Medicaid Showdown Looms

This weekend, the Milwaukee Journal Sentinel published a column by MacIver President Brett Healy.

In part, Healy wrote:

With Wisconsin stuck in the middle of the highly charged “recall season,” those on the left immediately seized upon this waiver in an attempt to maximize political damage. But what they conveniently forget to mention in this attack is that the program is broke and in need of a fix. What is their plan? Is it the plan suggested by the Obama administration?

In a February 2011 letter from Department of Health and Human Services Secretary Kathleen Sebelius, the Obama administration suggested the option of ending eligibility for 53,000 non-disabled, non-elderly and non-pregnant adults on Medicaid with income above 133% of FPL. This, the feds say, would save the state over $60 million of general purpose revenue a year. While I personally agree with this approach, the left in Wisconsin would certainly be apoplectic if DHS attempted this one-size-fits-all remedy.

If Wisconsin is granted the waiver, only individuals who refuse to pay the 5% premium, who have access to affordable employer-sponsored coverage, who fail to prove they are Wisconsin residents or who make too much money to qualify would be kicked out of the program.

In between when the column was written and when it was published, the Federal Centers for Medicare and Medicaid Services preliminarily approved parts of Wisconsin’s waiver request.  However, CMS said “it is unlikely we will be able to meet the State’s requested approval date of December 31, 2011, for all the proposed changes.”

They did approve e the following proposals as applied to non-disabled, non-pregnant adults with income above 133 percent of the Federal Poverty Level

  • Application of the 9.5% affordability test with respect to employer sponsored insurance that meets minimum benefit standards;
  • Premium increase for the adult family members up to 5% of family income (this item, as proposed by the State, would be for non-disabled, non-pregnant adults with income above 150% of the FPL); and
  • A 12-month restrictive re-enrollment period for Medicaid eligibility for the adults who fail to make a premium payment.

The Walker Administration continues to push for the full waiver application, but if the feds reuse to budge, the stalemate will likely force their hand to disenroll individuals in the manner by which the Obama Administration is suggesting.

Read Healy’s whole column, here.