‘Medicaid Matters’: What federal funding cuts could mean locally

By Steve Van Kooten

This past Monday, representatives from organizations that utilize Medicaid funding participated in a “Medicaid Matters” presentation at the Prairie du Chien Country Club.

In February, a federal budget resolution instructing the Energy and Commerce (E&C) Committee to cut $880 billion over the next ten years raised questions about possible reductions to Medicaid.

According to the Congressional Budget Office, Medicaid takes up $8.2 trillion, or 93 percent, of the E&C budget. The committee supervises Medicaid and Medicare funding.

As of April 1, Medicaid has not been named in any specific reductions, but it has not received the same safeguard from legislators as Medicare. 

Some lawmakers contend that the E&C cannot make $880 billion in cuts without culling money out of Medicaid.

“That’s why people are asking the question: if you’re taking Medicare out of the conversation, and let’s say [the E&C] did cut everything else, which is pretty unlikely. There isn’t enough money left in all of those other categories to be able to not take something from Medicaid,” said Dan McWilliams, director of Crawford County’s Department of Health and Human Services.

Medicaid divides services into two categories: mandatory and optional. 

“Mandatory programs are something that the federal government says every state has to provide. These have to be included. Depending on the state, there are also optional programs. We live in a pretty fantastic situation right now, where we have all of the options. We have more programs that are funded by Medicaid than most other states. That also means we have a lot to lose,” said Kristy Knoble, program director for the Opportunity Center.

Mandatory services include early and periodic screenings, inpatient/outpatient hospital services, physician screenings, lab and x-ray services, family planning, transportation and home-health services.

Optional services include prescription drugs, dental and vision services, case management, home- and community-based services and hospice. 

Pam Ritchie, executive director of the Opportunity Center, suggested that budget cuts could target those optional programs Wisconsin provides.

She listed possible ways lawmakers could decrease federal Medicaid funding: limiting the amount of Medicaid money spent on each person in their lifetime (a lifetime cap), making policies that make it easier to cut or exclude people from Medicaid programs, reducing federal money to the Affordable Care Act and reducing funding for Medicaid expansions.

Ritchie urged attendees to write and call their state and national representatives to let them know that ‘Medicaid matters.’ 

McWilliams encouraged people to research further, to check unbiased sources and to reflect on what the program does for the community.

More information on Medicaid can be found at https://www.dhs.wisconsin.gov/medicaid/index.htm.

A second presentation will be available at Cafe Hope at 120 North Beaumont Road in Prairie du Chien tomorrow at 5:30 p.m.

Local effect

Around the room, several placards displayed pictures of people in the Prairie du Chien and surrounding area who utilize Medicaid services. On each card, it listed how the funding impacts their lives. For some people, it provides transportation to medical appointments or access to job opportunities or coordination for their healthcare benefits.

“Medicaid is different from Medicare, and we often see people using those terms interchangeably and incorrectly,” said Nicole Baumeister, director for Crawford County’s Aging and Disability Resource Center. “The big difference between Medicare and Medicaid is that Medicaid is our medical assistance — in Wisconsin, it’s our Forward Health card — and Medicare is the federal insurance you’re entitled to when you turn 65 or become disabled.”

Medicaid funding comprises approximately 40 percent of the budget for ADRC of Eagle Country, which serves Crawford, Juneau and Richland counties, according to Baumeister.

“Medicaid is very important to what we do, and it does fund the majority of our budget.”

Medicaid funding pays for institutional care, all health and personal care services paid by the Forward Health card, healthcare for foster children, school-based medical and mental health services for students with individualized education plans (IEPs) and inpatient care for prisoners, among a myriad of other healthcare-related costs.

In Wisconsin, it funds more than 20 programs, including BadgerCare, IRIS, SeniorCare, the Community Support Program, Birth-to-3 programs and community recovery services.

“If your child has an IEP that qualifies for in-school supports, such as occupational therapy, speech therapy, or physical therapy, those things are all paid for by Medicaid dollars,” said Ritchie.

“Mental health services as well,” Knoble added. “A lot of school counselors are paid through Medicaid dollars.”

Other local organizations that utilize Medicaid funding include Crossing Rivers Health, Gundersen Health, Lori Knapp, the Opportunity Center and the Crawford County Department of Health and Human Services (DHHS).

“Medicaid is a big part of how we provide our services,” McWilliams said. “We have a wide variety of services in our department, and without Medicaid, there would be significant changes to some of those things. If Medicaid didn’t exist or changed in some form, it means that some of those services may not be accessible to people.”

He added that Crawford County is the 15th poorest county in the state of Wisconsin.

“There are [a lot of] people in poverty in our county, and they rely on Medicaid for different things.”

As of this past February, there are 3,474 Medicaid-eligible people residing in Crawford County, which is 20 percent of the population.

Elderly and disabled individuals comprise approximately 23 percent of the county’s Medicaid caseload. The county has more than 500 childless adults, 1,424 children and 452 disabled individuals receiving Medicaid services, according to McWilliams.

He added that the federal government accounts for approximately 25 percent of Crawford County’s DHHS revenue, and Medicaid is around five percent of that. 

The reduction or loss of federal Medicaid money could increase the amount of tax dollars the county has to contribute for services like emergency detentions and protective placements, among  many other services.

“If there’s a change at the level above us and it results in changes for even just a few people, [and] they come in contact with these programs, our local tax dollars are paying for those things. And that would increase,” he said. “What I want people to understand is let’s say Medicaid gets cut in some way. It doesn’t mean people stop struggling. If something changes above us in some form — even if it’s a small change — that has big impacts within our county.”