Wednesday, February 1, 2012

More Medicaid hijinks in Walker World - Just trust us and give Grandma the pills!

Looks like the Walker boys are still trying to live out their fantasies of screwing up Wisconsin's successful medical assistance programs in new and creative ways. This week, the Legislative Fiscal Bureau released updated Medicaid numbers, and it showed that Medicaid faced a deficit of nearly $141 million GPR through 2013. Interesting in that number is that it is up from the $92.3 million GPR deficit from the original Medicaid deficit figures released earlier, and like earlier, moves by the Obama Administration are lowering the costs to Wisconsin taxpayers, while Walker Administration screw-ups are causing the situation to be worse than it should.

I'll break down the LFB release that explains how we got here. First off, it goes over why the reduced deficit was first revealed at the start of January- lower-than-expected costs for many Medicaid-related programs, and lower costs from the Obama Administration on items such as Medicare part A and B and drug rebates (THANKS OBAMA!). The Walker Budget also overestimated the amount of people on Badgercare without children by NEARLY 50 PERCENT (oops!).

Then it's on to the good stuff- the costs of having to follow the Obama Administration's mandate to lift the Family Care cap. (remember that giant fuck-up and lie that Walker tried to pull?) The LFB says that it won't cost as much as the Walker folks thought it would, $71.8 million vs. an original estimate of $80.4 milllion, but that still won't keep ALEC cabin boy Robin Vos from whining "We can't afford it! We need to move these old and disabled folks into nursing homes so my contributors can get more income!" (Oh sorry, the second sentence only comes out in private, kinda like when he talks voucher schools with Mike Ellis at Inn on the Park).

The next is $23.2 million in savings due to a waiver given by the Obama Administration "that allows states to fully or partially restrict MA eligibility for non-disabled, non-pregnant adults with incomes over 133% [of poverty] if the state certifies that it has a state budget deficit in the current the upcoming fiscal year." Yep, this is from the Walker Administration's admission that we have a GAAP deficit of around $3.0 billion each of the next 2 years. This despite the budget being "balanced," of course.

Oh, and this $23 million isn't guaranteed either, as
Although CMS did not approve all of the components in the Medicaid 2014 Demonstration waiver by the December 31, 2011 deadline, it is the administration's position that CMS hs preliminarily approved enough of the Department's request to consider the waivger "approved."
Of course, what happens if the Obama Administration DOESN'T approve it? Well, there's another $23.2 million in cuts to go, now isn't there!

This "hey, trust us" sketchiness continues on the other cutbacks, as they assume the Obama Administration will allow the Walker boys to cut off 29,100 from BadgerCare Plus, and that the "barely above poverty" group on BadgerCare Plus will be pushed onto an "Alternative Benchmark Plan", which is another $26.2 million in cuts and higher premiums for people that are already living on the edge. Again, what happens if CMS says "No, cover people if you want to get paid by us."? Well, there's another $93 million to figure out.

There's another great group of $20 million in planned savings when it comes to elderly and disabled home care, only made possible by lifting of the Family Care caps that the Walker folks didn't want to raise in the first place. Nearly $14 million in savings are to be from people who go onto Family Care and get assistance at their homes instead of through a nursing home or other assisted-living facility, and another $6.2 million come from getting nursing-home patients to head home or to other living arrangements, due in no small part because of the cheaper costs to have that person on Family Care.

Another at-home program the DHS wants to put in is $36 million in estimated savings resulting from "...medication dispensers to [be placed] in the homes of approximately 6,700 elderly, disabled, and mentally ill MA patients", and it would reduce the need for hospital and nursing home stays due to people not taking their medication. That's right, Grandma and the disabled are going to get to take their prescription drugs home. (what could go wrong there?) Even the LFB paper admits the reasoning is iffy at best, since the idea was based on a study done in Oregon 30 YEARS AGO.
This study may have limited relevance to the DHS proposal for several reasons, including the study's age, the possibility that Oregon's population may not be similar to Wisconsin's, and that Wisconsin has had managed care for many years while Oregon did not in 1981. [And] Wisconsin's current nursing home population is much smaller and has greater care needs (acuity) than it had 30 years ago...
Oh, and there are other examples listed in the LFB write-up that show this study doesn't come close to applying to Wisconsin's situation and that little should be assumed to happen here. But otherwise, no problem, and I'm sure those $36.0 million in savings will materialize right away (sarcasm off).

Lastly, there's an assumption of $75 million in "Administrative" savings that the Legislature doesn't get to vote on. This includes DHS intiatives like better reporting systems and "Auditing Enhancements." Now, they can't guarantee any of this will happen, but hey, they're workin' on it, and shouldn't that be enough?

Uhhh, no that isn't enough. Almost all of the Walker Administration's methods to solve this $141 million Medicaid deficit (which proves the budget was never balanced) are based on hopes, prayers, half-baked ideas and rosy scenarios. It's a pathetic act, but it's become par for the course with these guys, and it's why I have to write out these long posts breaking down all these lies and trickeries, because you have to see how many ways these guys are wrong to understand the severe danger these guys are trying to impose. It's really like the college kid who's writing a paper on a subject he doesn't have a clue on - if you throw enough bullshit and random information together, maybe the grader gets confused, and you'll be able to slide by with a grade you don't deserve.

Sorry, but when you're talking health policy for our most vulnerable, we can't let that happen. Once these plans fail to come through (which you know will happen, it always happens in Walker World), then Dennis Smith and Company in DHS will use that "emergency" to dismantle the successful Medicaid program and give their insurance company donators a new group of fresh meat to grab high premiums from. So we have to cut this off and expose it NOW, or else be stuck in a bigger hole later.

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