Budget committee gets mixed response to health care, child welfare decisions

Child care stabilization funds, Medicaid postpartum coverage out; reimbursement rates hiked for hospitals, long-term care

By: and - June 16, 2023 7:34 am
Wisconsin Capitol - reflected in Park Bank

Wisconsin Examiner photo

This report has been updated.

Working into the early hours of Friday morning, Republicans on the Legislature’s Joint Finance Committee (JFC) rejected proposals to put $340 million in the state budget over the next two years to continue a child care subsidy program that began with federal pandemic relief money.

In its place, they proposed a revolving loan fund for new child care providers, setting aside an initial $15 million to fund it. They also made changes to the Wisconsin Shares child care subsidy program aimed at easing a fiscal cliff that has socked families with sharp increases in costs when their incomes go up.

The overall Department of Family Services (DCF) budget increased $135 million — less than half of what had been requested for child care support alone, in budget decisions approved after midnight Friday. That number includes increases from the state’s general fund, federal funds and program revenue — income received from fees and other charges to the public.

The committee also approved a $3.1 billion increase in the budget for the Department of Health Services (DHS), with state tax dollars accounting for about $800 million of that. Medicaid accounts for about $2.4 billion of the department’s total budget, according to the Legislative Fiscal Bureau.

Child care request rejected

Child care providers and advocates said Friday they were alarmed by the absence of any funding in the DCF budget along the lines of the $340 million infusion they, Gov. Tony Evers and the Democrats had sought for continued revenue support to the child care business. 

The Child Care Counts program was funded through the state’s allocation under the American Rescue Plan Act (ARPA) that expires by early 2024. Providers, parents and allied groups have been campaigning for months for the program to continue with state funding.

The committee’s decision not to do that “is a devastating blow to this industry,” Ruth Schmidt, executive director of the Wisconsin Early Childhood Association (WECA), said Friday. “This needs to be turned around or we’re going to see tuition increases, we’re going to see child care programs close, we’re going to see people needing to quit jobs because they can’t find or afford care for their kids.”

She said the loss of child care will lead to a soaring loss of workers in the state, “because families won’t be able to find care for their kids.”

Schmidt said WECA and its Raising Wisconsin campaign are rallying parents and providers to call on the committee to make “a significant state investment in child care” and insert it into the budget before the final vote on the document.

Brooke Skidmore, who co-owns and operates The Growing Tree child care center in New Glarus, said Friday she “was dumbfounded” by the decision after watching the recording of the meeting on Wisconsin Eye. 

“It goes against all logic, for our economy, for our children and for our state,” Skidmore said of the decision. The Republican lawmakers “offered no alternatives, they offered no reasoning.”

Skidmore is also a co-founder of WECAN, Wisconsin Early Childhood Action Needed, an advocacy group for providers and parents. She said she and parents have invited JFC Republicans to visit her center and made several requests to meet with them, getting no response. 

“I have even gone to [Sen.] Howard Marklein’s office with one of his constituents who is a child care provider to speak with us, and he refused,” Skidmore said.

Marklein, a Republican from Spring Green, is co-chair of the Joint Finance Committee. 

Instead of the proposal that advocates have been campaigning for, the finance committee majority included a $15 million revolving loan fund to be administered by the Wisconsin Economic Development Commission (WEDC). The budget puts the money in the committee’s supplemental appropriation, which it controls, and which gives the JFC the right to review and approve the details before releasing the money for the program.

How that money would be used was not specified in the Republican motion. But in advocating for it, Rep. Jessie Rodriguez (R-Oak Creek) said that she and her colleagues were working on “a packet of bills that would be coming up soon.” Those bills would be “about helping people to be able to open more childcare centers,” Rodriguez said, and the $15 million being set aside would be that legislation.

Skidmore called proposing to start up new child care centers without being able to provide adequate support “just plain dumb.”

“Why would we invest money to create more child care when the ones that we have are closing down because they can’t survive,” Skidmore said.

Rodriguez also noted the change in the GOP budget to the Wisconsin Shares low-income child care subsidy program. Currently the subsidy threshold is 185% of the federal poverty guideline, and recipients lose $1 of subsidy with every $3 in added household income above that level. 

WIth the change, families would continue to qualify for the full subsidy with incomes up to 200% of the poverty guideline. The change also would ease the phase-out of the subsidy above that level, reducing it by $1 for every $5 in added household income. 

That is “an important action to help working families with low incomes,” Schmidt said. “But that does not bring additional revenue into this field.”

For those same families, she said, child care “will increasingly not be there without a public investment in child care and in a really significant, big way.”

Health care reimbursement rates increase

Hospitals, nursing homes and health care providers have been campaigning for higher reimbursement rates under Medicaid, which includes BadgerCare, providing health care coverage to low-income people. Marklein said the GOP budget proposal provided that.

Long-term care providers praised the outcome Friday, saying increases would enable them to pay higher wages in order to attract new workers and retain existing staff.

The Wisconsin Board of People with Developmental Disabilities (BPDD) issued a statement Friday acknowledging the committee’s extension of a 5% increase for providers of home health and personal care through Family Care and other state programs that provide long-term care in people’s homes. 

Wages in the sector in Wisconsin remain “the lowest among Midwestern states,” said the BPDD, with 60% of the workers lacking health care coverage through their employers. Half of home health and personal care workers leave each year, and two-thirds of the agencies who provide services turn away potential clients because they don’t have enough workers, according to the board.

The statement said the BPDD and allied groups “look forward to working with the legislature on bold system change ideas to grow the care workforce this session.”

“We need to create jobs quality workers can afford to stay in,” said Beth Swedeen, co-chair of the Survival Coalition of Disability Rights Organizations. “People who can live in the community are being forced into expensive Medicaid funded nursing homes because they can’t find the help they need to stay independent. A major investment is still needed to protect the health and safety of our state’s most vulnerable residents.” 

Democrats on the finance committee were more critical of the overall health budget offered by the Republicans.

Rep. Evan Goyke (D-Milwaukee) said the $38 million reimbursement increase for Family Care providers was a little more than half of the $61 million that Evers had proposed.

Family Care is “the way we keep people out of the nursing home and out of an institutional setting,” Goyke said. Evers’ recommendations, which Democrats offered in a motion that failed 4-11, aimed to “increase the wages so that that workforce could be at least marginally competitive with the other industries that have increased their wages.”

Sen. LaTonya Johnson (D-Milwaukee) criticized the removal of a program Evers had proposed to expand the health care workforce through grants to community coalitions and training providers “to implement best practices [and] innovative solutions to increase worker recruitment and retention.”

Mental health: $10 million for crisis centers 

Republicans approved some additional funding to address Wisconsin’s ongoing mental health crisis, including money to support the state’s crisis centers. Democrats on the committee said the funding won’t be enough to make significant progress. 

The committee approved an additional $10 million in supplemental funding for crisis urgent care and observation centers, which became a focus during the budget discussion as people told lawmakers about having to travel hours to access care at the existing centers and a lack of availability. 

Marklein said the co-chairs weren’t able to come up with a specific package related to how the dedicated money will be spent, but that they’ll work on that.

“We’re putting $10 million into that, again, in the next budget,” Marklein said. “Hopefully we can continue to work with the department and come up with a system that will work for everybody so that we can start dealing with these people in crisis situations at a local level, rather than transporting them many, many hours.”

Republicans also approved $2 million for a telemedicine crisis response pilot program.

Evers, who declared 2023 the “Year of Mental Health,” had proposed many investments that Republicans ultimately decided to remove, including additional money to support the 988 Suicide and Crisis Lifeline, a deaf, hard of hearing, and deaf-blind behavioral treatment program, Wisconsin’s youth crisis stabilization facilities, grants for peer recovery centers, a peer-run respite center and a school-based mental health pilot program.

“The Republican motion here tonight cut a dozen different items that would provide access support for people struggling with a mental health crisis that is a challenge facing the entire state of Wisconsin and one that will not be solved without our action,” Goyke said. “And we miss an opportunity to invest in the resources necessary to provide treatment in our communities.”

The finance committee’s co-chair, Rep. Mark Born (R-Beaver Dam), pushed back on Democrats’ criticism. 

“There are a number of workforce initiatives and investments in this motion, even though it sounds like from some of the prior speakers, there was none or next to none,” Born said. 

Referring to Democrats’ criticisms that a suicide hotline had been left out of the Republican budget, he added: “It was never funded in the first place by state money. It’s always been federally funded. Most likely, it probably will continue to be.”

Evers “built a budget that spent recklessly, made with Monopoly money,” Born said. “So we have to right size the thing … it still means massive investments in things that are important to the people of Wisconsin, like the health care system.”

Sen. Kelda Roys (D-Madison) objected. “Of course it’s not Monopoly money,” she said. “Here, we’re talking about 7 billion United States dollars that we have in a surplus. That’s real money, and it could help real people.”

She said while the hotline is receiving federal funding, advocates have called for support from the state so that they can better serve individuals. 

The GOP majority’s health department motion also includes a provision to block Medicaid payments for puberty-blocking drugs or gender reassignment surgery. 

Roys described hearing from a constituent whose son, upon coming out as trans and being accepted, “is so much happier and healthier to be able to be who he authentically is.”

The parent reported that the youth “was scared because of the constant attacks, political attacks on kids that people in this building who are launching those attacks don’t know [and] are never going to meet,” Roys said.

“What does it matter to you?” Roys said. “Why do you care so much? Why do you want to hurt them so badly? Why are they the political punching bags because you think it’s going to get you more votes?”

GOP rejects extended health coverage for new mothers 

The GOP majority rejected extending Medicaid coverage for mothers beyond the current 60 days after they give birth. The extension would have given coverage to eligible new mothers for 12 months postpartum, a move that supporters say would help address Wisconsin’s concerning maternal mortality rates.

Democrats said the budget was the best chance for the change — which 43 states have already adopted or are going to adopt — to happen.

Johnson said the extension of coverage would have its greatest impact on Black women in Wisconsin. According to DHS data, maternal mortality in Wisconsin from 2006-2010 was five times higher for Black women than white women.

“In my community, especially in the African American community, infant mortality and postpartum death is real, and depending on what ZIP code you live in, in Milwaukee, those numbers increase,” Johnson said. She also noted that disparities exist in other populations as well, with women in rural areas at higher risk due to a lack of access. 

Rep. Tip McGuire (D-Kenosha) pointed out that the policy itself is supported by eight other lawmakers who sit on the budget committee, including Republican Sens. Joan Ballweg (R-Markesan), Mary Felzkowski (R-Irma), and Eric Wimberger (R-Green Bay), and Reps. Rodriguez and Tony Kurtz (R-Wonewoc). Along with Democrats Johnson, Goyke and Roys, each is a cosponsor on a bill that would make the change outside of the budget. 

“It ensures that for 12 months after birth, mothers have postpartum eligibility extension, under the [Medicaid] program,” McGuire said. “This is absolutely essential for parents, this is essential for parents to be able to take care of their kids to be able to move forward successfully as parents.”

While the bipartisan bill has been introduced, Assembly Speaker Robin Vos (R-Rochester) said this week he would oppose any such extension. 


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Baylor Spears
Baylor Spears

Baylor Spears is a staff reporter for the Wisconsin Examiner. She’s previously written for the Minnesota Reformer and Washingtonian Magazine. A Tennessee-native, she graduated with a degree in journalism from Northwestern University in June 2022.

Erik Gunn
Erik Gunn

Deputy Editor Erik Gunn reports and writes on work and the economy, health policy and related subjects, for the Wisconsin Examiner. He spent 24 years as a freelance writer for Milwaukee Magazine, Isthmus, The Progressive, BNA Inc., and other publications, winning awards for investigative reporting, feature writing, beat coverage, business writing, and commentary.