an estimated $52 million decline in expected federal aid to the programs.
In a letter to legislative leaders Monday, state Health Services Secretary Kitty Rhoades said the latest change in timelines was part of an agreement between the Walker administration and officials with the federal Centers for Medicare and Medicaid Services.
"A technical bill will be required to bring Wisconsin statutes and the agreement between Wisconsin and CMS into compliance. The (Health) Department will forward proposed language in early 2014 for legislative consideration in the January floor period," Rhoades wrote in the letter.
Earlier in December, lawmakers and Walker passed legislation to delay for about three months having 83,000 of the state's poorest residents join BadgerCare Plus while keeping a slightly smaller low-income group on the program for three months longer.
That legislation passed the Senate by an 18-12 vote, with all Republicans in favor, all Democrats in attendance opposing it and three Democrats absent. The Assembly voted for the bill 64-32.
The measures respond to problems with the rollout of the federal Affordable Care Act that have made it difficult for consumers to sign up for the federal law's online insurance marketplaces, or exchanges. That, in turn, has delayed Walker's plans to shift to the exchanges some 77,000 BadgerCare Plus recipients with incomes just above the federal poverty line.
Senate Majority Leader Scott Fitzgerald (R-Juneau) said Monday that he was willing to take up the second round of changes offered by the administration but that he wanted Democrats in Congress to address the problems with the ACA. He said he expected the Legislature to have to make other changes in the coming months as Obamacare is implemented.
"I think we're going to have something in February and March," he said. "The feds keep changing everything on a daily basis. It's a mess."
Under the legislation already signed, those state residents who are just above the poverty limit of $11,490 per year for single adults will stay on BadgerCare until April 1 instead of being dropped on Jan. 1. Republicans paid for those extra three months of coverage for the one group by delaying for three months the addition to BadgerCare of the 83,000 people below the federal poverty limit.
Under the latest proposal that Rhoades is describing, any qualifying Wisconsin parents or caretakers above the poverty line would be able to receive BadgerCare through March 31 so long as they apply for the coverage before Feb. 1.
After Feb. 1, the state will start using new federal guidelines for computing household income as laid out by the health care law. If those guidelines find that the applicant is above the federal poverty limit, the applicant will be directed to sign up for care through the federal exchanges.Jon Peacock, research director for the Wisconsin Council on Children and Families, said he had been encouraged by improvements in recent weeks to the federal exchanges and to reports that the federal law was resulting in more state residents being referred to BadgerCare coverage as well.
Peacock said the latest proposed changes had "pluses and minuses" for low-income families. On the one hand, the proposal would simplify the BadgerCare Plus transition, but on the other hand it might lead to a relatively small number of parents above the federal poverty level losing a month or two of state coverage, he said.
Democrats note that some GOP governors have extended Medicaid coverage more broadly in their states by taking extra federal money available for that health program under the federal law. Expanding coverage in that way would save the state up to $119 million through June 2015, according to the nonpartisan Legislative Fiscal Bureau.
But Walker and other Republicans say that is not a good long-term strategy for saving state or federal taxpayers money. The federal government can't be trusted for the long term to pay for an expanded Medicaid program, especially given the other problems with Obamacare, they said. The federal money still comes from taxpayers, they said.
Lawmakers and Walker have also delayed by three months the end of separate state high-risk coverage known as the Health Insurance Risk-Sharing Plan. HIRSP had been scheduled to end on Dec. 31.