The Department of Health Services has released their agency budget request for 2019-21, which can be viewed here: https://doa.wi.gov/budget/SBO/2019-21%20435%20DHS%20Budget%20Request.pdf. These requests help the Governor prepare the state budget, which will be introduced in January or February of 2019.
DHS is requesting a cost-to-continue budget for Medicaid, which is an additional $496 million GPR for the biennium. Part of this is to reflect increased long-term care costs due to statewide expansion of Family Care. DHS also requests an increase for administrative costs, which they say includes EVV for personal care in addition to increased administrative costs from FoodShare and Medicaid work requirements and other federal requirements.
Interestingly, DHS is projecting fee-for-service decreases in intensity/use for personal care, private duty nursing and home health (likely due to Family Care/managed care expansion) but increased fee-for-service costs for hospitalizations and prescription drugs. DHS also projects that nursing facility patient days will decline by 5.0% annually in Fiscal Year (FY)19, FY20 and FY21.
The major funding items they request for the biennium are:
· Increased Medicaid and FoodShare administrative funding for FSET and implementing Medicaid work requirements/FoodShare work requirements passed by the Legislature in the Spring as well as new federal administrative requirements, such as EVV for personal care ($22.5 million GPR)
· Increased costs for the FoodShare Employment and Testing Program, which DHS also plans to use as a way for people to meet the Medicaid work requirement they proposed to CMS for childless adults on BadgerCare ($64.2 million GPR)
· Cost-to-continue for Medicaid ($496 million GPR). DHS says the significant events that will impact Medicaid in the biennium are:
o Statewide Family Care, individuals continue to enroll off the waitlist in Adams and Dane
o Eliminating the waiting list for the Children’s Long Term Support Program, children continue to enroll. In addition, DHS must implement a statewide rate schedule.
o Expansion of SSI-Managed Care resulted in approximately 20,000 new managed care enrollees, this provides significant opportunities for cost-savings
o Phase-out of the enhanced federal matching for CHIP will begin in this biennium. However, standard FMAP is projected to increase while CHIP FMAP decreases.
o Strong growth of the Regional Comprehensive Community Services (CCS) program
o Increased costs for FQHCs
o Medicaid enrollment mix—growth of EBD population—managed care intensity
· Resources to address childhood lead poisoning ($11 million GPR)
· Funding for Income Maintenance Consortia to comply with new public assistance requirements, such as work requirements, health savings accounts and drug screenings ($1.8 million GPR)
· Expansion of the Mendota Juvenile Treatment Center ($11.6 million PR)
· Funding to sustain the Emergency Dispatcher CPR requirements from legislation passed this session ($233,400 GPR)
· Additional funding for outpatient competency examinations, conditional and supervised release, and treatment to competency programs ($4.5 million GPR)
· Increased funding for Mendota and Winnebago Mental Health Institutes to reflect changes in their patient populations ($4.3 million GPR)
· Increased funding for overtime costs at the Mental Health Institutes, DD Centers and the secure treatment centers ($7.7 million GPR)