Gov. Scott Walker failed to reveal that the federal government had ordered him to immediately lift an enrollment cap on a state program to help the disabled and elderly stay out of nursing homes, instead telling reporters that his administration removed restrictions after identifying tens of millions of dollars in efficiencies in the program.
Feds ordered Wis. gov to lift program cap
Walker, a Republican, called a news conference Wednesday morning to announce he would lift the two-year enrollment cap on the Family Care program and expand it to the 15 counties that don't currently offer it.
He imposed the cap in the budget that took effect July 1. Lifting it marks a surprising reversal for Walker, who has been pushing to slash state Medicaid spending since he took office in January.
Walker told reporters the move was spurred by discussions with Family Care program providers that identified $80 million in savings. He never mentioned that the federal Centers for Medicare and Medicaid Services had ordered him to remove the cap more than two weeks earlier. In a Dec. 13 letter to the state, CMS Associate Regional Director Verlon Johnson said the center was still reviewing whether to approve the enrollment cap. Until then, Johnson wrote, the state must run Family Care as it was before the cap was imposed and lift the limit straight away.
"We are directing the state to identify any individuals not currently enrolled onto the Family Care ... and immediately enroll those individuals in the ... programs," Johnson wrote.
Pressed by The Associated Press hours after the news conference about whether the federal government had denied the state permission to impose the cap, state Department of Health Services Deputy Secretary Kitty Rhoades was vague and made no mention of the CMS order.
Walker spokesman Cullen Werwie said in an e-mail Thursday morning that the letter was part of an "ongoing discussion" with the federal agency. He said the cap was always intended to be temporary and that the governor had been planning to lift it for months, pending data on the program's financial sustainability. Although the letter specifically ordered the removal of the cap imposed in the July budget, Werwie insisted the letter only referred to a permanent cap.
Minority Democrats in the Legislature wrote to HHS Secretary Kathleen Sebelius in mid-July, after the budget was finished, calling the cap bad public policy and asking her to reject it. They hammered Walker Thursday morning, calling his news conference a sham.
Rep. Jon Richards, D-Milwaukee, said Walker made a "despicable" attempt to take credit for something he was forced to do.
"I don't remember anywhere in the Boy Scout oath the dishonesty we saw yesterday," Richards said, playing on Walker's assertions that he learned to conduct himself with integrity as an Eagle Scout.
Werwie, the governor's spokesman, reiterated Thursday that the governor had planned for months to lift the cap.
Family Care offers a variety of programs through Medicaid that provide long-term care for the disabled and elderly to help keep them out of nursing homes. The programs' cost has been growing; Family Care cost $936 million last year; the state budget laid out roughly $1.5 billion for it in each of the next two years.
In an effort to control the program's burgeoning costs, Walker included a provision in the budget to cap Family Care enrollment at July 1 levels, which translated to about 43,440 people. As of October, about 6,600 people were on a waiting list to join.
Walker has made cutting Medicaid expenses a priority. Earlier this year his administration froze enrollment in BadgerCare Plus Basic, which provides health insurance coverage for childless adults and announced $554 million in cuts to various Medicaid programs, changes that could force as many as 65,000 poor adults and children off state health insurance. The CMS has given Walker the preliminary go-ahead for those changes, but final approval is pending.
A CMS spokesman said Thursday that all he could say was that the agency was talking to the state and "all issues are under consideration."
Lifting the enrollment cap will take legislation. Walker's fellow Republicans control both the Senate and Assembly, but Rep. Robin Vos, R-Rochester, co-chairman of the powerful finance committee, broke with Walker on Wednesday and said there's no evidence to suggest Family Care is cost-effective and expanding it would be irresponsible.
A message left at Vos' state Capitol office Thursday wasn't immediately returned.
Beth Swedeen, executive director of the Wisconsin Board for People with Developmental Disabilities, appeared beside Walker at his news conference Wednesday. She said Thursday she didn't learn of CMS' order to lift the cap until she saw media reports about it hours after the news conference.
She declined to comment on Walker's failure to disclose the letter, saying her organization is focused on making sure Family Care is adequately funded and provides high-quality services.
"For us, the bottom line is the outcome," she said. "We're very interested in making sure those cost savings won't be detrimental to the populations (Family Care programs) serve."
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