Wisconsin State Budget Impact on Women & Girls
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Elimination of IRIS and Expansion of Family Care Causes Uncertainty for Wisconsinites with Long-Term Care Needs

2/24/2015

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In the weeks since the budget’s release, disability advocates across Wisconsin have voiced their concerns about the potentially damaging effects of the Governor’s proposed changes to long-term care options. Gov. Walker’s budget proposes the expansion of Family Care to all counties by 2017, while simultaneously eliminating the Include, Respect, I Self Direct (IRIS) program. 

IRIS is Wisconsin’s self-directed, community-based program for adults with disabilities and elderly adults who have long-term care needs. Participants are able to choose and direct the services that they need to participate in their communities, instead of being forced to look to nursing homes and other institutions for long-term care solutions. According to the Department of Health Services, more than 11,000 Wisconsinites rely on the IRIS program to design flexible, personal care plans that allow for cost-effectiveness and individual priorities. The proposed elimination of the program came as a shock to many, as IRIS has been incredibly popular with program participants and organizations that advocate on behalf of people with disabilities and older adults.

Current IRIS participants fear that the elimination of the program will completely change their lives and remove their ability to self- direct their long-term personal care . Other concerns include uncertainty about whether caregivers currently employed by IRIS participants will lose their jobs, and a decrease in choice and competition in long-term care that could have detrimental effects for those who need the services the most. The Save IRIS campaign has been started by a group of IRIS participants, family members, and care providers to raise awareness and to advocate for the continuation of the program in Wisconsin.

The simultaneous expansion of Family Care across all 72 counties of Wisconsin may seem like a welcome change at first glance, but the program that will be expanded is a pared down version of its current form. Administration of Family Care will be restructured from a regionalized not-for-profit system to a statewide system open to for-profit insurers that may result in individuals having to change their doctors, caretakers, and even the group homes where they reside. Furthermore, it is unclear how Family Care will allow for self-directed care that is comparable to that offered under the current IRIS program.

Disability and Wisconsin Women
These proposed changes are particularly important to elderly Wisconsin women as they are more likely than their male counterparts to need long-term care services. Women over 65 are both more likely to have functional impediments that inhibit their ability to live independently and to lack a social network than men over 65. Furthermore, women live longer than men on average and make up a larger share of the over 65 population. This combination of disability prevalence, old age, and lack of support makes elderly women particularly in need of programs like IRIS.  

On the other side of long-term care, women make up 65% of caregivers and more than eight in ten are caring for a relative or friend age 50 or older. The future is uncertain for Wisconsin’s female caretakers and family members providing services and support to IRIS participants.  
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Full Medicaid Expansion Would Cover 81,000 More People and Save Wisconsin Taxpayers $345 Million

2/17/2015

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New estimates from the nonpartisan Legislative Fiscal Bureau (LFB) provide compelling evidence for both the human and fiscal benefits that would be gained if Wisconsin chose to expand Wisconsin's Medicaid program (known as BadgerCare) under the Affordable Care Act (ACA).  Under such an expansion, the income eligibility threshold for childless adults would increase from 100% to 138% of the Federal Poverty Line (FPL). 

Governor Walker and the Legislature have consistently refused to fully expand BaderCare under the ACA.  Instead, the Legislature approved the Governor's recommendation to set the BadgerCare eligibility limit for childless adults at 100% of the FPL.  This decision cost the state enhanced federal Medicaid funding that is offered to states that expand their Medicaid programs to previously ineligible people.  As a result, Wisconsin taxpayers pay 42% of the costs of covering the approximately 148,000 childless adults covered by the program.  A full BadgerCare expansion under the ACA would have resulted in substantial savings for Wisconsin taxpayers by substituting federal for state expenditures.  Under this scenario, the federal government would pay 100% of benefit costs for newly eligible enrollees in 2015 and 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and subsequent years.

Even more importantly, the full BadgerCare expansion would cover 81,000 more people who currently are without health care coverage.  Many of these people are working but do not earn enough income to afford private health insurance and are likely to delay necessary health care services.

Alternative Proposal Introduced

At the same time the new information about full BadgerCare expansion was released, some Democratic legislators introduced a compromise expansion proposal based on the model recently implemented in Iowa that uses federal Medicaid money to provide a subsidy to childless adults earning between 100-138% of the FPL so they can afford to purchase private health insurance plans in the federal health insurance Marketplace.  According the LFB estimates, the "Iowa Model" would still cover an additional 81,000 childless adults, but would only result in savings of $241 million because it is more expensive to subsidize private plans than to simply enroll people in BadgerCare.  The federal government would have to approve a state waiver in order for the Iowa Model to be implemented in Wisconsin.

The Governor's proposed budget does not include any proposals to expand BadgerCare under the ACA and Republicans who currently control the Legislature seem reluctant to pass any form of Medicaid expansion.  However, whether to expand BadgerCare in one form or another is likely to be a hot topic of discussion as the budget process continues to unfold.
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SeniorCare Program Proposed Changes Would Increase Prescription Drug Costs for Low-Income Seniors 

2/11/2015

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The Governor’s proposed 2015-2017 budget includes a proposal that would seriously change the SeniorCare program by cutting $15 million (about 40%) from the program’s budget and requiring seniors to first enroll in the Medicare Part D prescription drug program. Under the current SeniorCare program, low-income Wisconsin seniors apply directly to the Wisconsin SeniorCare program for a $30 annual enrollment fee with copayment and deductible rates based on a sliding income scale. According to the Wisconsin Aging Advocacy Network, the proposed required enrollment in Medicare Part D would increase average total out-of-pocket costs by $732 for SeniorCare enrollees, along with increasing the administrative complexity of signing up for prescription drug coverage. Furthermore, SeniorCare is more cost efficient than Medicare Part D as Wisconsin can negotiate with pharmaceutical companies for cheaper drug prices than individuals can often get with Medicare Part D.

Approximately 85,000 Wisconsin residents over the age of 65 depend on SeniorCare. The program was enacted in 2002 to ensure that low-income seniors would not have to choose between paying for prescription drugs and paying for other life essentials like food and housing. The proposed changes to SeniorCare put Wisconsin seniors at risk as many may not be able to afford the increased costs of purchasing insurance through Medicare Part D on their limited budgets.

Governor Walker proposed similar changes to SeniorCare in 2011, but they were removed by the Joint Finance Committee after 15,000 signatures were collected in opposition to the proposal. A similar petition was started this week by several state legislators.

Women make up 56% of all older Medicare beneficiaries and two-thirds of beneficiaries ages 85 or older. The proposed SeniorCare changes would disproportionately affect elderly women, as women live longer than men, on average, and experience a greater share of health and functional problems in their old age. Additionally, older women often have less income and receive lower Social Security and pension benefits than older men, due to lower-paying jobs and less time spent in the workforce during their working years.

Stay tuned for more updates and further information on how these proposed changes could affect Wisconsin women!
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Governor's Budget Proposes Dramatic Changes to BadgerCare

2/10/2015

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As we continue to read over the Governor's proposed 2015-2017 budget, one of the most striking proposals involves drastic changes to BadgerCare  for childless adults.  The proposal requires the Wisconsin Department of Health Services (DHS) to apply for a waiver from the federal Department of Health and Human Services (DHHS) that would allow Wisconsin to implement all of the following changes in regard to childless adults receiving BaderCare :
  1. Require such enrollees pay monthly premiums as determined by DHS;
  2. Impose higher premiums on enrollees who engage in behaviors that increase their health risks;
  3. Limit eligibility to no more than 48 months;
  4. Require a health risk assessment for all such enrollees; and
  5. Require a drug screening assessment and, if indicated, a drug test as a condition for eligibility
If the federal DHHS grants Wisconsin's waiver application, this would be extremely problematic for the childless adults who would be affected.  Remember, only childless adults at or below 100 percent of the Federal Poverty Line (FPL) are eligible for BadgerCare.  To put this in perspective, the current federal poverty line for a family of 1 is $11,770 per year, which certainly doesn't leave much wiggle room to pay for any sort of health care premium after paying for basic expenses.  We also have some indication of the real world impact of imposing premiums on BadgerCare recipients.  When Governor Walker implemented a plan to require premium payments to Transitional Medical Assistance adults earning above 138 percent of the FPL in 2012, there was significant program attrition from the affected enrollees.

In addition to being constitutionally dubious, the drug testing provision will do little to actually help people with substance abuse disorders.  Instead, it will unfairly stigmatize people who need BadgerCare in order to access health care.  For a more comprehensive look at the concerns regarding drug testing applicants for public assistance, see this letter from Community Advocates Public Policy Institute to Governor Walker that was signed by the Wisconsin Alliance for Women's Health.

The proposal to limit eligibility to 48 months is also problematic and would unduly restrict much needed access to health care for many people who have fallen on difficult economic times.  Like the other provisions mentioned above, this change would require approval from the federal DHHS. 

Stay tuned for more updates!  We will continue to provide more in-depth analysis of these BadgerCare provisions and other proposals contained in the budget as we continue to study the Governor's proposal. 



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Governor Walker Proposes 2015-2017 Wisconsin State Budget

2/3/2015

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Governor Walker provided an outline of his proposed 2015-2017 budget in an address to the Legislature tonight.  If you are interested in reading a transcript of the Governor's prepared remarks, the Milwaukee Journal Sentinel has posted a copy here.

The WAWH Budget Blog will provide ongoing analysis and updates of what the proposed budget's impact will be on the health of women and girls.  The Governor's full proposal will be online soon and the Legislative Fiscal Bureau will likely have more detailed analysis available within a few weeks.  Please check back to our site regularly for updates.  We will also announce any new posts on Twitter and Facebook.
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Governor Walker Proposes Drastic Cuts to UW-System Funding

2/3/2015

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Governor Walker announced last week that that he will propose a $300 million (13%) cut to the University of Wisconsin System, which will almost certainly be felt at all 26 system campuses.  In addition, tuition will continue to be frozen at all campuses until 2017.  After that, universities will be able to change tuition at their discretion.  Until then, existing university programs will likely have to be cut in order to make up for the reduction in state aid.  Please take a moment to click through to this Milwaukee Journal Sentinel article that provides an excellent rundown of the story.

In addition to the funding cut, Governor Walker announced that he would provide the UW System with significantly more autonomy from state laws that govern contracting for services and construction projects.  Perhaps more importantly, the Governor's proposal would eliminate state laws that govern professor tenure and shared institutional governance.  While it appears that many UW System administrators would like to maintain tenure and shared governance policies, such non-statutory policies could be abolished by the Board of Regents if Governor Walker's proposal becomes law.

For an idea of how these massive cuts to higher education may affect women and girls in Wisconsin, see pages 20-21 of the WAWH's 2013-2015 Wisconsin Women and the Budget Project.  Please stay tuned for updates and a more detailed analysis as we begin our work on the 2015-2017 Report!
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    Cecely Castillo is the Policy Director at the Wisconsin Alliance for Women's Health and is overseeing our state budget impact on women and girls.  

    WAWH is fortunate to have a formidable team of interns contributing to this project. Our 2019 budget team includes: Jordyn Anklam, Talia Coney, Sarah Gaydos, and  Nicole  Poellinger.

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The Wisconsin State Budget Impact on Women and Girls is a project of:
The Wisconsin Alliance for Women's Health.
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