Wednesday, February 8, 2023

Will WisGOPs allow Medicaid, child care coverage barriers to go back up in coming months?

As the COVID era ends, many of the additional boosts in services and higher federal assistance is also winding down. And that means states and localities are going to have to figure out if they want to keep providing those services, and figure out how to pay for them. In Wisconsin, Medicaid and child care programs are going to be in extra focus for the next state budget, precisely because help from DC is going away.

Let's start with the Medicaid situation. As the Legislative Fiscal Bureau mentions, Wisconsinites have not had to worry about being cut off of Medicaid since the COVID pandemic first broke out nearly 3 years ago. And the state has received more federal funding to pay for those Medicaid recipients in that time.
The federal Families First Coronavirus Response Act of 2020 (FFCRA) provides enhanced Medicaid matching rate for the duration of the federal public health emergency for the COVID-19 pandemic. As a condition of receiving the additional matching funds, states are required to maintain Medicaid eligibility for any person who was enrolled in the program as of March 18, 2020, or who later becomes eligible for coverage, until the federal public health emergency expires. In response to these provisions of the FFCRA, the Legislature passed, and the Governor signed, 2019 Act 185 in April of 2020, authorizing the Department to suspend disenrollment of current MA beneficiaries.

Owing to this moratorium on disenrollment, as well as the economic disruptions caused by COVID-19, enrollment in most MA categories increased over the next three years, but the increases were generally greater in BadgerCare Plus eligibility categories. Table 3.3 shows the enrollment for each of the BadgerCare Plus and related program eligibility groups in January of 2020 (prior to the pandemic), and in October of 2022, along with the percentage increase.

And in the next 8 weeks, that could change. Especially if the GOP-controlled State Legislature takes no steps to change enrolment measures (although they may lose the enhanced coverage amounts that phase down in 2023).
As a condition of receiving a temporary 6.2 percentage point increase in its federal medical assistance percentage, states have been required to maintain enrollment of nearly all Medicaid enrollees during the COVID19 pandemic. Federal legislation passed in December of 2022 established an ending date for this continuous enrollment policy of March 31, 2023, at which point all renewals that were postponed will need to be reprocessed. States may take up to 12 months, to initiate pending verifications, redeterminations based on changes in families' circumstances, and renewals, and return to normal eligibility and enrollment operations. After that, states will have an additional two months to complete all pending actions. In addition, states are required to take steps to transition individuals who, after the [Public Health Emergency] ends, are determined to no longer qualify for Medicaid, to other affordable insurance programs, including qualified health plans offered under the Affordable Care Act.
The Medicaid provisions that were part of the COVID emergency come to an end on March 31. At that time, a large number of Wisconsinites are going to have to re-enroll in Medicaid, or be taken off of Medicaid and either get insurance through another means, or go without any health coverage.

The Center for Budget and Policy Priorities says that this change will be especially disruptive in a state like Wisconsin, where Republicans in the Legislature have chosen not to expand Medicaid under the Affordable Care Act. In fact, the CBPP says that Wisconsin will have the highest percentage increase in the uninsured population once the COVID-era provisions end.

Along the same lines, child care services in Wisconsin are also facing a big cliff in 2023, leading to a situation that will come to a head in the coming months.
Evers plans to include more than $340 million in his executive budget toward making Child Care Counts, which has been operating under temporary pandemic funds, permanent. The state stabilization program, which financially supports child care businesses and the families that they serve, is credited with keeping more than 3,000 child care centers open. Advocates warn lack of investment could mean dire consequences for all Wisconsinites.

Evers also pledged more than $11 million each fiscal year for Partner Up, a state grant program that helps employers provide employees with free or reduced child care.
But these forms of state and federal support are set to phase out over the next year, and parents and child care centers could be forced to take on these extra costs themselves if the assistance isn't extended in the next state budget. Or parents and providers could lose the child care coverage they already struggle to pay for and provide.
A National Association for the Education of Young Children survey found over 60% of responding Wisconsin child cares would have to raise tuition if stabilization grants cease….

Child care is already unaffordable for most Wisconsin families. The U.S. Department of Health and Human Services considers child care affordable if it takes 7% or less of a household's income, all children included. Brooke Skidmore, owner and director of New Glarus' The Growing Tree Child Care Center and WECAN co-founder, said that many families devote 20% to 40% of their household income for one child alone.

In an effort to recruit and retain a notoriously low paid workforce in the midst of a staffing shortage, many child care businesses use Child Care Counts as a way to better compensate their employees. If the program ends, over 30% of Wisconsin providers included in the NAEYC survey said they would not be able to sustain wage increases and bonuses.
So are GOPs in the Legislature going to do nothing, and put a large number of child care centers and the families that rely on them into the lurch? And are Governor Evers and WisDems going to hammer into Wisconsinites’ brains that it is up to GOPs to decide as to whether these child care services continue to get support?

After 3 years of these expanded programs, and how we have seen it work in reducing the uninsured rates and expanding access to child care, are GOPs really going to shrug, and let us go back to the gaps and barriers that were subpar before COVID-19 was ever a thing? And are we going to let them?

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