Many individuals and families cannot afford health insurance in our state. This is a critical need for too many people in Wisconsin, and the situation is especially urgent for Wisconsin’s communities of color. We must take action. Governor Evers’ budget invests in access to affordable health care and commits to policies and funding designed to break down structural inequities and improve health outcomes.
Provide affordable health care coverage for more people
Too many Wisconsinites do not have access to high quality health insurance coverage, and many others have coverage that is too expensive. For any Wisconsinite to go without medication or medical and dental care is unacceptable, and it is past time to right that wrong.
BadgerCare Plus provides access to over one million Wisconsinites. Expanding Medicaid in other states has improved access to care and reduced out-of-pocket costs at the individual level, helped keep hospitals open at the community level, and reduced premiums in the private insurance market. Expanding access to Medicaid will cover approximately 90,000 more Wisconsinites, half of whom were previously uninsured, and will save Wisconsin $634 million in state funding by drawing down $1.3 billion in federal funding for Wisconsin.
Medicaid expansion will provide affordable health insurance to approximately 90,000 Wisconsinites, half of whom are currently uninsured. With insurance, members will seek more preventive care, including behavioral health care, which will improve physical and mental health outcomes.
- In other states, nearly 30% of people covered by Medicaid expansion have a mental health or substance use disorder.
- States with Medicaid expansion have seen an increase in treatments for opioid use disorders.
- In addition to health outcomes, expanding Medicaid will increase the financial stability of low-income families, as seen in other states.
Expanding coverage will make sure that Wisconsin will realize our fair share of federal funding to keep our citizens healthy.
Badger Coverage Plan
Families and individuals whose incomes are too high to qualify for Medicaid can purchase subsidized coverage on the Affordable Care Act Exchanges. However, many plans still have cost-sharing requirements that make affording that coverage difficult. To build on the coverage gains associated with Medicaid expansion and to make sure affordable coverage is accessible to all Wisconsinites, Governor Evers addresses these issues in the budget for the Office of the Commissioner of Insurance.
- Creating a state-based Affordable Care Act Marketplace will replace the current federally operated marketplace and more effectively meet the needs of the residents of Wisconsin and our insurance markets.
- Developing additional subsidies funded by the state will help Wisconsinites purchase private coverage.
- Developing a proposal for a public insurance plan in Wisconsin will make coverage more accessible in the future, helping protect families from the impossible choice between health care costs and paying rent or putting food on the table.
Hospitals and other health care providers are integral to their communities and help drive local economies. Investing in providers will increase their financial stability, help attract and retain medical professionals in Wisconsin, and drive local economic growth.
Expanding coverage and increasing Medicaid reimbursement for hospitals as well as primary care and specialty providers will reduce uncompensated care.
The accessibility and affordability of prescription drugs is a priority of Governor Evers’ budget. The Governor's Task Force on Reducing Prescription Drug Prices brought together stakeholders to comprehensively address soaring prescription drug prices in Wisconsin. The provisions in this budget build on the work of the Task Force to reduce prescription drug costs, increase transparency, and protect Wisconsinites. These initiatives will be implemented by several agencies across state government.
- Creating a Patient Pharmacy Benefit Tool through an Office Commissioner of Insurance budget provision will help prescribers take cost into considerate when choosing between medication options that are medically similar.
- The tool will help better inform discussions between patients and their health care providers when making decisions.
- Eliminating Medicaid and BadgerCare Plus copays for prescription drugs will make medication more affordable for Wisconsin’s older adults, individuals with disabilities, and families.
- A comprehensive drug benefit will cover both generic and brand name prescription medication, as well as some over-the-counter drugs.
- Increasing funding for free and charitable clinics will provide health services to more of Wisconsin’s most vulnerable populations.
- Free and charitable clinics provide vital services to uninsured, underinsured, and underserved Wisconsinites.
Many Wisconsinites, including those covered under Medicaid, have trouble accessing dental care. Incentivizing both existing and new provider types will help serve children and adults across our state.
- Providing critical access payments for Medicaid providers will expand the network of dental providers available to work with Medicaid patients.
- This will improve access statewide because the program will cover 68 counties in Wisconsin, while the remaining four are in an existing funding pilot program.
- Rural dentist loan forgiveness will allow dentists to receive up to $100,000 in loan forgiveness.
- This program exists for both dentists and physicians who practice in shortage areas or certain types of practices (like in rural areas).
- The increase for dentists would match them with the amount available to physicians.
- Creating licensure for dental therapists, similar to a licensure found in Minnesota, Michigan, Arizona, and several other states, will increase access to dental care for underserved populations.
- The services a dental therapist can perform are more limited than those authorized for a dentist.
- However, the services they can perform, such as dental exams, fluoride treatment, sealants, and crowns, are integral to dental hygiene and overall health.
- More people who can perform these services are needed in Wisconsin, but dental school is cost-prohibitive for many people who are interested in serving this need.
What's best for our kids
Our children are a priority for our entire state government, and protecting their health and safety is integral to our mission as a department and an administration. Ensuring Wisconsin is a place where every child can thrive is central to Governor Evers’ budget, including investments in protecting kids from dangerous substances, supporting children with special health care needs, and making behavioral health services accessible to youth in need.
Childhood Lead Poisoning Prevention
Lead poisoning can hurt anyone, and while children under the age of six are most vulnerable to brain and other bodily system damage, that effect can last a lifetime. Lead poisoning is also entirely preventable: we can protect children by making sure the homes they live and play in are free from lead dust.
The Birth to 3 program provides early intervention services to young children who are at risk for or who have developmental delays. Birth to 3 improves child developmental outcomes and reduces the need for long-terms supports for some children later in life.
- Currently, children with lead exposure are eligible for Birth to 3 programming if their blood lead levels are 10 μg/dL (micrograms of lead per deciliter). This is twice as high as the current definition of elevated lead blood level by the Centers for Disease Control and Prevention (CDC).
- Changing Birth to 3 eligibility to the CDC definition of will serve an additional 2,000 children and families each year with essential early intervention services which prevents lead poisoning.
By further supporting the Windows Plus Program, we will provide lead-safe renovation in 100 homes.
- This program is available to families with children (who have not yet been identified with lead poisoning), who meet income eligibility, and whose home was built before 1950.
- The construction work will be conducted by local contractors.
The Lead Outreach program at Sixteenth Street Community Health Center tested 7,253 children in 2019. The program has not seen an increase in state funding in 25 years, despite the increase in program and personnel costs.
The Lead Safe Homes Program, which is a Health Services Initiative operated under the Children's Health Insurance Program, makes it possible to abate lead hazards in eligible homes of children and pregnant women. The program is projected to abate hazards in over 800 homes over the biennium.
Tobacco Use Prevention
Tobacco is our state’s leading cause of preventable death. More and more young people are using vaping products like e-cigarettes, and they are starting to use at younger and younger ages. We must prevent tobacco use and vaping among children, and Governor Evers’ budget increases the age for tobacco purchase from 18 to 21 and increases the tax rate for e-cigarettes and other vaping products. The budget also creates a public health campaign run through DHS with the goal of preventing youth from starting tobacco use or vaping in the first place.
Eliminate Children's Long-Term Support Waitlist
The Children’s Long-Term Support program provides services and supports to individuals under the age of 22 with significant developmental, physical, or emotional disabilities, and it is designed to help children and young adults stay in their homes or communities.
- As of July 2020, 10,972 children were enrolled in the Children’s Long-Term Support program, and 1,198 children were on the waitlist.
- Governor Evers’ budget includes sufficient funding and changes to statutory language to ensure that any child who applies and is determined to be eligible will be able to enroll in the Children’s Long-Term Support program.
- The Children’s Long-Term Support Program is the only Medicaid long-term care program that does not already have a statutory commitment to serve all eligible individuals who apply.
Funding Increase for Autism Services
Autism Spectrum Disorder is a developmental disability that can cause significant social, communication and behavioral challenges, and Wisconsin’s current Medicaid reimbursement rates for behavioral treatment are lower than in neighboring states.
This increase in Medicaid reimbursement rates for behavioral treatment for children with Autism Spectrum Disorder will bring rates closer to rates in these other states and help ensure access to these services.
Expansion of Child Psychiatry Consultation Program
Wisconsin Child Psychiatry Consultation Program helps address shortages in child and adolescent psychiatry by supporting primary care providers caring for children and adolescents with behavioral health concerns.
The Wisconsin Child Psychiatry Consultation Program provides consultation, education, and referral support to primary care providers. Increasing the funding for this program is one piece of the puzzle in addressing the behavioral health needs of children and adolescents in Wisconsin.
Healthy women, healthy babies
Quality health care for women makes our state a healthier, safer place. In fact, studies show that infant mortality is a crucial indicator of the health of the overall population. Mothers and babies without access to affordable health insurance and vital services receive less preventive care and even have higher mortality rates. Structural barriers, like lack of health insurance, quality housing, and accessible transportation, and systemic racism exacerbate these inequities.
Wisconsin faces some of the worst health inequities in the country when it comes to maternal and infant mortality rates. Black babies are three times more likely to die than white babies (the white infant mortality rate is 5.2 per 1000 births compared to a rate of 15.7 for Black babies). Further, at 15.7 per 1000 births, the mortality rate of Black babies in Wisconsin is the worst in the nation. The rate of maternal mortality is five times higher for Black mothers in Wisconsin that it is for white mothers. Governor Evers’ budget proposes foundational reforms to address these disparities and ensure health for all women across the state.
Extend Postpartum Coverage for Pregnant Women in Medicaid
Medicaid covers pregnant women up to 300% of the federal poverty line. Under current policy, this coverage lasts for 60 days after the birth of a child, and this provision would extend that coverage to one year.
- After the birth of a child, women in the postpartum period are particularly vulnerable to depression and suicide, which can have a lasting effect on their health and the health of their child. At 60 days, women are losing coverage right when they need it most.
- Providing access to high-quality and uninterrupted health coverage for a full year improves the health of the mother and child. And as is true nationally, women of color are more likely than white women to be covered by Medicaid, meaning that they are more affected by these coverage policies. By expanding coverage to a full year, this budget will also help address the racial gap in maternal and infant mortality rates. It also gives the women more time to find and access other health insurance options.
Doulas provide physical, emotional, and educational support to mothers before, during, and following childbirth. Their support helps women and children see better health outcomes. Coverage for certified doula services under Medicaid will provide access to this valuable support for more women in Wisconsin. The focus of this coverage is to reduce the significant racial and ethnic disparities for birth outcomes in our state, ensuring the health of every mother and child.
Women's Health Block Grant Funding
We have built a statewide network of providers to ensure preventive and reproductive health services are accessible to low-income individuals in Wisconsin, including mothers, children, and families.
- These preventive and reproductive services include primary care, cancer screenings, developmental support services, services for sexually transmitted infections and contraception services, and more.
- By eliminating restrictions on services and types of providers allowed to partner with the state, women will have more options for care and will be able to make well-informed health decisions for themselves.
Ensure the health of every Wisconsin resident and community
In our state, structural barriers and systemic racism create a lack of access to quality health care, housing, transportation, and job opportunities, all of which have negative health outcomes. Health disparities make many Wisconsinites more vulnerable to illness, injury, and even death, and COVID-19 has only made the inequities along racial, ethnic, gender, age, income, and geographic lines even worse.
Compared to other states, Wisconsin consistently ranks among the lowest in health disparities by race.
- In our state, African American babies are three times more likely to die in infancy than white babies. Native American/Alaskan Native babies are two times more likely to die in infancy than white babies.
- African American women in Wisconsin are seven time more likely to die of a stroke than white women.
Low-income residents of Wisconsin are twice as likely to have a stroke or heart attack than middle or high-income residents.
It is past time to change this reality, but Wisconsin has a long tradition of pulling through by pulling together, and Governor Evers’ budget invests in communities to remove barriers and build together.
Health Equity Community Grants
Through grants to local and tribal health departments, this funding empowers departments to create health equity plans tailored to the unique health equity concerns found in their communities.
Health equity action plans will support community engagement and build capacity at the local level.
Community Health Benefit
Factors like housing instability or food insecurity, can have significant negative impacts on your health, just like illness. However, to address these economic and social determinants of health, we need to make critical investments in prevention.
The new community health benefit for Medicaid members will address non-medical drivers of health outcomes.
- Services will include housing referrals, nutritional mentoring, stress management, and others that can positively impact the economic and social situations of Wisconsin residents.
- This provision authorizes us to apply for the waivers we will need to implement the benefit.
- Fully implemented, this benefit will serve an estimated 12,500 residents of Wisconsin.
Community Health Workers
No one knows the strengths and challenges of a community better than the members of that community themselves. Investing in front line community health workers and clinics means investing in our communities and the quality of life of everyone who lives within them. An innovative model of care, community health workers promote health and reduce disparities in local communities through prevention, education, and early intervention. Prevention efforts lead to better outcomes and cost savings.
- Grant funding will make it possible for local communities to implement community health worker models.
- Providing Medicaid reimbursement for community health worker services will expand access to prevention services.
Community Health Centers and Free and Charitable Clinics
Serving low income and uninsured Wisconsinites, community health centers and free and charitable clinics are frontline providers in local communities. By investing more fully in these providers, we are investing our neighbors and protecting the health of Wisconsinites in need.
Minority Health Grants Expansion
Focusing on areas of the state where health disparities are high, these grants support the work of organizations serving communities of color. By increasing funding, these grants will focus on improving Black women’s health.
- Funding will go to community organizations led by Black women working to improve Black maternal and infant health.
- In connection with state agencies, community organizations, and public and private sector stakeholders, a grantee will develop a statewide public health strategy to advance Black women’s health.
Tribal Shared Savings Initiative
Federal policy allows state Medicaid programs to draw down enhanced federal funding to Medicaid members of federally recognized tribes. However, under current Wisconsin policy, the state does not have a mechanism to allow tribes to benefit from enhanced federal funding for when a tribal member receives care outside Tribal health centers.
By enacting this provision, the state will be able to share the federal funding with tribes for care beyond federally qualified health centers.
- Access to this funding will mean tribes strengthen their health systems, hire more staff, expand services, reduce uncompensated care, and update technology.
- By encouraging tribal health directors to enter into agreements with other facilities to serve tribal members, this provision will also increase federal funding to the state.
This is a key step towards addressing health disparities that have gone unanswered for far too long in Wisconsin. Establishing the necessary statutory definition will ensure these federal savings will be passed onto tribes on an ongoing basis.
Healthy Eating Pilot
Offering FoodShare members a discount on fresh produce and other healthy foods can serve as an incentive for Wisconsinites to eat healthier. Using the pilot to build a network of retailers to offer the incentives will create the potential to expand statewide. While this initiative was approved in 2019, state money was not appropriated for implementation.
FoodShare Access at Farmers' Markets
Healthy food options improve health and wellness, making sure FoodShare can be used at local farmers’ markets is a great way to meet this need. By making sure local farmers’ market vendors have the technology they need to accept FoodShare benefits, we will increase access to fresh fruits and vegetables for Wisconsin families while also supporting local farmers.
Health in All Policies Action Team
All state policies affect health and health equity, but not all policies are understood in this way.
- We will identify strategies for achieving health equity through state policies.
- To develop a collective action plan, the team will first engage with stakeholders and provide research and analysis.
FSET Statutory Language Repeal
Under current statute, there are work requirements for parents of school age children in the FoodShare program and for childless adults in the Medicaid program, as well as drug screening and testing requirements, as well as pay for performance awards for employment and training vendors. These provisions have not yet been fully implemented, and doing so will cost our state over $140 million to set up monitoring and reporting systems.
Repealing these requirements will save the state money and prevent unnecessary barriers to accessing food and medical care. This is especially important during a pandemic and economic downturn.