The state’s health care budget for the next two years has more money for nursing homes, more pay for some home caregivers and additional help for people with Alzheimer’s and other forms of dementia.
But it leaves out improvements in services that people with disabilities and their advocates have been campaigning for. It also provides much less than what the state’s poorest residents, especially Black families and other families of color, had hoped for based on the original spending plan from Gov. Tony Evers.
The Legislature’s Joint Finance Committee approved a health budget Tuesday night that represented a $3.56 billion increase over current spending. The document passed 11-4 with only Republican votes after the lawmakers voted down a Democratic alternative that would have included an additional $260 million.
For advocates who sought more, the final budget’s omissions were especially disappointing after new projections showing that over the next two years, the state’s tax revenues will be more than $4 billion greater than originally projected.
“Wisconsin Families were already hurting, and the pandemic exposed a lot of the pain and the disparity in that pain,” says William Parke-Sutherland, the health care policy specialist for Kids Forward, a nonprofit advocacy group for children and families in Wisconsin. “With historic, or close to historic, revenue projections, there was an opportunity to start to address health inequity and better health care for all Wisconsinites.”
Instead, he says, “at almost every turn” the health care budget that emerged Tuesday night from the Republican majority on the finance committee “either doesn’t live up to that, or turns its back on people who are struggling to get by and stay healthy.”
The Medicaid factor
A key part of the health budget revolves around how, and how much, the state spends on the Medicaid program, which covers health care for people at all ages who have low incomes.
Medicaid includes BadgerCare, which covers health care for adults with incomes at or below the federal poverty guideline ($12,880 for a single person and $21,960 for a family of three). But Medicaid also helps people with low incomes who need long-term care or who need care because of disabilities. The program is paid for by a combination of state and federal funds.
One bright spot, advocates say, is a 40% increase in what dentists receive when they treat Medicaid patients.
“Hopefully that will lead to more access for people who really struggle to find providers who will take current Medicaid rates,” says Parke-Sutherland.
In contrast to that, however, are a number of measures that fall short of proposals that could make a bigger difference when it comes to the health of Wisconsin residents, especially among the poor and marginalized, he says.
For example, the finance committee budget extends guaranteed Medicaid coverage for mothers after a pregnancy is over — post partum coverage — by 30 days, to a total of three months. Evers’ original proposal, in line with federal recommendations as well as the advice of health care researchers, would have provided a full year of coverage.
The difference is important, Parke-Sutherland says, because it ensures continued medical care for the mother and baby in the first year of the infant’s life. According to data cited by the Legislative Fiscal Bureau, as many as 45% of women covered by Medicaid when they give birth become uninsured if they lose their Medicaid coverage afterward.
Only adding 30 days to the post partum coverage period “doesn’t do anything to provide real continuity of care for mom and baby,” Parke-Sutherland says.
The budget also cuts Evers’ proposals for funding to support health programs to help Black women, allowing Medicaid coverage for doulas — professionals who help new mothers after they give birth — and providing more community health programs, including Medicaid coverage for community health workers.
While there were other additions to the budget, such as an increase in funding for outpatient mental health, most represented far less than the governor’s budget recommended, Parke-Sutherland says.
The continued refusal of the Republican majority in the Legislature to consider accepting a federally subsidized expansion of the Medicaid (BadgerCare) program with a bonus remains a particular disappointment for advocates. “There was an opportunity to expand BadgerCare and save more than $1.5 billion, which could have been invested in health families and communities,” Parke-Sutherland says.
Resources for elderly, dementia and long-term care
Janet Zander of the Greater Wisconsin Agency on Aging Resources says one advance in the budget is the expansion of a state program that provides specialists in helping people with Alzheimer’s and other forms of dementia.
The budget will now enable every county to have at least one dementia care specialist, who can provide guidance for caregivers but also assist communities in how to appropriately help and support dementia patients, Zander says. That’s huge.”
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For long-term care services in nursing homes, the budget added about $252.3 million over two years to boost nursing home reimbursements under Medicaid. That will increase payments to nursing homes by about 12% a year, according to the Wisconsin Health Care Association, a long-term care industry lobbying group.
The budget also adds about $104 million to workers who provide direct care services to long-term care patients who are living at home but covered by Medicaid under the state’s Family Care program. The funds will be used to increase the pay for those workers, who provide help with bathing, dressing and other forms of personal care. Advocates hope that may bring more people into the field, which has experienced a severe shortage of workers.
But while extra funds mark an improvement for residents and operators of nursing homes and for direct care workers who assist at-home residents covered by the Family Care program, direct care and personal care for large numbers of other people has been left out says Lisa Pugh, who represents a coalition of groups that advocate for people with disabilities. Pugh is also state director for The Arc Wisconsin, which represents people with intellectual and developmental disabilities and their families.
The increase in funding for direct care workers in the finance committee version of the budget “is getting at just a small part of the workforce crisis,” Pugh says. It doesn’t apply to other direct workers who help people at home in long-term care but through programs outside of Family Care — many of whom are people with disabilities.
“To not be making some significant increases in providing for community care, it sends a really poor message to people who want to be as independent as possible,” she adds.
Disability advocates: Needs were ignored
Pugh was part of a task force that Evers convened in 2019 and 2020 that discussed the workforce shortage in direct care and associated struggles of family caregivers. The task force made recommendations on increasing wages and benefits for all workers involved in caregiving, and also on helping people who serve as volunteer caregivers for members of their family.
“Those needs were reflected in the governor’s budget, and also in things that members of the public spoke about in Joint Finance Committee hearings and in communications to the Legislature,” Pugh says. But they were absent in the budget that emerged from the committee.
“We felt the needs of really vulnerable people were ignored,” Pugh says. Those weren’t limited to the health budget, she adds citing the “complete dismissal of the dire needs of special education” in the committee’s revisions to the state education budget.
Another shortcoming of the budget, both Pugh and Zander say, is the decision not to increase funding for the system of Aging and Disability Resource Centers in each county. As centers were added around the state after the creation of a pilot program, funding was inconsistent, Zander says, and none have seen an increase in funding since 2006, leaving “huge funding inequities” from one county to another.
By helping guide people to a wide range of resources as they are growing older or managing disabilities, the resource centers enable people to delay or even avoid going on Medicaid, she explains. They also help people avoid going into nursing homes by connecting them with programs that keep them at home even if their needs for care increase.
Expanding the capacity and the resources of the Aging and Disability Resource Centers would help reduce Medicaid costs, says Pugh. “To not invest in them is very shortsighted.”
The finance committee budget also left out a proposal to expand the state’s long-term care ombudsman program, which serves as an advocate for families and patients and a watchdog of long-term care providers.
“It is a big loss,” says Zander. “We have an aging population and the ratio of ombudsmen to persons served is just getting greater and greater.”
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