By Hoven Consulting – WiAHC’s Government Affairs Firm

The Legislature's Joint Finance Committee (JFC) has finished its work on reshaping Gov. Tony Evers' 2021-23 state budget proposal. While the Finance Committee completed their work on time, it was a challenging budget process with numerous moving pieces, including split government, billions of dollars in federal COVID-19 relief aid, and a projected $4.4 billion state budget surplus.

The budget bill must still be approved by the full Legislature and signed into law by Evers, who could also veto the legislation in part or in whole. However, both houses of the Legislature are likely to adopt the budget approved by JFC with minimal changes. 

While the Finance Committee did not include Medicaid Expansion in its spending plan, it did include over $1.5 billion in total funding the state’s Medicaid program and increased spending on several specific initiatives. In addition to the 10 percent Medicaid rate increase for home health care skilled nursing services added to the budget bill, the committee approved increases for personal care and direct care workers as follows:

• Direct Care Workforce Funding: Provide $53.8 million in 2021-22 and $50.4 million in 2022-23 to increase funding for the direct care workforce funding supplement.  
• Personal Care Reimbursement: Provide $18.9 million in 2021-22 and $59.3 million in 2022-23 to increase hourly rates paid for personal care services to $20.69 on January 1, 2022, and to $22.35 on January 1, 2023. 

Please find below an overview of additional Department of Health Services and Medicaid-related provisions included in the JFC-approved version of the budget bill:

Medicaid

• Medical Assistance Cost-to-Continue Estimate: Provide funding of $1.3 billion in 2021-22 and $1.25 billion in 2022-23. In addition, adjust the cost-to-continue re-estimate to provide $25,900,000  in 2021-22 and $51,400,000 in 2022-23, reflecting the impact of the Department's proposed rate increase to managed care organizations providing services under Family Care, PACE, and Partnership, subject to approval by the federal Centers for Medicare and Medicaid Services.  
• Nursing Home Reimbursement: Provide $82 million in 2021-22 and $170 million in 2022-23 to increase reimbursement rates paid to skilled nursing facilities and intermediate care facilities for individuals with intellectual disabilities. 
• Postpartum Eligibility Extension: Provide $2.5 million in 2022-23 to reflect the estimated cost of extending benefits, for women enrolled in MA as pregnant women, until the last day of the month in which the 90th day after the last day of the month that the end of the pregnancy falls, instead of the 60th day under current law.
• Outpatient Mental Health and Substance Abuse Services and Child-Adolescent Day Treatment Reimbursement: Provide $6.6 million in 2021- 22 and $13.2 million in 2022-23 for a 15% increase to reimbursement rates for outpatient mental health and substance abuse services. In addition, provide $1.3 million in 2021-22 and $2.6 million in 2022-23 for a 20% increase to reimbursement rates for child and adolescent day treatment services.  
• Medication-Assisted Treatment: Provide $1.2 million in 2021-22 and $2.4 million in 2022-23 to increase MA reimbursement rates for opioid treatment providers by 5% and increase rates for opioid-related patient evaluation and management provided by primary care providers by $5 per visit.
• MA Dental Reimbursement: Provide $15.4 million in 2021-22 and $30.8 million in 2022-23 to increase MA dental reimbursement rates by 40%. 
• Home Health Reimbursement Rate: Provide a budgeted sum of $473,300 as the state share of payments, and provide the matching federal share of payments, in 2021-22, and by a budgeted sum of $960,200, as the state share of payments and provide the matching federal share  of payments, in 2022-23, for the Department to increase the Medical Assistance rates paid for nursing care in home health agencies for dates of services beginning January 1, 2022. Specify that funding is to support licensed practical nurses, registered nurses, and nurse practitioners in home health agencies that are licensed under s. 50.49 of the statutes.

Public Health

• Community Health Center Grants: Increase grant funding for federally qualified health centers (FQHCs) by $1,000,000 annually.  

• Grants to Free and Charitable Clinics: Increase grant funding for free and charitable clinics by $1,000,000 annually.  

• Lead Screening and Outreach Grants: Provide $50,000 annually to increase a grant for lead screening and outreach activities provided by a community based human service agency that provides primary health care, health education, and social services to low-income individuals in the City of Milwaukee, from $125,000 to $175,000. 

Community Based Behavioral Health

• Child Psychiatry Consultation Program: Provide $500,000 in 2022-23 to increase from $1,500,000 to $2,000,000 the funding for the child psychiatry consultation program.

• Medication-Assisted Treatment Expansion: Provide $500,000 in 2021-22 and $1,000,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for medication-assisted treatment.  

• Methamphetamine Addiction Treatment Grants: Provide $150,000 in 2021-22 and $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for training for substance use disorder treatment providers on treatment models for methamphetamine addiction.    

• Substance Use Disorder Treatment Platform: Provide $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for development of a substance use disorder treatment platform that allows for the comparison of treatment programs in the state.  

• Behavioral Health Bed Tracker: Provide $50,000 in 2021-22 and $20,000 in 2022-23 to expand the purposes of the current psychiatric bed tracking system to include information on the availability of space for peer run respite beds and crisis stabilization beds.  

• Behavioral Health Trainee Provider Grants: Provide $250,000 in 2022-23 in the appropriation for treatment program grants to increase total funding for the program in that year to $750,000. Modify the program to: (a) specify that the Department may expend any available federal moneys received for this program; (b) require the Department to distribute a total of $750,000 per year, beginning in 2022-23; and (c) renumber the appropriation so that it is included as an appropriation under mental health and substance abuse services instead of under public health.