The power of advocacy can help make change happen. That is something we often hear, but seldom see in action. Fortunately, the entire WiAHC membership can now say they have witnessed firsthand the benefits of a comprehensive advocacy effort to deliver a long-overdue policy change to boost the skilled home health care industry in Wisconsin.

On Tuesday, June 15, the state Legislature’s powerful budget-writing committee, which is tasked with shaping the state’s two-year budget, voted to include a provision in the budget to increase Medicaid rates for home health care skilled nursing services by 10 percent. WiAHC has been advocating for this important change for nearly two years.

The budget bill must still be approved by the full Legislature and signed into law by Gov. Tony Evers, but approval of the increase by the budget committee was an extremely important step, as the budget created by the committee is highly likely to be adopted by the Legislature with minimal changes.

Due to in part to current Medicaid rates in Wisconsin, home health agencies struggle to attract sufficient nursing workforce. As growth in the utilization of home health care services continue, today’s workforce challenges will only worsen without a rate increase. The committee’s actions mark a significant step forward in addressing this issue.

“The skilled home health care industry is very grateful for the budget committee’s commitment to the services we provide and the patients we serve,” said WiAHC Board Chair Lisa Kirker. “We specifically want to thank Senator Mary Felzkowski (R-Irma) and Representative Amy Loudenbeck (R-Clinton) for their leadership on this issue. Their work was invaluable in ensuring a rate increase passed the committee.”

Under the provision approved by the budget committee, the state will provide more than $1.4 million in additional state funding – along with the federal match – over the upcoming two-year budget cycle to increase the Medicaid rate paid for nursing care in home health agencies. The rate boost would begin on January 1, 2022. The additional funding will support care offered by licensed practical nurses, registered nurses, and nurse practitioners in home health agencies.

The WiAHC Government Affairs Team will continue to work with lawmakers and the Governor’s office throughout the remainder of the state budget process to help make sure the provision is ultimately signed into law.  

First elected to the state Assembly in 2012, Representative Dan Riemer (D-Milwaukee) is serving his fifth term representing the 7^th Assembly District, which includes portions of the cities of Milwaukee and West Allis, as well as the Village of West Milwaukee.

Rep. Riemer holds a law degree from UW-Madison and is a full-time lawmaker. He currently serves on the Assembly Health Committee, and during his time in the Legislature has worked on numerous health care-related proposals.

Rep. Riemer took a few minutes to talk with us about a handful of topical health care issues facing Wisconsin and what health care policy priorities he believes should be pursued during the 2021-22 legislative session:

Question 1

As a long-time member of the Assembly Health Committee and a legislator who has worked on numerous health care-related polices during your time in the Legislature, what do you believe are the largest health care-related challenges facing the state? In addition, what policy solutions do you believe are needed to address those challenges? Lastly, what key health care policy proposals is the Assembly Democratic Caucus focusing on for the 2021-22 legislative session?

Answer: The single biggest health care challenge facing Wisconsin is the failure to expand Medicaid. This would increase the number of Wisconsinites with health insurance, and lower health care costs for newly Medicaid-covered individuals between 100%-133% of the Federal Poverty Line. Medicaid provides better benefits than Affordable Care Act plans or other plans and provides Wisconsin’s government with over one billion additional dollars, some of which could be devoted to other health care priorities.

As I have done for many years through legislation, Governor Evers has also repeatedly proposed Medicaid expansion. The Assembly Democratic Caucus has again made this a priority, as have Democrats in the State Senate. The time has come for the Republican majority in the Wisconsin Legislature to agree. That’s the simple solution to our biggest health care challenge.

Question 2

The cost of healthcare continues to rise, for both individuals and employers. In fact, a recent survey by the Kaiser Family Foundation and the Purchaser Business Group on Health found that 85 percent of large employers believe the government must take a bigger role in managing healthcare costs and coverage. Another survey found that 55 percent of small business owners say the cost of providing health insurance to their employees is the biggest challenge they face. What types of policies or future legislation do you believe are necessary to help drive down the overall costs of health care?

Answer: In addition to Medicaid expansion, which will reduce what Wisconsin’s taxpayers and government must pay for health care for a large sector of our population (a form of lowering costs), I strongly support other measures to lower the overall cost of healthcare in Wisconsin.  One step that I support would be to require that the Wisconsin State Employee Health Plan (WSEHP) be used as the vehicle by which all government employees obtained health insurance. 

A careful analysis of WSEHP by University of Wisconsin-Madison La Follette Professor of Economics John Mullahy and others compared the WSEHP’s experience in Dane County vs. Wisconsin’s other 71 counties. The study showed that  when a very large percentage of the employees in a county are offered a choice among competing health care plans, they have incentives to enroll in the lower-cost plans, because while higher-cost plans are always available, they must pay a modest additional premium to enroll in higher-cost plans. Given the choices, health care premiums and costs are held down.

If WSEHP served as the vehicle for enabling all government employees to obtain health insurance in the same way, it should be possible to replicate much of WSEHP’s unique success in Dane County in constraining health care premiums and costs.  One of the benefits of this is that, as the Dane County story suggests, it is not only the WSEHP and those it helps obtain health insurance for who experience reduced costs.  The model’s incentives put pressure on the competing plans to become more cost effective in general, which helps private employers as well.

Question 3

Skilled home health care offers a wide range of health care services, which are provided by skilled non-physician practitioners, such as nurses in a patient’s home. Not only does skilled home health offer patients with greater convenience, increased quality of life, and better outcomes, it is also typically less expensive than care delivered in a hospital or other facility. Unfortunately, despite the many benefits of home health care, the Wisconsin Medicaid reimbursement rate for home-based skilled nursing has not been increased in over a decade. With that in mind, would you support increasing the Medicaid reimbursement rate for home health skilled nursing services by 10 percent?

Answer:  I certainly would be concerned if the current Medicaid reimbursement rate for home health skilled nursing services is resulting in a reduction in the number of providers or the quality of care.

This is not an issue, however, that I know much about. I would welcome the opportunity to learn more.

The views and opinions expressed in this interview are those of the individual that was interviewed and do not necessarily reflect the official policy or position of the organization.

Governor Tony Evers has called a special session of the legislature to take up a proposal to expand the Wisconsin Medicaid program, which would capture an extra $1 billion in federal funds and cover more than 90,000 additional Wisconsin residents under the program.

The legislation would also use $850 million of the additional federal dollars for numerous economic development-related projects and transfer the rest to the state’s budget stabilization fund.

The Republican-controlled Legislature has said they would immediately gavel out the special session without taking up the proposed legislation.

As was reported in previous editions of the WiAHC Advocacy Newsletter, the Association has launched a Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiAHC members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

We are happy to report the program is now live on the WiAHC website and members can easily and quickly sign-up as a Key Contact.

As a Key Contact, you can help influence the legislative process at both state and federal levels by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature and the Wisconsin Congressional  Delegation, you can help us educate lawmakers on industry issues and influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in your field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

The U.S. Treasury last week issued guidelines for state and local governments on how they can access their share of the $350 billion in COVID-19 aid for state, local, tribal, and territorial governments included in the American Rescue Plan Act (ARPA).

It was also announced the state of Wisconsin will receive $700 million less in ARPA funding than originally anticipated – from and an anticipated $3.2 billion to an actual $2.5 billion. In addition, the direct federal funding to the state will be split into two payments a year apart. The reduction in funding is due to improvements in the state’s unemployment rate, which has returned close to pre-pandemic levels.

Governor Tony Evers (D) who has full control over the allocation of the federal aid had planned to put $700 million toward the state’s ongoing response to the pandemic and $2.5 billion toward economic recovery. That will now need to be revisited with less funding coming into Wisconsin.

Evers, along with Wisconsin U.S. Senator Tammy Baldwin (D) has sent a letter to the Biden Administration asking Treasury to reconsider the split payment approach.

The newly released rules provide guidance on allowable uses of the federal relief funding. The federal government’s funding objectives for the relief aid includes:

• Support urgent COVID-19 response efforts to continue to decrease spread of the virus and bring the pandemic under control.
• Replace lost revenue for eligible state, local, territorial, and Tribal governments to strengthen support for vital public services and help retain jobs.
• Support immediate economic stabilization for households and businesses.
• Address systemic public health and economic challenges that have contributed to the inequal impact of the pandemic.

State and local governments may use these funds to:

• Support public health expenditures, by, for example, funding COVID-19 mitigation efforts, medical expenses, behavioral healthcare, and certain public health and safety staff.
• Address negative economic impacts caused by the public health emergency, including economic harms to workers, households, small businesses, impacted industries, and the public sector.
• Replace lost public sector revenue, using this funding to provide government services to the extent of the reduction in revenue experienced due to the pandemic.
• Provide premium pay for essential workers, offering additional support to those who have and will bear the greatest health risks because of their service in critical infrastructure sectors.
• Invest in water, sewer, and broadband infrastructure, making necessary investments to improve access to clean drinking water, support vital wastewater and stormwater infrastructure, and to expand access to broadband internet.

Within these overall categories, recipients have broad flexibility to decide how best to use the funding to meet the needs of their communities.

For more information, please visit the U.S. Treasury website.

Although much of the focus in the State Capitol is on development of the 2021-23 state budget bill – the $91 billion two-year spending plan for the state – lawmakers are also acting on stand-alone, non-budget legislation, including many that impact the delivery of health care in Wisconsin. Legislation of interest to health care professionals across the state that have been introduced and are currently being considered by the Legislature’s Health Committees include the following:

• Assembly Bill 66 - Relating to community health center grants and making an appropriation.
• Assembly Bill 86 - Relating to providing complementary and alternative health care practitioners with exemptions from practice protection laws, requirements and prohibitions for individuals who provide complementary and alternative health care services.
• Assembly Bill 184 - Relating to application of prescription drug payments to health insurance cost-sharing requirements.
• Assembly Bill 281 - Relating to registration of pharmacy technicians.
• Assembly Bill 290 - Relating to reimbursement of pharmacist services under the Medical Assistance program.
• Assembly Bill 295 / Senate Bill 308 - Relating to licensing and regulation of pharmacies and remote dispensing sites under the pharmacy practice law and the practice of pharmacy.
• Assembly Bill 296 - Relating to funding for free and charitable clinics and defining telehealth.
• Senate Bill 337 - Relating to prohibiting businesses from discriminating against customers due to vaccination record.
• Senate Bill 340 - Relating to reimbursement rates for behavioral treatment services under the Medical Assistance program.
• Senate Bill 342 - Relating to prohibiting the state or other governmental entities from discrimination based on whether the person has received a COVID-19 vaccine.

For a full list of bills currently being considered by the Assembly and Senate Health Committees, CLICK HERE to view Assembly bills and HERE to view Senate bills. You bill be able to read the bills in full and track their status as they move through the legislative process.

With the state budget process fully underway at the State Capitol, the WiAHC Government Affairs Team remains highly engaged with key lawmakers and continues to pursue as part of the budget bill a 10 percent Medicaid rate increase for skilled nursing services provided by home health care agencies.

In addition to direct lobbying of legislators by Hoven Consulting, (WiAHC’s lobbying firm), we have ramped up our grassroots advocacy efforts by helping our members connect with lawmakers on the issue and have also earned statewide print and television news coverage on the critical need to boost the Medicaid rate to address the home health care workforce and patient access crisis.

Part of our advocacy strategy included having WiAHC testify before the Legislature’s Joint Finance Committee at last month’s budget hearings. We would like to thank WiAHC Board Member Tyler Baures who took time out of his busy schedule to testify before the committee on April 28. He represented WiAHC and the home health care industry extremely well and did a tremendous job expressing the need to increase Medicaid reimbursement rates for skilled home health care services.

Click here to read Tyler’s testimony before the Joint Finance Committee.

The Joint Finance Committee, the state Legislature’s budget writing committee, has begun voting to reshape Governor Tony Evers’ $91 billion state budget bill proposal. The most significant action the GOP-controlled committee took was the approval (along party lines) of a motion to pull more than 380 items from Evers’ two-year spending plan for the state. The items removed from the legislation were either non-fiscal policy items or provisions included by the governor that are opposed by the Republican majority in the Legislature.

More specifically, the motion removed the following health care-related items from the 2021-23 budget bill:

• Full federal Medicaid expansion
• Creation of a state-based Health Insurance Exchange
• Legalization of medical marijuana
• Raising to 21 the minimum age to purchase tobacco products

By removing the provision to expand Medicaid, Wisconsin is declining $1.6 billion in additional federal aid over the next two years, including $1 billion in American Rescue Plan Act (ARPA) funding for each state that approves Medicaid expansion. Proponents of the measure say expanding Medicaid eligibility would not only save the state money, but also provide health coverage to over 90,00 additional people.

Republicans who control the Legislature oppose Medicaid expansion, pointing to the lack of a coverage gaps between BadgerCare eligibility and eligibility for subsidies to purchase private coverage in the health insurance marketplace. They also believe expansion could put Wisconsin is a tough fiscal position in the future if the federal  government decides to reduce Medicaid contributions made to states. 

The Joint Finance Committee will continue to meet during the month of May to take further action on the budget bill. However, they are not expected to address major spending items, including Medicaid issues until next month.

By Hoven Consulting

In February, Governor Tony Evers introduced his 2021-23 biennial budget proposal. The 1,000+ page document lays out the Governor’s preferred spending levels for all agencies and programs administered by state government for the next two fiscal years.

The challenge for Democratic Governor Evers is getting the Republican legislature to pass his spending bill. Many of the major tenants of the proposal, including marijuana legalization and accepting federal Medicaid expansion dollars, have already been rejected by legislative leaders.

The bill is now in the hands of the legislature’s budget-writing Joint Committee on Finance, a committee compromised of 6 Republicans and 2 Democrats from the Senate and 6 Republicans and 2 Democrats from the Assembly.

There are three core stages of the committee’s process. The first occurred earlier this month when the committee invited select administrative agency heads to testify and further explain the Governor’s spending proposals as it affects their agencies. This year, the committee spent two days hearing from the leaders of the Department of Public Instruction, the Department of Workforce Development, the Department of Natural Resources, and the Public Service Commission. These four agencies compromise a significant portion of overall spending, along with the Department of Health Services and Department of Administration, which were not asked to testify.

These hearings are largely fact-finding missions, with some political barbs thrown in from time to time. They provide an early glimpse on how the legislature’s priorities differ from the Governor’s.

As of this writing, the committee is now in its second stage of holding hearings around the state to gain input from the public on how to prioritize spending. The first hearing was held in Whitewater on April 9, the second in Rhinelander on April 21, Menomonie on April 22, and finishing with a virtual hearing on April 28.

The public hearings are typically long days with hundreds of individuals testifying on a wide variety of issues. They provide the committee with general trends on what is important to the public and informs the committee’s third and final stage.

In May, the committee will begin voting agency by agency on its own spending proposals. They will typically meet two to three times a week each week in May spending many hours each day debating and voting on each proposal. This is the most important stage of the committee’s process as it’s basically the final chance to fight to put a priority in the budget or keep a bad proposal out of the budget.

This year, we expect significant departures from the committee’s (legislature’s) final budget proposal compared to the Governor’s. While proposals are beginning to solidify, much remains to be seen on major spending initiatives.

Complicating the matter is the $3.2 billion the state is receiving from the federal American Rescue Plan Act. Governor Evers has complete discretion on how to spend these dollars without any legislative approval. It seems the legislature wants to know the details of the Governor’s plan to inform their budgeting initiatives.

Once the committee finishes its voting in May, the bill will go to the full legislature for a vote in both houses. The goal is for that to occur in June as the fiscal year ends July 1. In Wisconsin, the governor has the ability to line-item veto spending bills. In other words, he or she can veto portions of the budget bill without vetoing the bill in total. In 2019, Governor Evers vetoed many items in the bill that eventual passed the legislature. That is expected to occur again.

In short, the budget process is a long, somewhat messy undertaking with priorities and ideas that seem to shift daily. It’s not really until the dust settles after the Joint Committee on Finance finishes voting in May that the public gets a good idea of a final proposal. Stay tuned for updates as the process continues.

The 2021-23 Wisconsin state budget bill was unveiled by Governor Tony Evers (D) in February and now resides in the hands of the Republican-controlled Legislature. Unfortunately, the $91 billion, two-year spending plan for the state as proposed by the governor DID NOT include a long-overdue Medicaid rate increase for skilled nursing provided in a home health care setting. However, lawmakers, who are currently holding public hearings on the Governor’s proposal, are expected to significantly rewrite the budget bill and can include a Medicaid rate increase for skilled home health care.

With that in mind, WiAHC is asking you to please contact your state lawmakers TODAY and urge them to support a Medicaid rate increase for home health care skilled nursing in the state budget bill.

BACKGROUND:

Operating in communities through the state, home health care agencies offer a variety of health care services provided in the homes of patients and are integral to comprehensive post-acute medical care in Wisconsin. In addition to offering quality, convenient care to patients in the comfort of their own homes, home health care agencies provide cost effective care that reduces the financial burden for patients as well as public and private payers.

Unfortunately, current Medicaid reimbursement levels make it difficult to operate home health care agencies due to the problems it creates, including workforce retention and patient access challenges. In fact, the Medicaid reimbursement rate for Wisconsin home health care skilled nursing has not been increased in over a decade and has created a crisis in the industry. In short, the state’s home health care agencies must receive an increase to sustain their skilled nursing services in Wisconsin.

During the 2019-20 legislative session, WiAHC advocated for legislation to increase reimbursement rates to $94.10. The non-partisan Legislative Fiscal Bureau found the increase would only cost the state $300,000 per year – or just 0.009% of the state’s $6.7 billion biennial Medicaid budget.

Even that modest additional investment will have a significant impact on home health care in Wisconsin. It will serve to strengthen the home health care workforce, increase patient access to care in their own homes, and ultimately reduce state spending by shifting certain patients away from expensive institutional-care facilities for post-acute care.

WHAT YOU CAN DO TO HELP:

E-mail your state legislators today and urge them to support a Medicaid rate increase for home health care skilled nursing services. Please feel free to use WiAHC’s sample e-mail when contacting your lawmakers. All you need to do is cut-and-paste it into an e-mail, but please consider personalizing your e-mail to include examples of your experiences that capture the workforce and patient access challenges created by stagnant Medicaid compensation.

If you don’t know who your state legislators are, or do not have their contact information, simply CLICK HERE and type your home address in the upper right corner text box. Remember to contact both your state senator and state representative.

If you have any questions on this WiAHC Advocacy Action Alert request or would like additional information on the issue, please contact WiAHC at erik@hovenconsulting.com or tim@hovenconsulting.com.