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Little-Known Piece of Wisconsin Budget Bill Has Huge Consequences for Medicaid

Along with its far-reaching restrictions on collective bargaining by many state employees,  Wisconsin Governor Scott Walker’s “budget repair bill” includes a little-known provision that would give him almost total control over the state’s Medicaid program.

Specifically, the bill would strip the legislature of practically all of its authority to set the guidelines for the program (known as BadgerCare), leaving the power to do so almost solely in the governor’s hands.  Consequently, Wisconsin residents who normally get a chance to voice their views to the state legislature on proposed changes to BadgerCare — e.g., changes to who gets coverage, what benefits they receive, and how much doctors and hospitals get reimbursed — would have to find some way to influence the governor.  That could prove disastrous for the more than 1.1 million low-income children, seniors, people with disabilities, and adults who rely on BadgerCare for their health coverage, and the providers that serve them.

Currently in Wisconsin as in most other states, state law defines key features of Medicaid.  That is, the legislature makes any significant changes in Medicaid through legislation, which it sends to the governor for his (or her) signature.  If the governor vetoes the measure, the legislature can try to override the veto or make enough changes in the legislation to secure the governor’s approval the next time.

As part of the legislative process, the people whom the legislation would affect usually get a chance to be heard, such as by testifying in public at a committee hearing.  So, for example, if the legislature were to consider dropping coverage of supplies that people with diabetes rely on or limiting the number of doctor visits that BadgerCare will cover, Medicaid beneficiaries, health care providers, and consumer advocates could weigh in so that lawmakers could make a fully informed decision.

This would all change under Governor Walker’s bill.  It would enable Wisconsin’s Department of Health Services, which administers BadgerCare and which reports to the governor, to override state Medicaid laws as it sees fit and institute sweeping changes.  The only check would be a “passive review” process by a legislative committee, whose two co-chairs would have 14 days to set a meeting.  If they failed to schedule a meeting, the rules would take effect immediately; if they did schedule one, the committee alone — not the entire legislature — would vote on whether to block the proposal. That the legislature is currently in Republican hands makes it unlikely that one of its committees would move to confront the current Republican governor over one of his Medicaid changes.

The bill also would enable the Department to reduce Medicaid costs by imposing more burdensome paperwork requirements on people trying to apply or renew coverage, making it harder for eligible individuals to enroll and stay enrolled.  Or it could do away with special eligibility procedures designed to ensure that pregnant women can get health care without delay.

The federal government would have to sign off before most changes could take effect.  However, states have lots of flexibility to set their Medicaid rules, so approval would be likely unless a change went beyond what federal law permits.