Wisconsin Medicaid Director Michael Heifetz says the Walker administration’s push to drug test childless adults on the health care program isn’t about kicking people off the program. Rather, its aim is to help people get the treatment they need and “move back into productive lives.”

Heifetz spoke May 4 as part of a WisPolitics.com panel discussion that focused in part on a key Medicaid waiver to the Trump administration. Critics have called the drug screening and testing requirement — the first in the nation for Medicaid — a mean-spirited proposal that would push people off their health care.

One attendee, for instance, said some European countries are seeing success by giving people more access to treatment, jobs and education, asking Heifetz “how does kicking people of Medicaid” if they have a drug problem help them in any way.

But Heifetz said the premise that the state is “kicking people off” a program is wrong, noting people would have the option to enter treatment if they test positive. The correct way of viewing the proposal, he said, is that the state is “helping folks and providing the resources necessary” for them to beat their addiction.

“There are a lot of jobs in this state, and employers simply can’t fill them because folks can’t pass a drug test,” he said. “We’re trying to help with that.”

Joining Heifetz on the panel was Wisconsin Hospital Association President and CEO Eric Borgerding; John Russell, the president and CEO of Columbus Community Hospital; and Jon Peacock, the research director at the liberal-leaning Wisconsin Council on Children and Families.

Peacock said there are “far better ways” to help with people’s addiction problems than drug testing them. One key solution, he said, is taking the Medicaid expansion under the Affordable Care Act, which he said would expand people’s access to primary care doctors who would then be able to talk to patients “without bureaucrats in between” about substance abuse issues and get them help.

The Department of Health Services is planning on filing its request with the Trump administration this month, and its changes would largely affect only childless adults on the program.

DHS wants to require childless adults on Medicaid to answer a set of written questions, and the agency would then drug test those whose answers indicate they might use drugs. If people test positive, they could enter a treatment program. But people would lose eligibility for six months if they don’t enter that program or refuse to take the questionnaire or test.

DHS also wants to add premiums to Medicaid for those under the federal poverty level, though those who make between zero and 20 percent of it wouldn’t be subject to the premiums. The amounts people would pay range between $1 to $10 per month, depending on the household’s income. The proposal applies to non-pregnant childless adults between 19 and 64 years old, and those who don’t pay premiums can lose Medicaid benefits for six months.

Peacock said premium payments would be difficult for people who have several other priorities to pay for don’t have checking accounts

“Those are huge barriers for people to participate in BadgerCare, and we’re going to see a very sharp drop-off,” he said.

WHA’s Borgerding added that that DHS may not be able to collect all the premiums and people would then lose their Medicaid benefits. That, he said, would lead to people showing up at emergency rooms and sticking hospitals with the bill, adding that the “impact in uncompensated care dwarfs that $2 that wasn’t collected.”

He also said it’d be difficult to collect co-pays from people who go to the emergency room, as a separate item in the DHS request would call for.

Russell said people who lose Medicaid benefits are “still going to come to us” in emergency rooms, which generally leads to higher health care costs.

“If they delay care, they’re still going to need care — and maybe more expensive care then at that point,” he said.

The hospital leaders also raised concerns about the state’s reimbursement rates for those who treat Medicaid enrollees, which Borgerding said shifts $1 billion in costs to everyone else.

Low reimbursement rates are also a problem for other types of providers such as dentists or those who offer mental health services, Peacock said, though he said overall Medicaid is an “extremely effective program.”

Sen. Janet Bewley, D-Ashland, raised concerns during the event over provider shortages in northern Wisconsin and asked how the state can prevent rural areas from turning “into medical deserts.” People in her district, she said, are more dependent on Medicaid, affecting providers across all areas of care who aren’t getting paid enough.

“We are finding more and more, in behavioral health, in addiction treatment, in general Medicaid and in nursing homes — we are losing the ability to just literally stay in business,” she said.

Borgerding said it’s “a big problem and it’s not just limited to Medicaid,” saying the state needs to continue focusing on how to grow the workforce in the health care field by, for example, boosting training and opportunities for medical students who want to practice in rural areas.

Heifetz said of nursing home closings are “obviously a challenge” the state recognizes, adding that Walker’s budget makes some progress on that issue.

Still, he said, the state can’t come up with money to boost reimbursement rates for every provider, and the industry is going to need to “come to us with a little bit more creativity” on managing costs.

“Everyone tells me they’re under-reimbursed, but I do not print money, nor does the governor,” he said.

Listen to the luncheon: https://soundcloud.com/wispolitics/luncheon-the-future-of-medicaid/s-XSzK8

Print Friendly, PDF & Email