Saturday, January 1, 2022

WisGOPs fine with Feds helping expand medical services. But don't call it ACA or BBB

Wanted to circle back on a request that the Evers Administration put in near the end of 2021 to allow the Feds to pay more for certain Home and Community Based Services (HCBS). I went over this at the time, and the memo from the Legislative Fiscal Bureau noted that Wisconsin was set to have the Feds pay for an additional $700 million in services between now and March 2024, as part of the Biden/Dem-approved American Rescue Plan Act (APRA).

Even better, these services wouldn't require any extra tax dollars needed at the state level, because the Feds would give another 10% of Federal Medical Assistance Percentage (FMAP). But the JFC still had to sign off on this, and we know these guys haven't allowed other Federal funding to go through and/or messing it up.

But not only did the GOPs on Finance allow this extra HCBS funding to go through, we saw some Republicans singing the praises of the extra funding, including State Rep. Donna Rozar from Marshfield.
The Wisconsin Department of Health Services was just granted approval by the Joint Committee on Finance to use new federal money to provide a 5% increase to reimbursement rates for Medicaid home and community-based services (HCBS). Types of HCBS receiving this rate increase include: alcohol and drug abuse, behavioral treatment, in-home nursing, mental health, in-home occupational therapy, respiratory care, respite, and self-directed personal care, among others.

Representative Donna Rozar (R-Marshfield) advocated among her colleagues for approval of this funding and issued this statement after funding was secured:

“As a nurse, I have first-hand knowledge of the benefits in-home services provide and I could not be more pleased to see this funding increase approved. I strongly support this type of funding being used to supplement wages of the people doing the work on the ground so we can recruit and retain top-tier healthcare workers within these critical systems. I appreciate that the service providers in these areas are being recognized for their hard work, but I’m even more pleased for the clients who will have better outcomes for their health needs by being cared for by appropriately compensated individuals. I want to thank my colleagues on the Joint Finance Committee for approving this important request.”
Nice thoughts Rep. Rozar, and getting more long-term care at home or in community settings is indeed badly needed, especially given how overloaded our hospitals and medical facilities are right now.

Want to know what would do the same thing, except have another 20% covered by the Feds? Expanding Medicaid under the Affordable Care Act! But Robbin' Vos and the rest of the Koched-up "leadership" in the WisGOP Assembly won't even consider it, even when it would have saved Wisconsin taxpayers over $1.6 billion dollars over the next 2 years under the same ARPA stimulus that Rep. Rozar praised.

Know what else allows for more HCBS services? The Build Back Better Act! As the Center for Budget and Policy Priorities describes
The Build Back Better legislation creates a financial incentive for states to improve the quality of and increase access to Medicaid HCBS, which are optional services that states don’t have to cover. First, states could apply to receive planning grants from the Department of Health and Human Services (HHS) to develop comprehensive HCBS improvement plans. After the HHS Secretary approves a state’s plan, the state would get a 6 percentage-point increase in its FMAP for Medicaid HCBS. In addition, states would get an 80 percent FMAP for administrative costs associated with implementing the plan, significantly greater than the regular 50 percent FMAP for state administrative costs....

Build Back Better builds on the HCBS investments included in the American Rescue Plan, which made additional federal funding available (also through an FMAP increase) for one year beginning in April 2021 for states to bolster their efforts during the pandemic to help seniors and people with disabilities live safely in their homes and communities rather than in nursing homes or other congregate settings. This funding is helping states shore up HCBS and prevent an erosion of services that could undermine future efforts to expand HCBS to all people who need them.

But even before the pandemic, people already encountered considerable barriers to accessing Medicaid HCBS, with over three-quarters of states reporting wait lists for some services, and widespread reports of workforce shortages and lack of affordable, community-based housing.[19] The HCBS provisions in Build Back Better would allow states to continue the critical work they are beginning with the Rescue Plan investments and make long-term, systemic changes to improve access to HCBS, including through unprecedented actions to bolster the direct care workforce, which is composed primarily of low-income women of color.
A lot of these items just continue what ARPA has already started (albeit at a slightly lower match rate, saving Federal tax dollars), and given the caregiver crisis and filled hospitals, you'd think this would be needed more than ever. So I'm sure Rep. Rozar and the 12 WisGOPs ponm Finance approved of these expanded services in December are demanding that Ron Johnson go along with this provision, right?

Right, guys?

See, Republicans know that bringing long-term care to the home and community works, but they don't want to actually pass a bill to do so because...Obamacare. Or something.

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