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The post Budget boosts providers; Evers vetoes gender-affirming care Medicaid restriction appeared first on Wisconsin Health News.

Gov. Tony Evers on Wednesday signed into law the state’s 2023-25 budget, leaving intact its Medicaid rate increases and using his veto authority to strike a proposal barring Medicaid coverage of gender-affirming care.

The governor said he was vetoing the provisions because they perpetuate “hateful, discriminatory and anti-LGBTQ policies and rhetoric.”

“Gender-affirming care for transgender and gender nonconforming people with gender dysphoria is recognized as the standard treatment by most major medical associations,” Evers wrote in his veto message. “Reducing access to gender-affirming care would only magnify the inequities in health outcomes already faced by the LGBTQ community.”

Assembly Speaker Robin Vos, R-Rochester, said that Medicaid “should not be funding” gender-affirming care and that doing so reduces the dollars available for other services.

A 2019 court decision blocked the Department of Health Services from enforcing coverage exclusions for gender-affirming care.

Evers also cut proposed additional reporting requirements for both Family Care managed care organizations and the Medical College of Wisconsin’s psychiatric and behavioral health residency program.

He tweaked other health-related provisions in the spending plan to provide additional funding for the state’s newborn screening program and to expand a study of the state-run nursing home for veterans at King to include other veterans homes.

The budget boosts Medicaid rates for hospitals by $236 million in state and federal funds. It provides nursing homes with $146.4 million more for support services, like housekeeping, maintenance and dietary staff, and directs DHS to implement a new payment system for those services.

The budget increases Medicaid rates for primary care services, emergency doctors and chiropractic services by $149 million. It continues through June 2025 a 5 percent rate increase for home and community-based services that was set to expire next year after federal COVID-19 relief dollars run out. And it increases the direct care and services portion of Family Care capitation rate by $38.4 million.

In his veto message, Evers said Wisconsin started the biennial budget process in the strongest fiscal position it’s ever been, but the spending plan sent to him by the Legislature doesn’t include key priority areas like BadgerCare expansion, expanded paid family leave, marijuana legalization and tax relief for caregivers.

“This budget, while now improved through strategic vetoes, remains imperfect and incomplete,” he wrote.

The Legislature should take a “second chance” in the coming months on proposals like expanding paid family leave and investing in high-speed internet, he said.

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The post Healthcare providers, long-term groups applaud proposed Medicaid rate increases appeared first on Wisconsin Health News.

The Republican-controlled Joint Finance Committee on Friday advanced a $3.1 billion health plan in all funds, including $837.8 million in state money, that would in part boost Medicaid rates during the 2023-25 biennium.

The budget-writing committee voted 11-4 along party lines a few minutes before 1 a.m. to include the plan in the state’s next budget, which GOP lawmakers are still crafting and is subject to approval by the Assembly, Senate and Gov. Tony Evers.

“There’s a lot of wonderful things we’ve done in this motion,” said committee Co-Chair Sen. Howard Marklein, R-Spring Green.

“There’s some things that we have talked about for months, with our partners in healthcare and long-term care, and why those things are important,” committee Co-Chair Rep. Mark Born, R-Beaver Dam, said. “That’s why they’re in this motion.”

But Rep. Evan Goyke, D-Milwaukee, said that the plan didn’t provide enough support.

“This majority party motion does not provide the investments in our healthcare workforce that providers around the state of Wisconsin and their patients need,” he said.

The motion includes 54 items, including $354.2 million in state dollars to meet Medicaid’s cost-to-continue estimate. It would continue a 5 percent rate increase funded by COVID-19 relief dollars for Medicaid home and community-based services through the end of the biennium, a move that would cost $88.7 million in general purpose revenue.

The plan would provide $52.2 million in state dollars over the biennium to boost Medicaid primary care provider reimbursement rates. It would provide $48.2 million in state dollars to boost payments to hospitals that serve a disproportionate number of Medicaid patients, $26.6 million to raise rates for hospital services and $12 million to increase payments for hospital behavioral health units.

GOP lawmakers also opted to provide $56.9 million in general purpose revenue for nursing home support services — like housekeeping, maintenance and dietary staff — and direct the Department of Health Services to set a nursing home payment standard for the services similar to the one it has for direct care services.

They want to put $15 million in state dollars toward increasing the direct care and services portion of capitation rates DHS provides to managed care organizations to fund long-term care services in Family Care. And they want to use $15 million in state dollars to increase personal care reimbursement rates.

Other provisions in the plan would raise Medicaid rates for emergency doctors and chiropractors as well as boost funding for medical residency program grants.

The plan would bar Medicaid from covering gender-affirming care, to the extent permitted under federal law. The provision drew a rebuke from Sen. Kelda Roys, D-Madison, who questioned why GOP lawmakers want to “hurt” transgender children and why they were treating them as “political punching bags.”

The GOP motion would provide $5 million for allied health professionals’ training, $2 million for a telemedicine crisis response pilot program and $1.5 million more in grants for free and charitable clinics.

Republicans also opted to provide $10 million for grants to support regional behavioral health crisis facilities, $5 million to establish a general dentistry residency program at Marquette University School of Dentistry and $5 million for a complex patient pilot program.

Marklein said that details for the pilot program, which would help hospitals transfer complex patients to post-acute facilities, would be determined through future legislation. However, Sen. LaTonya Johnson, D-Milwaukee, questioned why the plan reduces the $15 million that Evers proposed for the program.

Republicans rejected a Democratic amendment to the motion that would provide $13.4 million in state dollars to extend Medicaid postpartum coverage to a year.

“This just makes good common sense,” Johnson said. “It’s a simple bill that could help save a life.”

No Republican lawmakers spoke against the amendment, but Assembly Speaker Robin Vos, R-Rochester, said this week he opposes the extension in part because new mothers who make more than the poverty level can find private coverage, including with help from Affordable Care Act subsidies.

Before acting on the budget, the committee amended a plan by state health officials to spend $8 million from opioid settlements with drugmaker Johnson & Johnson and drug distributors Cardinal Health, McKesson Corp. and AmerisourceBergen.

In March, DHS proposed using the money to support capital projects, school programming and access to anti-overdose drugs and fentanyl test strips. However, an objection raised during the committee’s review process put the brakes on the proposal.

The committee voted 11-4 along party lines to spend:

• $2.9 million for distributing the anti-overdose drug Narcan and fentanyl test strips.
• $2.5 million for grants to counties and tribes for room and board costs of Medicaid members receiving residential substance use disorder treatment.
• $2 million for supporting medication for addiction treatment.
• $300,000 to pay a vendor for collecting and maintaining information regarding treatment providers for the state’s substance use disorder treatment platform.
• $300,000 for the Surgical Collaborative of Wisconsin to train surgeons on preventing prescription opioid abuse.

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