Governor Jim Doyle’s Roadmap to Universal Access to Health Care for all Wisconsinites Even During Difficult Economic Tim

1. Governor Jim Doyle’s Roadmap to Universal Access to Health Care for all Wisconsinites Even During Difficult Economic Times Jason A. Helgerson Wisconsin Medicaid Director February 22, 2010

2. Governor Doyle’s Health Care Vision • Every Wisconsin resident will have access to affordable health insurance • Every child will have access to high-quality health care services • The state must lead the way in meeting these goals • Health care programs must be simple and easy to access

3. Wisconsin’s Health Care Challenges • Access – While progress has been made, some Wisconsin residents do not have access to affordable health insurance that meets their needs • Cost – Costs are increasing, both for health care and for insurance coverage • Quality – Lack of easily accessible information about the quality of care and medical errors are far too common • Medicaid Financial Stability – State must maintain sustainable financing for Medicaid

4. Three Phases for Health Care Reform Wisconsin continues to expand access to health care during difficult economic times • Phase One: BadgerCare Plus – All Kids • Phase Two: BadgerCare Plus Core Plan - Adults with no dependent children • Phase Three: BadgerCare Plus Basic Plan - Adults on the Core Plan waitlist • Together the programs ensure that 98% of Wisconsin residents have access to affordable health insurance

5. Impact of Expanding Access to Health Care • Phase One: In just under two years, approximately 200,000 individuals enrolled, including more than 122,000 kids • Phase Two: In three months, received 72,000 applications from childless adults. 65,000 individuals are currently enrolled • Phase Three: Approximately 23,000 individuals on the Core Plan waitlist will have the opportunity to buy into the Basic Plan • Across all programs, Wisconsin Medicaid provides health care services for 20% of Wisconsin residents (1.1 million)

6. Wisconsin’s Budget Climate Wisconsin continues to expand access to health care during difficult economic times • In the current biennium, Wisconsin solved a potential deficit of approximately $6 billion, including a $600 million budgetary challenge for the Medicaid program • Enhanced FMAP - estimated $1.2 billion over ARRA period • Wisconsin Medicaid needs to be part of solving the budget challenges • Working with providers in a new and unique way to find savings – MA Rate Reform Project

7. Wisconsin Medicaid Rate Reform Project • On track to save $633 milllion all funds as required by the 2009-11 state budget • However, Medicaid program grows during difficult economic times • Demand for Medicaid services exceeds current funding • Continually looking for more efficiencies and enhancements to the program • Result = Wisconsin Medicaid Rate Reform 2.0

8. Wisconsin Medicaid Rate Reform Project: Guiding Principles • Identify savings to reach targeted reduction levels • Look for both short-term solutions and long-term systemic changes • Ensure that no one provider group is singled out for rate reductions • Ensure access to care for MA patients • Align payments with value rather than volume • Build on previous MA quality improvement efforts including managed care P4P initiative • Implement care management/coordination strategies • Focus on high-intensity services • Cost containment now about “continuous improvement”

9. Wisconsin Medicaid Rate Reform Project – Specific Proposals • SE Wisconsin Managed Care RFP • Reimburse Physicians based on cost effectiveness • Create an incentive for nursing homes to avoid preventable adverse health conditions (e.g. pressure ulcers) or other alternative • 100 Day Supply requirement for specified maintenance drugs/early refill limits • Reimburse C-Sections at Same Rate As Vaginal Deliveries, Unless C-Section is Medically Necessary • Care Management contract for high cost Fee-For-Service members

10. Conclusion • Thanks to BadgerCare Plus, Wisconsin leads the nation in health care access. • Budgets are about values and priorities. Governor Jim Doyle has made health care access a priority during good and challenging budget times. • Managing the budget effectively must include engaging stakeholders and thinking creatively. • In Wisconsin, we have adopted a “continuous improvement” approach to managing Medicaid.