By Lindsay Wallace, Executive Director
Wisconsin plans to apply for a Section 1115 Medicaid Waiver to revamp its existing Medicaid program for childless adults (also known as BadgerCare). The waiver includes work requirements as a condition of receiving coverage, but includes exemptions for people with mental illnesses. The waiver would also cap the total number of years a person can be enrolled (48 months, or 4 years) and requires drug screening and testing. Further, the waiver would establish monthly premiums ranging from $0 to $10 per household, depending on household income.
NAMI Dane County and Journey Mental Health provided joint testimony to the Division of Medicaid Services. The testimony we submitted is provided below.
Joint Testimony from Journey Mental Health and NAMI Dane County
Thank you for the opportunity to comment on Wisconsin’s application to amend the Section 1115 BadgerCare Reform Demonstration Waiver. This letter conveys concerns also shared by the Dane County affiliate of the National Alliance on Mental Illness (NAMI).
Areas of concern for Wisconsin residents using mental health and substance abuse treatment services, and for agencies providing those services, include the introduction of work requirements; time limits on eligibility; lock-out provisions for failure to make monthly premium payments, and Emergency Department (ED) co-pays.
We recognize that the amendment exempts individuals with a verifiable disability or mental illness from a work requirement and eligibility time limits. We are opposed to the inclusion of language that has the potential to impede or bar access to mental health or substance abuse treatment for individuals with a chronic condition that has yet to be determined as a disability; or who are homeless and do not have access to the care required to reach a determination; or who are experiencing mental health symptoms as the result of an undiagnosed physical condition – for example, traumatic brain injury. Additionally, instituting a six month period of ineligibility following 48 months of enrollment carries with it the possibility of breaking the most basic rule of healthcare delivery: continuity of care. In the absence of language that fully specifies limits to the application of these requirements; none improve health care or access to care for Wisconsin’s most vulnerable populations.
The amendment establishes monthly enrollment premiums; co-pay charges for ED utilization; and mandatory health risk assessments. For the populations that we serve, and for Wisconsin’s most at-risk populations as a whole, this raises concerns ranging from an individual’s inability to pay, to lack of a bank account; to delaying an ED visit until the individual is in crisis; to penalizing those who, as part of their treatment, live with the metabolic side effects of psychotropic drugs (e.g.; Risperdal and obesity).
The amendment’s requirement to submit to drug screening and testing as a condition of eligibility will deter some who need Medicaid from ever applying – a likelihood now heightened by U.S. Attorney General Sessions’ recent announcement of a return to maximum sentences for low-level offenses.
As Wisconsin considers how best to serve its Medicaid population of 1,188,603 enrollees and prepares for negotiations with CMS, an issue brief published this month by the Kaiser Family Foundation, Proposed Medicaid Section 1115 Waivers in Maine and Wisconsin, is useful in highlighting provisions in the amendment that have not been approved in any state: work requirements, time limits, and drug testing. The brief also discusses provisions that have never been approved for traditional non-expansion populations; such as lock-outs for failure to pay premiums. A quote: “Both states’ waiver proposals estimate less coverage and higher costs as a result of the waiver. Wisconsin notes that its baseline costs will be adjusted to account for the financial impact of collecting premiums and higher emergency department co-pays and time-limited eligibility … “.
We appreciate the significance of the process that is about to begin. As a pillar of America’s mental health care system, Medicaid provides roughly a quarter of all financing for mental health and substance use treatment services. Journey Mental Health and NAMI Dane County are committed to working with DHS and Wisconsin healthcare stakeholders at this critical time in order to ensure that the health and mental health care needs of our state’s most vulnerable populations are met. Thank you for your support in maintaining this important dialogue. Let us know what we can do to help.
Ron Lampert, Executive Director, Journey Mental Health &
Lindsay Wallace, Executive Director, NAMI Dane County