After weeks of speculation and media coverage, the Republican-controlled Legislature passed a number of bills in a “lame duck” Extraordinary Session. All bills were passed on party-line votes, and while Governor Walker has signaled his willingness to sign the legislation, he has provided no details.
Evident by the media reporting on the Extraordinary Session, these proposals were by and large forgone conclusions; they were destined to pass regardless of outside support or opposition. While the Senate Republican caucus, in particular, was divided on key items in the various bills, ultimately they were able to make amendments sufficient to secure votes for final passage of the legislation. (Though unrelated to healthcare, the controversial proposal to change Wisconsin’s presidential primary election date was not taken up.)
Of particular interest to WACEP and other health organizations is Senate Bill 886, which makes a variety of changes to how the Department of Health Services (DHS) can make or recommend changes to the Medicaid program. In advance of yesterday’s votes, and to no avail, a group of 20+ healthcare organizations and systems (led by the Wisconsin Medical Society and Wisconsin Hospital Association) wrote a joint letter to the Legislature expressing concerns about the breadth of SB 886, the lack of time for a full analysis of the legislation and the potential for unintended consequences.
Among other things, the original SB 886 solidified in statute items contained in the most recent Medicaid Waiver approved by the Federal Government related to Wisconsin’s Medicaid/BadgerCare coverage for childless adults, including new work and premium requirements for eligibility. Among those items, the Waiver contained a new $8 copay for non-emergency visits to Emergency Rooms – quoting SB 886’s official Analysis:
DHS must charge recipients an $8 copayment for nonemergency use of the emergency department and must comply with other requirements imposed by the federal DHHS in its waiver approval effective October 31, 2018. The requirements in the bill must end no sooner than December 31, 2023, and the bill prohibits withdrawal of the requirements and DHS from requesting withdrawal, suspension, or termination of the childless adults demonstration project requirements before that date unless the legislation has been enacted specifically allowing for withdrawal, suspension, or termination.
In addition, the original SB 886 limits DHS’s ability to make other changes to Medicaid programs including changes to provider reimbursement – again, quoting SB 886’s official Analysis:
This bill prohibits DHS from submitting an amendment to the state's Medical Assistance plan or implementing a change to the reimbursement rate for or making a supplemental payment to a provider under the Medical Assistance program without first submitting the proposed state plan amendment, rate change, or payment to JCF. If the state plan amendment, rate change, or payment has an expected fiscal effect of less than $1,000,000 from all revenue sources over a 12-month period following the implementation date of the amendment…
Ultimately, to secure agreement on SB 886, the Senate adopted (and the Assembly concurred) an amendment raising the original $1,000,000 fiscal effect to $7,500,000. In other words, DHS may still make changes that cost less than $7,500,000 for the immediately following 12-month period without Legislative approval.