Gov. Tony Evers celebrates "historic" tax cuts in the last state budget. Schools are still facing austerity. Photo via Gov. Evers' Facebook page

As Republicans in Congress struggle to deliver President Donald Trump’s massive cuts to Medicaid, food assistance, education, health research and just about every other social good you can think of, in order to clear the way for trillions of dollars in tax cuts to the richest people in the U.S., here in Wisconsin Gov. Tony Evers and state lawmakers are working on the next state budget.

The one thing our Democratic governor and Republican legislative leaders seem to agree on is that we need a tax cut.

After throwing away more than 600 items in Evers’ budget proposal, GOP leggies now say they can’t move forward with their own budget plan until  Evers makes good on his promise to meet with them and negotiate the terms for the tax-cutting that both sides agree they want to do. Evers has expressed optimism that the budget will be done on time this summer, and said the tax cuts need to be part of the budget, not a separate, stand-alone bill. Evers wants a more progressive tax system, with cuts targeted to lower-income people. In the last budget, he opposed expanding the second-lowest tax bracket, which would have offered the same benefits to higher earners as the lower middle class.

But what if we don’t need a tax cut at all?

It has long been an article of faith in the Republican Party that tax cuts are a miracle cure for everything. Trickle-down economics is  a proven failure:  The wealthy and corporations tend to bank their tax cuts rather than injecting the extra money into the economy, as tax-cutters say they will. The benefits of the 2017 tax cuts that Congress is struggling to extend went exclusively to corporations and the very wealthy and failed to trickle down on the rest of us. 

 In the second Trump administration, we are in new territory when it comes to tax cutting. The administration and its enablers are hell-bent on destroying everything from the Department of Education to critical health research to food stamps and Medicaid in order to finance massive tax breaks for the very rich. 

If ever there were a good time to reexamine the tax-cutting reflex, it’s now.

Evers has said he is not willing to consider the Republicans’ stand-alone tax-cut legislation, and that, instead, tax cuts should be part of the state budget. That makes sense, since new projections show lower-than-expected tax revenue even without a cut, and state budget-writers have a lot to consider as we brace for the dire effects of federal budget cuts. The least our leaders can do is not blindly give away cash without even assessing future liabilities.

But beyond that, we need to reconsider the knee-jerk idea that we are burdened with excessive taxes and regulations, that our state would be better off if we cut investments in our schools and universities, our roads and bridges, our clean environment, museums, libraries and other shared spaces and stopped keeping a floor under poor kids by providing basic food and health care assistance. 

Wisconsin Republicans like to tout the list of states produced annually by the Tax Foundation promoting “business friendly” environments that reduce corporate taxes, including Wyoming, South Dakota, Alaska and Florida. They also like to bring up ALEC’s “Rich States, Poor States” report that gave top billing last year to Utah, Idaho and Arizona for low taxes and deregulation. 

What they don’t track when they lift up those states are pollution, low wages and bankrupt public school systems. 

I’m old enough to remember when it was headline news that whole families in the U.S. were living in their cars, when homelessness was a new term, coined during the administration of Ronald Reagan, the father of bogus trickle-down economics and massive cuts to services for the poor. 

Somehow, we got used to the idea that urban parts of the richest nation on Earth resemble the poorest developing countries, with human misery and massive wealth existing side by side in our live-and-let-die economy.

Wisconsin, thanks to its progressive history, managed to remain a less unequal state, with top public schools and a great university system, as well as a clean, beautiful environment and well-maintained infrastructure. But here, too, we have been getting used to our slide to the bottom of the list of states, thanks in large part to the damage done by former Republican Gov. Scott Walker. 

We now rank 44th in the nation for investment in our once-great universities, and the austerity that’s been imposed on higher education is taking a toll across the state. Our consistently highly rated public schools have suffered from a decade and a half of budget cuts that don’t allow districts to keep pace with inflation, and recent state budgets have not made up the gap. 

Now threats to Medicaid, Head Start, AmeriCorps, our excellent library system, UW-Madison research and environmental protections do not bode well for Wisconsin’s future.

In the face of brutal federal cuts, we need to recommit to our shared interest in investing in a decent society, and figure out how to preserve what’s great about our state.

Tax cuts do not make the top of the list of priorities.

U.S. House Freedom Caucus Chair Andy Harris, R-Md., center, speaks to reporters on Wednesday, May 21, 2025 at the U.S. Capitol. From left are Republicans Keith Self of Texas, Scott Perry of Pennsylvania and Chip Roy of Texas. (Photo by Jennifer Shutt/States Newsroom)

This report has been updated.

WASHINGTON — U.S. House Republican leaders released changes to their “one big beautiful bill” late Wednesday after marathon negotiations with conservatives demanding deeper cuts to safety net programs, teeing up debate and a final vote likely sometime Thursday.

The alterations, which will have to be adopted later, moved up implementation of work requirements for Medicaid by at least a couple of years and tossed out plans to sell some public lands. The new language also tightened the timeline for clean energy tax breaks and raised the ceiling for taxpayers who deduct state and local taxes.

The package of adjustments — the manager’s amendment — was incorporated into the larger reconciliation bill, which was approved by the House Rules Committee just before 11 p.m. Eastern on an 8-4 party-line vote. Far-right holdout Rep. Chip Roy of Texas was absent.

Next, the package must pass a procedural vote on the House floor before lawmakers can debate and take a final vote.

With a razor-thin margin, House Speaker Mike Johnson can only lose a handful of members on each vote. Democrats are expected to uniformly vote “no” in the procedural and final votes.

Medicaid

Republicans moved up implementation of work requirements for Medicaid enrollees from taking effect after January 1, 2029 to no later than December 31, 2026. That could mean some states will make the changes before next year’s midterm elections.

The provision would require those who rely on the state-federal health program for lower-income Americans and some people with disabilities, who are between the ages of 19 and 65, to work, participate in community service, or attend an educational program at least 80 hours a month.

The language has numerous exceptions, including for pregnant people, parents of dependent children, people who have complex medical conditions, tribal community members, people in the foster system, people who were in the foster system who are below the age of 26 and people released from incarceration in the last 90 days, among others.

The GOP changes also would bar Medicaid from covering gender transition procedures for anyone in the program. The bill previously barred that type of treatment for anyone below the age of 18.

Clean energy tax credits

Republicans also tightened the timeline on the termination of clean energy tax credits enacted under President Joe Biden. Hardliners focused on reducing the deficit had demanded a quicker phase-out for the credits.

The new language would accelerate phase-outs for clean energy investment tax credits to 2028, up from 2031, with special carve-outs for nuclear facilities. Companies that break ground on new facilities 60 days after the bill is enacted, if passed, will not qualify for the tax credits. The same applies to any facility placed into service after 2028.

State and local taxes

A separate contingent of Republican holdouts reached a deal with Johnson to raise the SALT cap to $40,000, up from the $10,000 lid enacted under the 2017 tax law. The SALT cap  — the amount of state and local taxes constituents can deduct from federal taxable income — is a top issue for Republicans who represent districts in high-tax blue states, including California, New Jersey and New York.

The amount of SALT taxpayers can deduct decreases for those making more than $500,000 annually. The SALT cap and the income cut-off will increase by 1% each year from 2027 until 2033.

Public lands sale

The amendment removed language that would have allowed the sale of public lands in Nevada and Utah.

The National Wildlife Federation credited Montana Republican Rep. Ryan Zinke with removing the provision.

“Thank you to Rep. Ryan Zinke and his colleagues who listened to their constituents and worked with House leaders to eliminate the provision from the budget reconciliation bill,” NWF Associate Vice President for Public Lands David Wilms said in a statement. “We urge all members of Congress to refrain from similar attacks on America’s public lands.”

Jessica Turner, president of the Outdoor Recreation Roundtable, wrote in a statement that “Congress avoided setting a dangerous precedent that lands can be sold anytime the U.S. Treasury needs a budget ‘pay-for’ and threatening outdoor recreation businesses and rural communities alike that need certainty, access, and long-term infrastructure.”

The Center for Biological Diversity’s Great Basin Director Patrick Donnelly wrote in a separate statement that it was “appalling that GOP leaders tried to get away with auctioning off some of our country’s most beautiful landscapes to fund tax cuts for billionaires and make developers richer. This is Gilded Age-level stuff, and I hope people remember it the next time Republicans try to pretend they care about public lands.”

A separate provision in the amendment appeared to narrow the federal authorizations energy projects could bypass by paying a $10 million fee. The section had been attacked by environmental groups as a “pay-to-play” for energy companies.

White House meeting

The changes come after Johnson, a Louisiana Republican, and far-right holdouts huddled with President Donald Trump at the White House Wednesday afternoon.

Johnson, speaking to reporters at the Capitol following the meeting, said that lawmakers had “a good discussion” and that he believes the GOP is “in a very good place.”

“I think that all of our colleagues here will really like this final product, and I think we’re going to move forward,” Johnson said.

Johnson said members of the Freedom Caucus, who previously argued the legislation doesn’t go far enough to restructure Medicaid and reduce federal spending, may end up supporting the bill, in part because Trump plans to address their other concerns through unilateral actions.

“You will see how all this is resolved. But I think we can resolve their concerns and it’ll be probably some combination of work by the president in these areas as well as here in Congress,” Johnson said. “So there may be executive orders related to some of these issues in the near future.

“And, you know, this is a commitment the president has made. He wants to go after fraud, waste and abuse.”

White House press secretary Karoline Leavitt released a written statement saying the “meeting was productive and moved the ball in the right direction.

“The President reiterated how critical it is for the country to pass the One Big Beautiful Bill as quickly as possible.”

Complex process

Republicans are using the complex reconciliation process to move the package through Congress with simple majority votes in each chamber, avoiding the Senate’s 60-vote legislative filibuster, which would otherwise require bipartisanship.

Reconciliation measures must address federal revenue, spending, or the debt limit in a way not deemed “merely incidental” by the Senate parliamentarian. That means the GOP proposals must carry some sort of price tag and cannot focus simply on changing federal policy.

Republicans are using the package to extend the 2017 tax law, increase spending on border security and defense by hundreds of billions of dollars, overhaul American energy production, restructure higher education aid and cut spending on Medicaid.

A new Congressional Budget Office analysis released late Tuesday projected the massive reconciliation package would decrease resources for low-income families over the next decade while increasing resources for top earners.

Freedom Caucus

Earlier Wednesday, members of the Freedom Caucus told reporters following a different meeting with Johnson that they believed negotiations were moving in the right direction, but were skeptical of trying to approve the entire package this week.

Maryland Republican Rep. Andy Harris, chairman of the group, said they wanted the legislation to go further in terms of addressing “waste, fraud and abuse” within Medicaid, though he declined to elaborate.

The Medicaid proposals in the version of the bill prior to the negotiated changes would cut $625 billion in federal spending during the next decade, under a CBO analysis. Democrats have warned the result would be millions of vulnerable people losing access to the health program for lower income people and some people with disabilities.

Texas Republican Rep. Chip Roy said during that same impromptu press conference that leadership and members of the Freedom Caucus had made “significant progress” toward a final agreement.

“We’re trying to deliver so that the people who are actually out there working hard can actually get the health care that they want to get, that they can get, and get it the best way possible,” Roy said. “That’s what this is all about; changing a broken system, making sure we’re saving taxpayer dollars and being able to provide a better environment for people to be able to thrive.”

Pennsylvania Republican Rep. Scott Perry, who used to chair the Freedom Caucus, said that holding a House vote before Memorial Day was a made-up timeline and that if negotiations needed to last longer, they should.

“This is a completely arbitrary deadline set by people here to force people into a corner to make bad decisions,” Perry said. “It’s more important to get this right, to get it correct, than to get it fast. We are sitting at the table to do that.”

Jacob Fischler contributed to this report.

This story was originally published by The 19th.

Jolene Baxter’s daughter, Marlee, has overcome immense challenges in her first eight years of life.

Marlee, who was born with a heart defect, has undergone four open-heart surgeries — suffering a stroke after the third. The stroke affected Marlee’s cognitive abilities — she’s in the second grade, but she cannot read yet. A mainstream class with neurotypical students felt overwhelming, so Marlee mostly attends classes with kids who also have disabilities. Her care includes physical, occupational and speech therapies.

For years, Baxter has relied on Medicaid to cover Marlee’s medical expenses while advocating for her daughter’s right to an equal education. Medicaid — which covers therapies, surgeries and medication for Marlee — and disability protections under the Department of Education have been a critical safety net for Baxter, a single mom in Oklahoma City. Now Baxter fears that proposed cuts to Medicaid and those already underway at the Department of Education, which President Donald Trump has effectively gutted, will have a disastrous impact on her daughter. 

As the Trump administration overhauls federal agencies with budget cuts, layoffs and inexperienced leadership, parents of children with complex medical needs and disabilities told The 19th they are navigating uncertainty over how the federal government plans to maintain key pillars of their kids’ lives.

Baxter, who fostered and, later, adopted Marlee, fought to give her life-saving medical treatment when the child was an infant. Since Marlee was both an abandoned child and is Kiowa, the officials overseeing her welfare weren’t invested in getting her the care she needed to survive, Baxter believes. Cuts to Medicaid would be yet another obstacle for the Baxters to overcome.  Just getting Marlee enrolled in local public schools that tried to turn her away was a battle, Baxter said. Now, the mom is gravely concerned that her daughter will be left behind due to the restructuring of the Department of Education.

“I’ll do everything I can at home, but she’ll just fall through all the cracks, and she won’t get the education that she deserves,” Baxter said.

In March, Trump signed an executive order to close the Department of Education. The Republican-controlled Congress is also considering massive funding cuts to Medicaid, the federal-state program that provides health insurance to millions of low-income Americans and is a key safety net for Americans with disabilities.

“It is 50 plus years of work to get these protections for people with disabilities that we could potentially see — maybe not fully diminished — but very deeply eroded, in a very short period of time,” said Robyn Linscott, director of education and family policy at The Arc, an organization that advocates for people with intellectual and developmental disabilities.

The Department of Education’s primary duty has been to ensure that all students have equal access to education, and it is equipped with an Office for Civil Rights to investigate schools accused of discrimination. In March, the Department of Education cut nearly half of its staff, with workers who enforce students’ civil rights hit particularly hard. Advocates worry how this could potentially impact students with disabilities, and a lawsuit filed in March began to paint a picture: newly closed regional offices, frozen investigations and new alleged politically based cases. 

The Trump administration claims that the nation’s most vulnerable will be spared from his plans for federal downsizing. 

The White House has tentative plans to assign oversight of special education to the Department of Health and Human Services. Conservative groups are calling for the Trump administration to refer civil rights complaints to the Department of Justice, an agency that has had an exodus of staff departures since Trump returned to office and changed its mission. 

Nicole Jorwic, chief program officer at Caring Across Generations, a national caregiver advocacy organization, said the Education Department’s Office for Civil Rights receives about 20,000 complaints annually. She worries about the impact of staffing cuts on handling these complaints on the families of children with disabilities.

“Some of those staff were the ones who were looking into those complaints,” she said.

It’s not just OCR complaints, she added. When she was a practicing special education attorney, Jorwic turned to reports and guidance issued by the agency. That helped local school districts, superintendents and special educators know how to implement different laws or changes.

“The lack of that federal agency to provide that clarity is also important, as well as something that we’re really worried about,” she said.

Parents and advocates are doubtful that students with disabilities won’t be impacted. Before the Department of Education was created in 1979, schools often denied these children a right to education with impunity. Dissolving it, families fear, could see a return to the period when states and schools failed to prioritize special education. 

Baxter’s daughter, Marlee, is guaranteed the right to free and appropriate schooling by the Individuals with Disabilities Education Act (IDEA) of 1975, which is enforced by the Department of Education. This federal law mandates that children like Marlee attend classes suited to their cognitive and physical abilities and that they get the services needed, such as speech, physical and occupational therapy, to attend school . Ninety-five percent of students with disabilities attend public schools, a higher share than the 90% of students overall who do — and that’s largely because of the services federal policy requires public schools to provide.

Kim Crawley, a mother to a teenager with medically complex needs, has a 25-year career as a special education teacher. As part of her training, she learned about the history of education, including how five decades ago, schools were not obligated to accommodate students’ special needs. The agency never took power away from the states, she said, but stepped in to ensure that they educated all students equitably. 

“We learn about this for a reason because we don’t want to repeat it,” Crawley said. “We don’t want to have to start over again. To think of losing everything we have gained through the Department of Education over these years is scaring not only parents but teachers. Teachers are scared because we don’t know where this is going to end up for those kids. And that’s why we go to work every day.”

Critics of closing the department and redirecting disabled children’s needs to other agencies say that it will create a bureaucratic nightmare for parents. Instead of one federal agency overseeing research on students with disabilities, state funding for special education or discrimination claims, multiple departments would be involved. Families might not know which agency to reach out to with questions and concerns.

As it is, families are sometimes unaware of the services legally available to them — a reality that has cost them time and energy in the past and could be even more complicated in the future.

Baxter, for one, pulled Marlee out of class for two years to homeschool her after the child’s kindergarten teacher retired and subsequent teachers did not know how to educate her properly, she said. It was not Baxter’s first choice to homeschool Marlee, an option unavailable to most working parents, but one she made after multiple public schools said they could not accommodate her child. 

“Our special needs are full,” Baxter said they told her. “We don’t have room for her.”

When an acquaintance told her that public schools could not lawfully refuse to enroll Marlee, Baxter finally got a local public school to admit her. But after her ordeal last year, she has no faith that the federal government will hold schools that discriminate against children with disabilities accountable if the education department is disbanded. 

“We have enough stuff to worry about (with) making sure that she gets taken care of as far as medical care,” Baxter said of parents like herself. “We don’t need to worry about what we’re going to do as far as their education.”

For some families, the potential Medicaid cuts could unravel both a child’s well-being and their family’s finances.

In Philadelphia, Meghann Luczkowski has three kids with varying levels of specialized health care needs, including a 10-year-old son who spent his first year of life in a hospital intensive care unit.

“His ability to grow and thrive and be part of our family and part of this community is dependent upon significant health care support at home,” said the former special education teacher, who now works in public health.

Luczkowski said her husband has robust health insurance for the family, but it does not cover a lot of her son’s home-based medical needs — a reality for many families whose children are on Medicaid for care related to a disability. Private insurance never paid for his ventilator to breathe, or home health nurses who allow family caregivers to sleep at night.

“It doesn’t pay for the nurse to go to school with him, to make sure that he can be at school, accessing his education with his peers,” she said. “That’s all been provided through Medicaid.”

In the first months of his second term, Trump has mostly indicated support for Medicaid when asked about his budgetary plans for other popular programs like Social Security and Medicare. But the president has also said he supports cutting fraud and waste — a description that health policy experts warn could be used to defend more expansive cuts. Congress is considering hundreds of billions of dollars in Medicaid cuts, a dollar figure that goes way beyond known cases of fraud.   

Among the considerations are work requirements and a cap on Medicaid enrollee spending. Such restrictions could have ripple effects on state education budgets and subsequent reductions in services for students with disabilities. Medicaid is one of the largest providers of funds to public school districts. It is the responsibility of school districts and states to find funding if Medicaid reimbursements are insufficient. Trump has not addressed general concerns about how such spending cuts could impact disabled children and adults.

“We know that before 1975 and the passage of IDEA, 50% of kids with disabilities were not educated at all. So we know that this is a crucial piece of legislation, and that mandate to find funding for these is really important,” said Linscott, who previously worked as a special education teacher in New York City. “But we also recognize that school districts and state budgets are so limited, which is why we want Medicaid to be able to provide as robust funding and reimbursement as they possibly can for students and for these services.”

Jorwic said federal funding for special education services is crucial, and local governments cannot make up for the lost funds. The federal government currently spends more than $15 billion annually on special education services, and Medicaid funding accounts for about $7.5 billion annually in school-based services.

Jorwic said Medicaid cuts could also translate into higher taxes on a local or state level. This month, the Democratic Kansas governor said she had asked the state’s congressional lawmakers not to cut Medicaid in large part because of the ramifications on services. 

“There’s no state, even the wealthiest states, that could afford cuts to those programs, either when it comes to education or when it comes to providing home and community-based services,” Jorwic said.

Rachael Brown is the mom of a medically complex second grader in Washington, D.C., who receives special education services and multiple therapies at his public school. 

Brown’s son, who has autism and cerebral palsy, has a rare vascular anomaly in his brain that has required multiple surgeries. He receives extensive support from Medicaid and IDEA, which are crucial for his care and education. Brown is concerned about how cuts to Medicaid would impact her son’s care and her family’s personal finances. She noted that pediatric hospitals are heavily reliant on Medicaid. If the rate of that reimbursement is cut, those hospitals’ operational costs would be on the line — impacting everything from how many doctors and other health care providers are hired to what therapies are covered for her son.

“There’s just a ripple effect for our whole community,” she said, adding: “We are relatively privileged. There’s a lot of families who aren’t. It would be much worse for families for whom Medicaid is their only insurance.” 

Brown said she lives in fear and worry about what happens next, and it’s exhausting. While she and other advocates have some experience fighting for health care rights given previous political battles, “this time, everything feels a little more cruel.”

Luczkowski planned to travel to D.C. — taking a day off from work and rearranging child care needs — to advocate for Medicaid as part of a multi-organization advocacy day. She said parents of kids with medically complex needs and disabilities often aren’t able to get out and advocate as much as they would like to, in part because of the needs of their families.

“Despite the fact that it’s an incredible hardship on my family for me to be in D.C. talking to legislators and being at rallies on the Capitol steps, that’s what me and a great number of families are doing — because our kids’ lives depend on it,” she said. “We’re hopeful that our voices will be valued, and our children will be valued.”

This story was originally reported by Barbara Rodriguez and Nadra Nittle of The 19th. Meet Barbara and Nadra and read more of their reporting on gender, politics and policy.

‘She’ll fall through the cracks’: Parents of kids with disabilities brace for new reality is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Rep. Derrick Van Orden (R-WI) speaks to reporters on the steps of the U.S. Capitol Building following a vote on July 25, 2024 in Washington, D.C. (Photo by Tierney L. Cross/Getty Images)

U.S. Rep. Derrick Van Orden (R-Prairie du Chien) has said he’s opposed to Republican efforts to make changes to the federal government’s Supplemental Nutrition Assistance Program (SNAP), more commonly known as food stamps, even though he voted for the Republican-authored federal budget blueprint that calls for more than $200 billion in cuts to programs including SNAP. 

Despite voting for the budget blueprint, earlier this week Van Orden co-sponsored legislation that states he’s against a budget bill that would reduce Medicaid and SNAP benefits. 

Republicans in the House of Representatives have been searching for $230 billion in budget cuts for their budget reconciliation bill — which also includes a permanent extension of President Donald Trump’s 2017 tax cuts. Progress on the bill has stalled as some Republicans have objected to the cuts to popular programs in the blueprint. 

Van Orden sits on the House Agriculture Committee, which oversees SNAP. The committee has been considering a proposal that would, for the first time, pass some of the cost of operating the program on to the states while also adding work requirements and implementing methods to limit future increases to benefits. 

Last week, Van Orden walked out of a Republican House Agriculture briefing and yelled an insult at staff, according to Politico. The outlet also reported he raised concerns that the SNAP changes unfairly penalized Wisconsin during a meeting of House Republicans. 

Democrats said that if Van Orden were really against the cuts, he wouldn’t have voted for the budget blueprint. 

“If Derrick Van Orden really wanted to save Medicaid and SNAP, he should have voted ‘NO’ on the Republican budget that cuts both,” Democratic Congressional Campaign Committee Spokesperson Justin Chermol said in a statement, He signaled that Democrats will use the blueprint vote against Van Orden in the 2026 election.

Four of the Wisconsin 14 – from (l to r) Jeff Davis, Kai Gardner Mishlove, Pat McFarland and Thomas Lang – urged state lawmakers to extend postpartum Medicaid on March 18, 2025. (Courtesy of Builders)

Thomas Lang and Jeff Davis — conservative Catholics from Wisconsin — did the unexpected on a recent Tuesday: They asked some of their conservative legislators to extend a social safety net for pregnant women.

Both men support local crisis pregnancy centers and groups opposed to abortion, and they typically oppose expanding public services. Davis said he’s always been a conservative spender, having grown up with a Depression-era father.

But after participating in a civic engagement program about abortion a year ago, both said their empathy for pregnant women is better informed.

“My wife was a great sounding board for me being more empathetic towards women, because she was a very empathetic woman, and I kind of lost a little bit of that when she passed away,” Davis said, noting it’s been two years. “I didn’t have her level of compassion, and this helped me, seriously, to be more compassionate, and not just to women who are having an abortion, but just people in general.”

One year ago, 14 people around Wisconsin, dubbed the Wisconsin 14, were recruited by the civic engagement nonprofit Builders (formerly known as Starts With Us) to try to find common ground on reproductive health policy despite their deep divisions on abortion. For most of the participants, as the emotionally grueling Citizen Solutions sessions would reveal, their beliefs are rooted in personal trauma.

A year later, several of the participants who had severe disagreements have come back together to fight for their first consensus solution: extending postpartum Medicaid.

While the Wisconsin 14 ultimately could not agree on a single abortion-related policy, they were united on five policy proposals to make it easier and safer to give birth. Several of the participants returned to the Capitol in Madison last month to lobby their state legislators to pass Assembly Bill 97/Senate Bill 23, which like one of their proposals, would extend Medicaid coverage for women from 60 days to 12 months after giving birth if they do not already qualify for the state’s Medicaid program. Under current law, pregnant individuals in Wisconsin are eligible for Medicaid at a higher income threshold than those who are not pregnant: 306% instead of 100% of the federal poverty level. But they can lose that coverage 60 days after giving birth if their income increases beyond the non-pregnant eligibility threshold.

Reproductive health experts have identified postpartum Medicaid extension as the first step to maternal health equity, as States Newsroom has reported. According to a new study in the Journal of the American Medical Association, more than 80% of pregnancy-related deaths nationwide are preventable, and almost one-third of pregnancy-related deaths occurred after delivery.

Wisconsin and Arkansas are currently the only states cutting off postpartum Medicaid after 60 days, despite these being largely popular policies.

“Last spring, 20,000 Wisconsinites from 70 counties across the state weighed in on the proposals during a public feedback period,” said Builders communications director Tori Larned in an email. “Nearly three-quarters (73%) of people favored extending Medicaid postpartum.”

This is the second year the proposal has been introduced in the legislature, and like last year it has received bipartisan support but severe opposition from House Speaker Robin Vos. The Republican has described the bill as an expansion of “welfare,” including last week, when the bill passed the Senate 32-1.

“My position has been fairly clear from the very beginning: I’ve never supported an expansion of welfare. I can’t imagine that I would ever support one,” Vos said at a press conference after the April 22 vote, according to the Wisconsin Examiner. “But we have to talk about it as a caucus.”

Vos’ office did not reply to a request for comment for this story.

In the past month, several among the Wisconsin 14 have lobbied their legislators in person, talked about the bill in public, and a few have or are currently writing op-eds. Larned told States Newsroom nearly every participant has called Vos’ office urging him to extend postpartum Medicaid to a full year. 

“[S]tagnation on this issue does not reflect the public will,” wrote Kateri Klingele Pinell and Kai Gardner Mishlove, two of the Wisconsin 14, who fundamentally disagreed on when abortion should be legal and accessible, in a recent Milwaukee Journal Sentinel op-ed. “Extended Medicaid coverage is crucial for the physical, emotional, and mental well-being of mothers and their children. Sixty days is insufficient to address the vast array of medical needs that arise during the postpartum period.”

They cited a 2024 Wisconsin Maternal Mortality Review Team report showing that between 2019 and 2020 the majority of pregnancy-related deaths were caused by cardiovascular conditions or hypertensive disorders or due to mental health conditions, including drug overdoses. They also noted that Black women and women from low-income households suffer worse maternal health outcomes. They cited an American Hospital Association report to argue that prolonging postpartum coverage would generate cost savings.

They ended the op-ed addressing Vos directly.

“We have faith that Speaker Vos and his colleagues in the Assembly will answer our call,” they wrote. “Vos has already expressed his desire to, ‘protect life while ensuring women receive necessary medical care.’ The passage of this bill offers him the opportunity to properly represent his constituents.”

Klingele Pinell is a clinical mental health professional who opposes abortion, but believes in expanding public health services, especially as someone who says she has relied on them as a young single mom. Gardner Mishlove is a grief doula and the executive directive of Jewish Social Services in Madison, which she said provides short- and long-term case-management and advocacy to vulnerable populations.

“We need to reassure moms and families that they will not lose coverage during this crucial time,” Gardner Mishlove told States Newsroom. “Can you imagine deciding to maintain a pregnancy and then realizing that you’re going to lose your health insurance 60 days after? Being a new mom, there’s a lot to deal with, a lot to juggle, and if that’s one less thing for you to juggle so that you can make sure that you maintain connection to your healthcare provider, to your behavioral health provider, for the health and wellness not only of yourself but your family, then that’s a huge burden that’s lifted from that mother, from the family, from the health care system.”

Bridging the divide 

In mid-March, four of the Wisconsin 14 joined a lobbying event co-sponsored by Main Street Alliance, where they urged state lawmakers to pass the postpartum Medicaid extension, focusing on more reluctant Assembly and Senate Republicans.

Davis, the 77-year-old widower, said it felt out of his comfort zone just to drive from his farm to the Capitol and navigate traffic and parking, but he felt it was important to do.

“I just kind of thought that maybe my input, because of being pro-life and being for the bill, would carry some weight,” Davis told States Newsroom.

Davis and Lang said they didn’t initially appreciate how difficult it would be to move the needle with some of the Republican legislators, especially after learning how much extending postpartum Medicaid is likely to cost the state.

The state has projected that an additional 5,020 women would have coverage per month under the bill, costing an estimated $18.5 million, including $7.3 million in state general purpose revenue with the rest coming from the federal government. As the Wisconsin Examiner has reported, if Wisconsin joined other states that have accepted the full federal Medicaid expansion, the cost for the postpartum coverage would be reduced to $15.1 million in all funds including $5.2 million in general purpose revenue. However, under the Trump administration, the federal Medicaid program as a whole is under threat. 

“We’re talking a drop in the bucket,” Lang said. “We’re talking about a small annual average number of pregnant women in Wisconsin, so the fiscal hawks really don’t have much to worry about, and more importantly we’re talking about getting women out of a corner. … Everybody agrees that no woman gets pregnant to have an abortion. It’s always something of a compulsion. So let’s get her out of the corner if we want her to have choice, right?”

Gardner Mishlove and Patricia McFarland — whose politics and abortion views veer widely left from Davis’ and Lang’s — said they tried to find common ground with more conservative legislators. 

“[We’re] trying to end the divide, to find ways to talk to each other about basic human issues, so that you are not just pro-birth, but if you’re pro life, you really want the family to thrive,” said McFarland, who had a traumatic illegal abortion before Roe v. Wade enshrined federal abortion rights in 1973 and is now an abortion-rights activist. “You want that baby to be born and to have all the care they deserve.”

The fate of the bill remains uncertain, but the Wisconsin 14 have not given up on it.

Jacob VandenPlas, a dad, farmer, agricultural educator and veteran from Door County, has some of the most nuanced politics and abortion views among the 14.

VandenPlas ran for Congress as a Libertarian in 2022 and is considering a future run for governor as an independent or for Wisconsin state Senate as a Republican. He said he believes abortion should be broadly legal through the first trimester and then restricted with exceptions for health and rape. VandenPlas said he’s been calling different legislators about the postpartum Medicaid bill; lobbying his representative, Republican Rep. Joel Kitchens, at the gym; and is currently working on an op-ed. He pitches it from a Libertarian angle.

“This is our future generation, and the constriction on the pocketbooks of the American people and how much the government has robbed from us makes it very difficult to start families,” VandenPlas said. “We’re talking the cost of housing and everything else. It’s very, very important to be able to help the future mothers and future families of our state.”

“Most importantly,” he continued. “This is one of the single best ways that we can address abortion. If you want to start limiting those numbers, we have to start addressing the reasons why women are choosing abortion, and this is one of them. We can save babies’ lives by extending postpartum care, and we can save the lives of mothers.”

Builders head of programs Ashley Phillips said the organization has not given up on trying to pursue abortion consensus solutions in other states, as abortion restrictions continue to broadly impact reproductive health care, including for those who want to have babies but have a shortage of health care options. She said Builders is conducting listening sessions in Texas, the next likely state for their third Citizens Solutions initiative. But this time participants will determine the policy area, she said.

“One thing I have learned is that this work is messy, it’s complicated, it’s hard, and in the moment, it often doesn’t feel great,” Phillips said. “And then I saw a subset of those people this weekend in Wisconsin, and the joy was back, and the belief that they could do something despite having a lot of discomfort around that issue of abortion.”

Lt. Gov. Sara Rodriguez and state Sens. Sarah Keyeski (D-Lodi) and Brad Pfaff (D-Onalaska) listen to community members at an April 24 roundtable in Richland Center. (Hery Redman | Wisconsin Examiner)

RICHLAND CENTER — In a 90-minute roundtable meeting at the Richland Center community center Thursday, President Donald Trump’s name was mentioned just twice. But community leaders highlighted how his administration’s policies are already wreaking havoc on the county with the sixth highest poverty rate in the state. 

About 15 area leaders representing small business owners, farmers, schools, hospitals and community advocacy groups met Thursday with state Sens. Sarah Keyeski (D-Lodi) and Brad Pfaff (D-Onalaska) and Lt. Gov. Sara Rodriguez. Throughout the event, the attendees discussed how the policies and plans of Trump and the Republican-controlled Congress to cut or diminish Medicaid, Social Security and education funding while instituting widespread tariffs on imported goods from countries around the world and making it harder for migrant workers to obtain visas could decimate their region. 

“None of this is right. Where I’m at that age in my life where I don’t get more thoughtful, I get more pissed,” Brett White, executive director of the Southwestern Wisconsin Community Action Program, said. “And because this is all not necessary, this is completely unnecessary, which means that it’s intentional.” 

The group noted repeatedly that a cut to programs in one area had a ripple effect across every other community institution. 

White, and Chris Frakes, the organization’s senior director, said that the cuts to Head Start early childhood education programming that have already come and are set to deepen under Trump are their biggest worry. 

There are currently about 70 kids in Richland County enrolled in Southwest CAP’s Head Start program, according to Frakes. If those programs are lost, poor kids in Richland County will never catch up, she said. 

“Because we know if you enter kindergarten already behind, there’s virtually no chance to catch up by third grade,” Frakes said. “If you’re not on grade level reading in third grade, we know your life prospects go down dramatically, right? So Head Start fills this critical, vital need to get those kiddos onto par with their middle class peers when they hit kindergarten, so that they are ready to learn, and their families have the sort of surrounding supports, whether that’s food, whether that’s access to transportation, for medical care.” 

If Head Start gets cut, the children who are affected will eventually reach Aaron Mithum, the middle and high school principal for the Kickapoo Area School District. Mithum says the district is “waiting for the other shoe to drop” on the future of the approximately $800,000 it gets annually from the federal government as Trump seeks to shut down the U.S. Department of Education. 

If Head Start leaves poor kids behind before they turn five, by the time they reach Mithum at a middle school that’s also struggling financially, there won’t be many options. 

“We’re getting them when they get into pre K or kindergarten, and now we’re trying to go from there, and now, all of a sudden, they don’t have any of that foundational aspect,” Mithum said. “It’s a building block, trickle effect, and not in a positive way. So now it’s that much harder for us to do what [Head Start wasn’t] able to do, and it continues to go up. And it’s just really hard to think about, what does that look like? What does that look like to be a parent with a special ed kid who needs speech services or reading services, or whatever. And the answer is, sorry, not our problem.” 

While the child care and education system of a community that’s already seen the closure of its local University of Wisconsin campus faces the prospect of being unable to keep poor kids from falling behind, the area’s food system is also being hit. 

Retaliatory tariffs on the area’s wheat, corn and soybean farmers are hurting their ability to find international markets for their products while tariffs imposed by Trump have made fertilizer and machinery more expensive, said Sally Leong, Wisconsin Farmers Union member and former professor of plant pathology at UW-Madison. 

Those struggles are continuing to push up the price of food, causing local families to rely on food pantries more than used to, according to Jackie Anderson, executive director of Feeding Wisconsin. 

Under Trump, the U.S. Department of Agriculture (USDA) paused funding for The Emergency Food Assistance Program (TEFAP), which Anderson said has amounted to about a 30% cut to what food banks are able to buy. USDA has also ended a program that connected local farms with food pantries to supply fresh produce. 

“Food banks are really looking at the bottom line and saying, like, ‘How are we going to be able to get that amount of food here?’” Anderson said. 

The tariffs are also affecting the companies providing jobs in the area. Marty Richards, the county tourism director, said that Rockwell Automation has delayed and cancelled orders because of Trump’s tariffs. Meanwhile it’s getting harder to find local workers and Trump’s restrictive immigration policies have made it nearly impossible to hire migrant workers. Richards said the company has had a hard time getting workers from its plant in Mexico to come to the U.S. even temporarily for technical training

Teri Richards, board member of the Greater Richland Area Chamber of Commerce, said the county desperately needs more people and she doesn’t know where to find them. 

“We’re obviously not having enough babies. We’re struggling to get that immigrant population and we can’t keep stealing from each other,” she said. “So it’s time to go into Chicago or Milwaukee, to even get a few of those folks moved out here? I don’t know.” 

With fewer people moving in and federal policies discouraging investment from the business community and cutting funds from schools and child care, the community is also facing the management of an aging population. About 30% of the population is older than 60 and 14% is disabled, according to Roxanne Klubertanz, manager of Richland County’s Aging and Disability Resource Center (ADRC). 

That aging population means the community is only going to become more reliant on federal programs like Social Security, Medicare and Medicaid. Currently, the ADRC helps people in the community apply for Medicaid to pay for the services that will help them stay in their homes for as long as possible or move to an assisted living facility — currently a cost of about $3,800 per month, she said. 

Republicans in Congress are currently weighing a budget proposal that would slash Medicaid funding. Klubertanz said without the program people won’t be able to access those services and will ultimately get sicker and require a placement in a nursing home — a cost of about $10,000 per month. 

“So if that funding, that Medicaid funding, goes away, what’s going to happen?” she said. “Maybe right away, you’re going to see some decreases, but people are going to get sicker and need more services, and then they have to pay for that nursing home placement, which is almost three times the cost. So if you’re trying to fix something today, you have to think about what it’s gonna be like in five years. You’ve gotta have that long range thinking.” 

Chewbacca, Yoda and Princess Leia watched over Joe Mannchen and colleagues as they worked on their Yahara House computers, some designing birthday cards for fellow clubhouse members. 

Taped above each desktop, the “Star Wars” cutouts distinguished the computers from others — a more lively equipment tracking method than four-digit codes, Mannchen explained.   

“We’re not numbers,” the 15-year clubhouse veteran joked. “Why should our computers just be numbers in the system?”

The cutouts accented colorful decor inside Yahara House, which overlooks Lake Mendota on Madison’s isthmus. A pride flag, bulletin boards and photos covered bright blue walls of a mansion built in 1902 and once occupied by Adolph Kayser, a former mayor. Hanging beside century-old stained glass: a “Pets of Yaharans” photo display of cats Pumpkin Boy, B.B. King Cat, Mookie, Spock and Purr. Photos of human Yaharans hung elsewhere.

Yahara House, part of the nonprofit Journey Mental Health Center, is a community mental health program focused on building relationships and job opportunities. The clubhouse model reduces hospitalizations and boosts employment in adults with serious mental illnesses, experts and advocates say. 

Mannchen, who once edited videos professionally, uses those skills to help create updates for members. He and others are considering starting a podcast to promote Yahara House to the community. 

“At the risk of being a little saccharine, it brings me joy,” he said.

Other members work in the Yahara House offices, reception desk or its kitchen, the Catfish Cafe. Still others fill temporary jobs at local shops, restaurants and the State Capitol. A bulletin board celebrates three dozen members with permanent jobs.

Wisconsin has few places like this. Yahara House is one of seven clubhouses in the state and just three with international accreditation, according to Clubhouse International’s latest count. Neighboring Michigan has 37 accredited clubhouses. Advocates want Wisconsin to learn from Michigan to expand clubhouses statewide. 

Medicaid cuts could jeopardize services

Reimbursement from Medicaid, the joint state and federal program to help low-income residents afford care, funds nearly all of the Yahara House budget, said director Brad Schlough.

But budget cuts in Washington may threaten that funding. Seeking to pay for tax cuts and some mandatory spending increases, the Republican-led U.S. House has proposed cutting up to $880 billion in spending over the next decade from the committee that oversees programs including Medicare and Medicaid. For a variety of reasons, including the large size of the program, Medicaid is a likely target for significant cuts. 

“I’m not sleeping well at night worrying about the human costs the proposed funding cuts will inevitably bring,” Schlough said. 

The Trump administration has already made cuts to COVID-era mental health funding and eliminated an office focused on helping older adults and people with disabilities live independently.

More than one in three U.S. adult Medicaid enrollees have a mental illness. Most in Yahara House rely on Medicaid for services within and outside of the clubhouse.

The clubhouse already struggles financially to serve members waiting to enroll or ineligible for Medicaid support services.

“Clubhouses are intended to be open to anyone in the community with a mental illness. The problem is that the funding doesn’t always follow that,” Schlough said.

When members do join the right Medicaid programs, Wisconsin requires hours of recordkeeping for clubhouses to get paid. That contrasts with Michigan, which streamlines payments for clubhouses. 

Yahara House members pride themselves on finding solutions. The community is celebrating 25 years of international accreditation this year and has served adults with mental illness for much longer.

Its longest-tenured member is Michael Larscheid at 47 years. His photo hangs on a bulletin celebrating continuing education. He recently started swimming classes.

While many of his friends have moved or lost touch over the years, Yahara House remains a constant. 

“This is my family here,” he said.

An ‘antidote for loneliness’ 

Larscheid works weekdays in the Catfish Cafe, calling out lunch orders that cost around $1 each.

Mark Benson, a 40-year clubhouse member, joins him, preparing food for about 30 people. Benson researches recipes for twice-weekly desserts that cost 50 cents. In February, he debuted a diabetic-friendly pecan pie. 

Benson is retired from outside work. But when he first joined, Yahara House connected him with a job at an upscale furniture store.

“I was vacuuming around these like three $30,000 consoles and glass tables,” he recalled. “I had to be very careful where I went. It was a good job.”

People with mental illness can often find jobs on their own, but some struggle in workplaces that lack flexibility for mental health days, Schlough said. They might also face transportation barriers. Yahara House keeps a list of more flexible Madison-area employers. The clubhouse trains staff for each job, allowing them to fill in when a club member can’t make a shift. 

Yahara House also provides safe spaces during the day and on holidays and fosters community through weekly events like karaoke. 

Schlough calls clubhouses an “antidote for loneliness.”

Few Wisconsin clubhouses

Despite the advantages, Wisconsin has seen limited clubhouse expansion.

That surprised Sita Diehl, public policy and advocacy director for the National Alliance on Mental Illness Wisconsin chapter. She sees the model as underutilized.

Wisconsin prioritizes other types of services. 

Democratic Gov. Tony Evers’ latest budget proposal does not include specific funding for clubhouses, state Department of Health Services spokesperson Jennifer Miller confirmed in an email to WPR and Wisconsin Watch.

Still, Evers’ budget would expand the state’s behavioral health system, fund suicide prevention and improve crisis response, Miller wrote, adding: “Supporting people with mental health concerns is a top priority” and that the administration worries that federal Medicaid cuts would harm Wisconsin residents. 

Substantial funding changes for clubhouses would require legislative and state health department approval. There are no current plans to seek a new clubhouse waiver, Miller said but added that expanding Medicaid like other states would boost resources for many services. 

Yahara House’s Medicaid reimbursements flow through the state’s Comprehensive Community Services waiver for people with mental health or substance use issues that could lead to hospitalization. That program best accommodates easier-to-document treatments like psychotherapy, which unfold in hourlong blocks of time, Schlough said.

Yahara House serves members more sporadically throughout the day, leaving staff to spend as many as six hours daily logging time spent serving members — necessary for reimbursement, Schlough said. The exercise conflicts with a clubhouse spirit that encourages staff to treat members more as peers than patients.  

The clubhouse doesn’t pepper new members with questions about diagnoses and limitations. 

“We say, ‘We’re glad to see you,’” Schlough said. “What do you like to do? What are your interests?’” 

‘We want to be a right door’

As a lifelong Madisonian, Rick Petzke probably drove past Yahara House thousands of times. He didn’t know it could help him until his tour almost five years ago.

He joined and received a temporary job at Hy-Vee.

“They liked me so well, they hired me permanently,” Petzke said.

He regrets not learning earlier about a clubhouse members call “Madison’s best kept secret” — like a fancy restaurant on a hidden street. 

Joining requires little more than having a mental illness and not being a harm to yourself or others. But it can take members up to four months to properly enroll with the county in the right  Medicaid program, and a few don’t qualify, Schlough said. 

When members aren’t enrolled? Yahara House eats the cost.

“There are too many wrong doors in this system, and we want to be a right door,” Schlough said.

The clubhouse has few funds for non-reimbursed services, particularly after Dane County cut part of that budget this year, Schlough said. Proposals for the state to allocate a $50,000 matching grant to each Wisconsin clubhouse failed in consecutive legislative sessions. 

The Wisconsin Mental Health Action Partnership wants state lawmakers to appropriate those funds, streamline Medicaid reporting requirements and adopt a clubhouse-specific Medicaid waiver.

The possibility of federal Medicaid cuts could only harm that cause, leaving Wisconsin with fewer dollars to spread around, Diehl said.

Investing in clubhouses could save governments money over time, experts say. Compared to others living with severe mental illness, clubhouse members are less likely to be incarcerated, more likely to pay taxes and less likely to take costly trips to the emergency room.

‘I need to go back to my house’

Jennifer Wunrow left Yahara House for a decade following more than 10 years as a member. During her years away she felt herself “going down” and slipping toward a crisis. 

“I need to go back to my house,” Wunrow recalled thinking.

Members greeted Wunrow upon her return, asking where she’d been. 

When she secured her own two-bedroom apartment with Yahara House help, members and staff helped her move. 

A year later, Wunrow calls herself “the biggest mouth in the house” and helps situate new members. 

“I take a lot of pride in this house,” she said. “I love it here.”

‘Madison’s best kept secret’: People living with mental illness find work, care and community at a clubhouse built for them is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Hundreds of protesters gathered in front of U.S. Sen. Ron Johnson’s Madison office Tuesday to voice their concerns over potential cuts to Medicaid.

The Republican-led Congress is considering significant cuts to Medicaid, the government health insurance program for low-income households. In Wisconsin that includes programs like BadgerCare Plus, which serves children, pregnant people and non-disabled adults, and long-term care programs for people with disabilities and seniors.  

The House budget proposal could cut more than $880 billion in mandatory spending from the committee that oversees Medicaid, according to reporting by KFF Health News. While the Senate’s proposal doesn’t specify exact cuts, they plan to offset over $300 billion in new spending, according to NPR.

Dane County resident Laurine Lusk organized the protest because her daughter Megan is disabled and relies on the government program.

“She’s not safe without this care,” Lusk said.

She wanted to voice her concerns over any cuts to her daughter’s care, but she says she struggled to get in touch with Johnson’s office. 

In a response to questions from WPR and Wisconsin Watch about the protest and complaints that constituents were having trouble reaching him, Sen. Johnson provided a statement. He wrote: “It is difficult to respond to complaints and protests that have no basis in truth or fact. It is unfortunate that Democrat elected officials are lying to their supporters regarding the Senate Budget Resolution and encouraging them to take to the “streets.” I sincerely hope their actions do not result in violence. My primary goal is to keep my Wisconsin staff safe while enabling them to continue dedicating their efforts to help constituents.” 

The Republican senator’s office was closed to visitors Tuesday due to “previously scheduled outside commitments,” according to a sign taped to the office door. 

Protesters chanted, “Hey, hey, ho, ho Ron Johnson has got to go.” One protester held up a sign that said, “Answer your phone, Ron.”

U.S. Rep. Glenn Grothman faced a hostile crowd last week at a town hall in Oshkosh. When asked about Medicaid, he said cutting the program “would be a mistake,” according to previous WPR reporting. Other Republican lawmakers have come out against cuts to Medicaid.

Dorothy Witzeling drove from Appleton to join the protest. “I am terrified of what I am seeing happening with our government,” she said.

Witzeling carried a sign with a photo of her brother who had Down syndrome and relied on Medicaid for care.

Former Madison alder and former Dane County Board member Barbara Vedder said she attended the protest because she has a disability and couldn’t live without Medicaid.

“This is what democracy looks like,” Vedder said. “It brings my spirits up to see so many people speaking up because this needs to change.”

‘Not safe without this care’: Wisconsin Medicaid recipients fear budget cuts is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

There’s no getting around the fact that transporting students is an expensive enterprise. Add to that the extra measures needed for serving students with disabilities, and costs grow substantially higher than for other routine operations.

For school some districts, at least a portion of that extra expense is being offset with funds from the federal government. Through provisions in the legislation authorizing Medicaid funding, school systems may file for reimbursement for transportation to and from specified eligible services that students with disabilities need during the school day. These services can include physical therapy, occupational therapy, speech pathology or therapy services, psychological counseling, and nursing services.

Of course, that’s based on acceptable submission of the required reports, which in turn rests on providing accurate ridership figures. Currently, reporting practices vary among school districts across the country, from relying on paper-based approaches to capitalizing on advanced features offered by routing software and related student ridership verification.

Teena Mitchell, special needs transportation coordinator for Greenville County Schools in Greenville, South Carolina, noted that considering the extra costs involved in serving special needs riders, seeking reimbursement is well worth the effort.

“I think it’s safe to say the cost of transporting students with disabilities is substantially higher than transporting those without them and plays a major role in the overall cost of educating our students with disabilities,” said Mitchell, who is also president of the National Association for Pupil Transportation.

Even if reimbursements go back into a school district’s general fund rather than the transportation department’s budget, she added, the dollars benefit the entire district and can be tracked back to the benefit of the transportation department in supporting areas such as personnel, training and equipment needs.

Of the 78,000 students Greenville County serves daily, nearly 16 percent are students with disabilities. The vat vast majority of those students, 88 percent according to Mitchell, receive the same transportation as non-disabled students and ride general education buses. The remaining 12 percent receive specialized transportation and are served on 111 specialized school buses.

Payment is based on a standard amount per trip. For the 2023-2024 school year, the amount was $13.35 per trip although the rate as of Oct. 1 has increased to $29.06. At the standard of $13.35 per trip, a typical school district of Greenville’s size could have expected to receive about $221,000 this school year, Mitchell calculated.

To file for reimbursement, school bus drivers are given a form that lists qualified students listed for the route in question and the dates transported. When two weeks of information has been recorded, a clerk who manages the program enters the information into the Medicaid system for payment.

The school district has routing software but as of this report wasn’t using for tracking Medicaid reimbursements. However, transportation staff were evaluating options for moving in that direction.

This step has already been taken at Colorado’s Weld County School District 6, said Chad Hawley, director of transportation. Routing software is now being used to track ridership in the district’s 60 routes, including 26 designated for serving students who require specialized transportation.

Software features include custom reporting functionality to capture and document data such as days qualifying students rode, where and what time they were picked up and dropped off, and which personnel were involved. A student information specialist incorporates the relevant details in a report that is shared with the Medicaid specialist in the district’s finance department.

Along with improved accuracy, the workload involved in reporting has been reduced.

“We used to have someone collect daily student counts from all of our specialized routes, input the data into a spreadsheet, and then send all the spreadsheets to the finance department,” Hawley noted. “The previous way was time consuming and not always accurate.”

Plans for a similar approach are in the works at El Dorado Union High School District in Placerville, California, where drivers log attendance and submit monthly reports for transportation provided to an average of 130 students who meet Medicaid requirements.

“When drivers turn in reports, they go first to our dispatchers, who enter the data into a shared spreadsheet,” said Sarah Lemke, director of transportation. “This spreadsheet is then accessible to both the finance team and the student success team, which also tracks our McKinney-Vento [Homeless Assistance Act] students.”

This collective info feeds into a report for both state and federal reimbursements.

Transportation staff currently use routing software to support route planning. “While it doesn’t track attendance directly, this capability is expected once we fully implement the software,” Lemke said, adding the goal is to have it fully operational to support Medicaid tracking this school year. “We’re working to streamline this process into one centralized system. The shared Google sheet we currently use has been very effective for transparency across departments, so we’re optimistic that routing will further enhance that.”

Services provided by an outside firm are central to Medicaid reporting at Hutto Independent School District, where the number of special needs riders has been growing. Currently, the school district located northeast of Austin, Texas transports 242 special needs students out of 4,568 total riders, an increase of 14 percent from last year. This necessitates running 15 routes for students with individualized education programs and 35 general routes with some specialty shuttles and McKinney-Vento routes as well, noted David Uecker, director of transportation.

“A contractor does the filing for us,” Uecker says. “We submit rider counts to the company with our [special education] department handling the reporting.”

Hutto leaders plan to enhance reporting with the implementation of new software. Slated for full adoption in the spring, that move will support tracking of riders with disabilities.

Some school districts have elected not to pursue Medicaid reimbursements, at least for now. That’s the case at Deer Creek School District in Edmond, Oklahoma. The district currently utilizes eight routes to transport 100 students with IEPs each school day but meets those demands without additional federal funding.

“The time it takes to go through the reimbursement process makes it difficult to pursue and maintain districtwide,” said Robert Feinberg, transportation director, echoing a common sentiment of peers nationwide.

At the same time, that decision is subject to review. “There is always a possibility of us beginning to use the program,” Feinberg noted. “Our district will continue to evaluate the process versus the manpower it would take to submit the claims.” He said one scenario that might prompt Deer Creek to begin seeking Medicaid funding would be if the school district experienced a large influx of students who meet reimbursement requirements.

Making It Work
Dealing with the federal government is never simple, and the Medicaid reimbursement process is no exception.

Given the complexity involved, good organization is a must. “Prioritize organization from the beginning,” Lemke said. “And establish a reliable system for collecting needed information in advance.”

The same goes for maintaining the necessary knowledge base. “Special needs transportation is definitely a challenge for many districts,” Feinberg said. “Knowing the local, state and federal laws pertaining to their transportation is vital.”

Targeted training can be a key to effective practice in this area, Mitchell pointed out.
“Training your drivers and attendants to be accurate and consistent can be a challenge, especially if you’re in a larger district,” said Mitchell.

Greenville addresses this need during new-hire training, with all incoming transportation employees receiving at least four days of training in transporting students with disabilities. That includes the Medicaid tracking and reporting process in addition to driver training instruction.

“During this training, we impress on the employees the importance of accuracy and remind them that their signature is their assurance that the form is accurate,” Mitchell added.

“Occasionally there may be updates to the process, and when this happens as it did recently, we schedule an in-service training and also give hand-outs with specific instructions.”

Even with the best training, mistakes can occur. To ensure accuracy, Mitchell said she has found it beneficial to have a staff member oversee the process and review the information generated.

Katrina Morris, who directs transportation at both West Shore Educational School District and Mason County Eastern School District in Michigan, advises those in transportation who have not yet pursued this type of funding to consider going for it.

A lot of districts do not realize that there is money for Medicaid reimbursement for students with special needs who require services,” said Morris, who is also the executive director for the Michigan Association for Pupil Transportation. “Please work with your special ed departments to see if this is an option to help receive the funding you are entitled to.”

Mitchell offered similar advice. “If your program is set up and maintained properly, it can run rather smoothly and bring much-needed funding back into the district to offset our diminishing budgets,” she concluded. “These funds can aid you in providing safe transportation with qualified staff.”

Editor’s Note: As reprinted in the January 2025 issue of School Transportation News.

Related: 5 Questions to Ask Before Implementing New Software
Related: TSD Conference Panel Discusses Routing for Students with Special Needs
Related: Bus Surveillance Software Solution is Game-Changer for Florida District
Related: Managing Transportation Data and Keeping It Safe

The post School Districts Use Data, Routing For Medicaid Reimbursements appeared first on School Transportation News.

The fate of postpartum Medicaid expansion, a bipartisan effort in the state Legislature, yet again falls in the hands of Assembly Speaker Robin Vos, who said Tuesday that it’s “unlikely” his chamber will get to vote on it.

Congress previously gave states a permanent option to accept federal funds for 12-month extensions of postpartum Medicaid coverage. Wisconsin and Arkansas are now the only two states that have turned down the federal extension. Wisconsin’s coverage currently lasts 60 days after birth, far shorter than what health experts recommend. 

Extending the coverage has emerged as a way for states to fight maternal mortality rates. Though pregnancy-related deaths are rare,  a third of them in Wisconsin occur beyond the 60-day coverage window, according to the Department of Health Services. 

Rep. Patrick Snyder, R-Weston, on Tuesday reintroduced a bill that would expand coverage to 12 months. The legislation mirrors the extensions that have been introduced in previous sessions, yet have failed to pass the Legislature. That same day, Vos, R-Rochester, said a vote on the 12-month extension would be “unlikely.” 

“Our caucus has taken a position that expanding welfare is not a wise idea for anyone involved,” Vos told reporters. 

Republican lawmakers previously agreed to a three-month coverage period. Democratic Gov. Tony Evers’ 2021-23 state budget proposal asked for a 12-month extension, but Republican lawmakers on the powerful Joint Finance Committee amended it to instead require DHS to request federal approval to extend postpartum Medicaid eligibility to 90 days instead of the 60 mandated by federal law. 

Vos accused the Evers administration of not applying for the 90-day extension the Legislature already granted, which isn’t true — something Vos acknowledged in response to a follow-up question to his office. DHS submitted the application for the extension, but the federal Centers for Medicare and Medicaid Services last year said it would not approve a waiver request for coverage shorter than one year. 

“I’m glad that I was wrong and it has been submitted,” Vos responded. “The waiver request should be resubmitted to the Trump administration.”

“Going from the 60 to 90 days is pretty negligible,” said Rep. Clint Moses, R-Menomonie, chair of the Assembly Committee on Health, Aging and Long-Term Care.  

During the last legislative session, the Republican-controlled Senate passed a bipartisan bill in a 32-1 vote that would have extended postpartum coverage to 12 months. The lone opponent was Duey Stroebel, who lost his re-election bid in November. In total, 73 lawmakers cosponsored the bill — over half of the state Legislature. The bill authored by Snyder this session is currently circulating for cosponsors. 

Interest groups from both sides of the aisle came out in support of the previous legislation, including Pro-Life Wisconsin, the Wisconsin Catholic Conference, the American College of Obstetricians and Gynecologists, and Kids Forward.

“It made sense to me because if I am pro-life and I don’t want people to abort their babies, why would I not do everything I could to support those mothers to have the babies,” former Republican Rep. Donna Rozar, who authored the bill last session, told Wisconsin Watch. 

But despite bipartisan support, the Assembly never scheduled it for a hearing before adjourning for the rest of the session in February last year. 

Rozar said she and other lawmakers couldn’t get Vos on board. “He dug his heel in, there was no doubt about it,” she said.

Moses put the bill on the agenda for a hearing. But in addition to Vos blocking it, the committee was jammed near the end of the session and didn’t have time to schedule it, he said. 

“There’s 132 people in this building. I don’t think we should legislate by one,” Sen. Mary Felzkowski, R-Tomahawk, said of Vos. “It’s up to his caucus to elect a different speaker or change his mind. So his members have to put enough pressure on him to get it done.” 

Without Vos’ approval, Moses said it’s not likely that lawmakers will secure a 12-month extension, but he’s hopeful that an extension of at least six or nine months can be agreed to in this year’s state budget, despite the Centers for Medicare and Medicaid Services’ indication that anything less than 12 months would not be approved. Moses is willing to schedule a hearing for the upcoming bill, but if Vos remains opposed, it may not get referred to him, he said. 

“When it comes to the budget, if there’s something that we want that would be attractive to negotiate this out with, I think that’s a possibility,” Moses said. 

A fiscal estimate last session estimated the bill expansion would cost $21.4 million per year, including $8.4 million in state taxpayer funds with the rest coming from federal taxpayers. It would increase monthly Medicaid enrollment by 5,290 members. Felzkowski, who sponsored the Senate version, said it’s an extension for those who are already covered rather than an expansion that puts more people on Medicaid. She also said it’s good for taxpayers. 

“The reason states have done this — blue states, red states, purple states — is it’s a return on investment for the taxpayers and it makes sense to do it,” Felzkowski told Wisconsin Watch. “We see the number of complications that happen in that first year, and those complications, by not being covered, cost money — cost a lot of money.” 

Wisconsin’s 306% Medicaid income eligibility limit for the 60 days of postpartum coverage is one of the highest in the country — something Vos has pointed to. 

“When you make a choice to have a child, which I’m glad that people do, it’s not the taxpayers’ responsibility to pay for the delivery of that child,” Vos said in 2023. “We do it for people who are in poverty. We’ve made the decision to go to 300%, that’s the law. But to now say beyond 60 days, we’re going to give you free coverage, no copayment, no deductible, until a year out, absolutely not.”

A 2021 version of the bill failed to get a floor vote in both the Senate and the Assembly, yet had only one lobbying group registered against it.

That group was Opportunity Solutions Project, the lobbying arm of the Florida-based Foundation for Government Accountability. The conservative advocacy group did not respond to Wisconsin Watch’s requests for comment. FGA has a track record of lobbying against Medicaid expansion and other bills in Wisconsin. 

“I think it’s a little premature to have any discussions about the Medicaid budget right now. We have a brand new administration coming into D.C.,” Rep. Tyler August, R-Walworth, said in a Tuesday press conference with Vos. “I think the Trump administration is actually going to put some common sense into some of these programs federally.”

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Republicans and Democrats agree on postpartum Medicaid expansion — Robin Vos says it’s unlikely is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.