ABC for Health, a public interest law firm, argues that a Dane County health assessment should have addressed the problem of medical debt. (Getty Images)

ABC for Health, the public interest law firm, has filed a complaint with the IRS, charging a team of hospitals led by UW Health of falling short of federal standards when they filed a Community Health Needs Assessment required of health nonprofits under federal law.

Late last year, the hospitals  released their report on the health needs of Dane County.

Federal law requires nonprofit health care providers to file such a  document every three years. The December report covered reproductive care, chronic illness, mental health and substance abuse, along with special sections about health concerns for children and youth as well as the elderly.

But in 63 pages, the report included no discussion of how the cost of care and medical debt have burdened people without money and hampered their access to the health care system.

For Bobby Peterson, that was a glaring omission — and on Thursday, Peterson and ABC for Health, the firm he founded and directs, filed a complaint with the IRS, charging the report doesn’t live up to the federal law’s requirement for a Community Health Heeds Assessment (CHNA).

ABC for Health focuses on health care access along with helping people overcome or avoid medical debt.

The organization’s complaint argues that failing to address that issue in the Dane County health needs document violates the collective responsibility of UW Health and the other three nonprofit hospital systems that produced it.

“Their insistence to exclude medical debt from consideration during the CHNA betrays many principles and requirements of non-profit hospitals,” the complaint states. “We maintain that UW Health’s intentional indifference towards the medical debt epidemic stems from a value for their own revenue at the expense of their community. That value is at odds with UW Health’s duty towards its community.”

Sara Benzel, media relations manager for UW Health, defended the report Thursday as well as the hospital system’s handling of medical debt.

“UW Health stands behind the priorities identified in the community health needs assessment process,” Benzel told the Wisconsin Examiner in an email message.

“Regarding the UW Health Financial Assistance Policy, we are proud of the work we do every day to make this support accessible, and the work we have done to simplify the process and lower barriers to accessing financial support.”

She said the hospital system’s financial assistance program is posted online in English and Spanish.

“The application has been simplified over the years using an equity lens, requires minimal supporting documents, and goes up to 600% of the federal poverty level, well above others in the state,” Benzel said.

Medical debt critic

ABC for Health has been a longstanding critic of hospitals’ handling of medical debt and has published several reports finding fault with how hospital systems address the problem of patients unable to pay their health care bills.

While hospitals have programs for financial help when a patient has no insurance and can’t afford to pay out of pocket, ABC has argued those programs are too often needlessly complex. The organization also contends that hospitals’ financial counselors don’t take actions that could circumvent a problem — such as helping patients enroll in Medicaid if they qualify.

The requirement for a Community Health Heeds Assessment is a little-noticed provision in the 2010 Affordable Care Act — the legislation nicknamed Obamacare that has helped drive down the numbers of uninsured Americans since its passage 15 years ago. Nonprofit health care systems must  produce a CHNA report for their communities every three years.

“The IRS is regulating this because they are looking at their tax-exempt status,” Peterson said Thursday. “And to be a tax-exempt organization, to be able to step away from all the property tax requirements that many of us face, they have a responsibility then to give back.”

He sees a hospital’s approach to medical debt as a direct measure of how they give back.

“They have a community benefit that they need to provide, and part of that benefit is making sure that they’re providing enough charity care and services to the vulnerable in a community,” Peterson said.

The 2025-2027 CHNA report, like several previous editions, was the work of Healthy Dane Collaborative, a coalition of the county’s four hospital systems: Unity Point-Meriter, SSM Health-St. Mary’s Hospital, Stoughton Health and UW Health. The report’s drafters conducted a survey, collected and analyzed data, met with a variety of community organizations and held focus groups

The final report included discussions of health care disparities by race, income and gender. It called attention to the health care needs of the LGBTQ and immigrant communities, including undocumented migrants.

Early on, the text of the report emphasized concern for health equity — “ensuring fair distribution of health resources, outcomes, and opportunities across different communities.”

Seeking a voice

At an ABC for Health symposium Thursday on Medicaid and health care access, Peterson said the report’s priorities were “good things” and were all important.

“But what we wanted to see was access to health care coverage,” Peterson said, along with a discussion about improving financial assistance policies and better coordination among providers. “It wasn’t there. That’s not part of what they wanted to give out to the community.”

Peterson said ABC started reaching out more than a year and a half ago to offer input for the CHNA report.

“We wanted to make sure that the people that are in the planning process understand what the access to health care coverage needs are, what the barriers in the financial assistance process are, and how can we make it better. What can we do to improve that process?” Peterson said.

“We thought this is a real opportunity for us to make sure that all these issues that we see every day can be put up in this Community Health Needs Assessment process,” he added. “We wanted our voice and the voice of our clients to be heard.”

The IRS complaint includes email messages ABC Health sent various people about the assessment process starting in mid-2023.

In a message Aug. 13, 2024, Peterson told Adrian Jones, UW Health Director of Community Health Improvement, “ABC remains eager to engage in Dane County’s 2024 CHNA process.”

The message asked for updates on the CHNA “process and timeline” and mentioned that ABC for Health was “preparing a report with recommendations to provide input, from the perspective of our clients, to inform Dane County’s CHNA process.”

In her Aug. 14 reply, Jones invited Peterson to “share your report with us.” She wrote that “we have also held our own community input sessions and survey and have analyzed a lot of quantitative and qualitative data.”

Peterson followed up with an email Aug. 16 that included a half-dozen questions about the data being collected, when and where community meetings had been conducted, whether more community meetings were planned and the timeline for completing the assessment document.

“ABC for Health is eager to continue engagement with the Dane County CHNA process,” Peterson wrote. “Please keep us posted about future community input sessions and meetings.”

Correspondence ends

There was no further response, and “the Dane County hospitals quietly released the CHNA report in late 2024, without ABC’s input that we maintain failed to take into account the perspective of the many communities we represent,” the complaint to the IRS states.

“Unsurprisingly, this report ignored access to health care coverage issues. The report lacks any recommendations to improve financial assistance policies, practices, and processes to equitably serve populations negatively affected by health disparities. It fails to address the impact of medical debt on Dane County patients,” the complaint states.

“It lacks broad community input and instead reflects a hospital-driven marketing piece that ignores and sidesteps Affordable Care Act requirements. ABC was largely shunned despite our multiple efforts over the past 2 years to provide client-based input.”

ABC for Health released its report shortly after Peterson learned that the CNHA report was published. Its critique was unsparing.

“Dane County hospitals must do more to justify extensive tax breaks and better serve patients impacted by health disparities,” the report states. “In 2023, Dane County hospitals spent an average of only 0.7% of their gross patient revenues on charity care. The national average is 2.3%.”

ABC for Health bases its calculations for Dane County charity care on Wisconsin Hospital Association data, and the national average on a 2022 Wall Street Journal report.

Peterson sent a letter reiterating ABC for Health’s concerns and the organization’s complaint about its lack of input in the CNHA report to UW Health’s CEO, Alan Kaplan, in January. He said there was no response.

ABC for Health also invited Kaplan and other hospital leaders to the ABC for Health event Thursday. The invitations were ignored or declined, Peterson said.

GET THE MORNING HEADLINES.

SUBSCRIBE

Oneida Community Health Center in Hobart, Wisconsin. | Photo by Jason Kerzinski for Wisconsin Examiner

As Congress mulls potentially massive cuts to federal Medicaid funding, health centers that serve Native American communities, such as the Oneida Community Health Center near Green Bay, Wisconsin, are bracing for catastrophe.

That’s because more than 40% of the about 15,000 patients the center serves are enrolled in Medicaid. Cuts to the program would be detrimental to those patients and the facility, said Debra Danforth, the director of the Oneida Comprehensive Health Division and a citizen of the Oneida Nation.

“It would be a tremendous hit,” she said.

The facility provides a range of services to most of the Oneida Nation’s 17,000 people, including ambulatory care, internal medicine, family practice, and obstetrics. The tribe is one of two in Wisconsin that have an “open-door policy,” Danforth said, which means that the facility is open to members of any federally recognized tribe.

But Danforth and many other tribal health officials say Medicaid cuts would cause service reductions at health facilities that serve Native Americans.

Indian Country has a unique relationship to Medicaid, because the program helps tribes cover chronic funding shortfalls from the Indian Health Service, the federal agency responsible for providing health care to Native Americans.

Medicaid has accounted for about two-thirds of third-party revenue for tribal health providers, creating financial stability and helping facilities pay operational costs. More than a million Native Americans enrolled in Medicaid or the closely related Children’s Health Insurance Program also rely on the insurance to pay for care outside of tribal health facilities without going into significant medical debt. Tribal leaders are calling on Congress to exempt tribes from cuts and are preparing to fight to preserve their access.

“Medicaid is one of the ways in which the federal government meets its trust and treaty obligations to provide health care to us,” said Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, a nonprofit policy advocacy organization for 33 tribes spanning from Texas to Maine. Malerba is a citizen of the Mohegan Tribe.

“So we view any disruption or cut to Medicaid as an abrogation of that responsibility,” she said.

Tribes face an arduous task in providing care to a population that experiences severe health disparities, a high incidence of chronic illness, and, at least in western states, a life expectancy of 64 years — the lowest of any demographic group in the U.S. Yet, in recent years, some tribes have expanded access to care for their communities by adding health services and providers, enabled in part by Medicaid reimbursements.

During the last two fiscal years, five urban Indian organizations in Montana saw funding growth of nearly $3 million, said Lisa James, director of development for the Montana Consortium for Urban Indian Health, during a webinar in February organized by the Georgetown University Center for Children and Families and the National Council of Urban Indian Health.

The increased revenue was “instrumental,” James said, allowing clinics in the state to add services that previously had not been available unless referred out for, including behavioral health services. Clinics were also able to expand operating hours and staffing.

Montana’s five urban Indian clinics, in Missoula, Helena, Butte, Great Falls, and Billings, serve 30,000 people, including some who are not Native American or enrolled in a tribe. The clinics provide a wide range of services, including primary care, dental care, disease prevention, health education, and substance use prevention.

James said Medicaid cuts would require Montana’s urban Indian health organizations to cut services and limit their ability to address health disparities.

American Indian and Alaska Native people under age 65 are more likely to be uninsured than white people under 65, but 30% rely on Medicaid compared with 15% of their white counterparts, according to KFF data for 2017 to 2021. More than 40% of American Indian and Alaska Native children are enrolled in Medicaid or CHIP, which provides health insurance to kids whose families are not eligible for Medicaid. KFF is a health information nonprofit that includes KFF Health News.

A Georgetown Center for Children and Families report from January found the share of residents enrolled in Medicaid was higher in counties with a significant Native American presence. The proportion on Medicaid in small-town or rural counties that are mostly within tribal statistical areas, tribal subdivisions, reservations, and other Native-designated lands was 28.7%, compared with 22.7% in other small-town or rural counties. About 50% of children in those Native areas were enrolled in Medicaid.

The federal government has already exempted tribes from some of Trump’s executive orders. In late February, Department of Health and Human Services acting general counsel Sean Keveney clarified that tribal health programs would not be affected by an executive order that diversity, equity, and inclusion government programs be terminated, but that the Indian Health Service is expected to discontinue diversity and inclusion hiring efforts established under an Obama-era rule.

HHS Secretary Robert F. Kennedy Jr. also rescinded the layoffs of more than 900 IHS employees in February just hours after they’d received termination notices. During Kennedy’s Senate confirmation hearings, he said he would appoint a Native American as an assistant HHS secretary. The National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for tribes, in December endorsed elevating the director of the Indian Health Service to assistant secretary of HHS.

Jessica Schubel, a senior health care official in Joe Biden’s White House, said exemptions won’t be enough.

“Just because Native Americans are exempt doesn’t mean that they won’t feel the impact of cuts that are made throughout the rest of the program,” she said.

State leaders are also calling for federal Medicaid spending to be spared because cuts to the program would shift costs onto their budgets. Without sustained federal funding, which can cover more than 70% of costs, state lawmakers face decisions such as whether to change eligibility requirements to slim Medicaid rolls, which could cause some Native Americans to lose their health coverage.

Tribal leaders noted that state governments do not have the same responsibility to them as the federal government, yet they face large variations in how they interact with Medicaid depending on their state programs.

President Donald Trump has made seemingly conflicting statements about Medicaid cuts, saying in an interview on Fox News in February that Medicaid and Medicare wouldn’t be touched. In a social media post the same week, Trump expressed strong support for a House budget resolution that would likely require Medicaid cuts.

The budget proposal, which the House approved in late February, requires lawmakers to cut spending to offset tax breaks. The House Committee on Energy and Commerce, which oversees spending on Medicaid and Medicare, is instructed to slash $880 billion over the next decade. The possibility of cuts to the program that, together with CHIP, provides insurance to 79 million people has drawn opposition from national and state organizations.

The federal government reimburses IHS and tribal health facilities 100% of billed costs for American Indian and Alaska Native patients, shielding state budgets from the costs.

Because Medicaid is already a stopgap fix for Native American health programs, tribal leaders said it won’t be a matter of replacing the money but operating with less.

“When you’re talking about somewhere between 30% to 60% of a facility’s budget is made up by Medicaid dollars, that’s a very difficult hole to try and backfill,” said Winn Davis, congressional relations director for the National Indian Health Board.

Congress isn’t required to consult tribes during the budget process, Davis added. Only after changes are made by the Centers for Medicare & Medicaid Services and state agencies are tribes able to engage with them on implementation.

The amount the federal government spends funding the Native American health system is a much smaller portion of its budget than Medicaid. The IHS projected billing Medicaid about $1.3 billion this fiscal year, which represents less than half of 1% of overall federal spending on Medicaid.

“We are saving more lives,” Malerba said of the additional services Medicaid covers in tribal health care. “It brings us closer to a level of 21st century care that we should all have access to but don’t always.”

This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

Wisconsin 7th District Republican U.S. Rep. Tom Tiffany (left) and 8th District Republican U.S. Rep. Tony Wied held an over-the-phone town hall Monday evening. (Tiffany image: Official congressional photo; Wied image: WisEye screenshot. Wisconsin Examiner photo illustration.)

U.S Rep. Tony Wied defended President Donald Trump and billionaire Elon Musk’s work inside the Trump administration Monday evening during his first town hall, which was hosted by phone. 

Wied, who represents Green Bay and other parts of northeast Wisconsin, scheduled the call after GOP congressional leaders told members to avoid in-person town halls. The guidance came after several lawmakers, including Wisconsin U.S. Reps. Glenn Grothman and Scott Fitzgerald, were met with backlash at in-person town halls because of Musk’s so-called Department of Government Efficiency (DOGE) project.

The call lasted a little less than an hour. Wied was joined by U.S. Rep. Tom Tiffany, who helped answer questions from callers. 

A few poll questions were asked during the call, with participants answering using their keypad. The first question was “Do you believe the federal government spends too much taxpayer money?” The results were shared on the call, with 43% of callers answering “yes” and 57% answering “no.” Another question asked was, “Do you believe men should be allowed to participate in women’s sports?” No results were shared. 

While Wied wasn’t met with the pushback his colleagues had, perhaps because of the controlled nature of a telecall, a handful of callers expressed worries about the potential for cuts to a number of federal programs and asked where Wied stood on the issues. He mostly defended the actions of Trump, Republicans and Musk. 

A nurse practitioner asked Wied about his position on Medicaid and Medicare. Questions about Medicaid cuts have been circulating and creating anxiety among many Wisconsinites who rely on the program. Trump has said he won’t cut the programs — or Social Security — but a recent report from the Congressional Budget Office found that lawmakers can’t meet their goal of cutting $880 billion without significant cuts to Medicaid. 

“A lot of my patients rely on [Medicaid and Medicare]. My parents are on Medicaid, and I’m sure both of your parents are also on Medicare. What are your plans as far as trying to save it?” the caller asked. “Lots of rumors going around that there’s going to be $800 billion that will need to be cut over the next decade, and while Trump says that he won’t be touching Medicare or Medicaid, there’s serious concerns about where that money will come from.”

Wied and Tiffany said they want to protect Medicaid, but lawmakers will be looking for savings, including by potentially establishing work requirements for the program and keeping “illegal immigrants” from accessing the program.

Tiffany said there are too many able-bodied adults on Medicaid and rhetorically asked if “we want them getting help there from the federal government, from you, the taxpayer?” He implied that people should get a job so they can get insurance through their employer. “The second thing is illegal immigrants.” 

Medicaid is funded partially with federal funds and partially with state funds, and approximately two-thirds of Medicaid recipients are working. Undocumented immigrants are already not eligible for federal Medicaid, though some states have expanded access using state funds, including California, which recently expanded its Medicaid program to cover all residents regardless of immigration status. 

Tiffany said that “if we have too many people that are on the program via waste, fraud and abuse, it jeopardizes the program. What we want to do is protect and save Medicaid for the future so people can count on it.” 

Wied said the government needs to be “prudent” and looking at the programs is part of getting rid of “bureaucratic waste, fraud and abuse,” and said Musk is helping with that. 

“[Musk is] somebody that has a lot of experience working on big budgets and finding efficiencies, and his job is only to identify, then it comes down to the elected officials to make the decisions and ultimately do what they need to do again, to make sure that we keep these programs,” Wied said. 

Another caller asked lawmakers whether they have a “red line” for where their support of Trump and Musk ends. 

Wied said Musk is “designated as a special government employee” and “there’s no evidence that he or the team has unlawfully accessed or used any sensitive data.” 

“If there is, I would certainly be concerned and make sure that I push back, but you know, the whole role of the Department of Government Efficiency is to streamline the government’s outdated and bloated systems,” Wied said. 

Musk’s DOGE team has been seeking access to databases that store personal information of millions of Americans. The administration has also been muddying who is in charge of DOGE and downplaying Musk’s role by appointing a new “acting administrator,” though Trump recently said Musk is in charge of DOGE.

“Trump is in charge, he’s our president. He’s making the decisions. Elon Musk has not fired anybody,” Wied said. The comment is in line with what Musk has reportedly told other Republicans. 

A Green Bay caller had concerns about benefits for veterans, given the Trump administration’s goal of cutting over 80,000 Department of Veterans Affairs employees, who provide health care and other services for millions of veterans.

“My son served in Afghanistan twice and uses the VA insurance. Our clinic here in Green Bay is awesome. I’ve been there a couple times with him, and he gets his surgery done there,” the caller said. “What are you going to do with 83,000 jobs that are cut in the VA, and where are the people that I love when they have their health care?”

The caller also added that tax cuts for the rich are “not worth it if it means hurting our veterans for they have served our country.” 

Wied said he would “make sure that we continue to fund that at the appropriate level, so that people have the best care possible within the VA system.” 

Some callers were supportive of Trump. 

“There’s a lot of waste in government,” said one. “We have to cut back. We just have to — on the waste. I see people who are alcoholics, get early Social Security disability. I’ve worked with people who are overweight and get out and take early disability. I don’t think people realize the numbers of abuse and it takes from our Medicare, Medicaid, it takes from all of us.”

The caller added, “I’m middle class. I’ve worked hard all my life. We have to give President Trump a chance.”

GET THE MORNING HEADLINES.

SUBSCRIBE

As Congress considers cuts to Medicaid, advocates warn that proposals will hike state costs or reduce services for people with no other resources. (Getty Images)

Of the laundry list of proposed Medicaid cuts circulating on Capitol Hill, policy watchers say some stand out as the most likely to be implemented because they’ve either been tried before, frequently embraced, or both.

Advocates argue that none of the ideas will actually help the program do a better job of its central mission: make it possible for poor and low-income people to get either primary or long-term health care. Instead, they contend, the outcome would be to transfer the costs to states unwilling to cut services or kick people off the rolls who have no other health care resources.

Broad outlines of the proposed Medicaid wish list for Congressional Republicans were outlined in a U.S. House memo that Politico published in mid-January, along with 50 pages of details. The memo is the basis for a summary of those proposed cuts from policy analysts and advocates at the Georgetown University Center for Children and Families.

Among the proposals that have garnered the most attention and concern are:

• Instituting work requirements for Medicaid recipients.
• Capping the current federal contribution to a state’s Medicaid budget, also known as turning Medicaid funds into a state block grant.
• Lowering the federal government’s minimum share of the cost of Medicaid, currently 50%.
• Ending the increased federal government match for states that have adopted Medicaid expansion under the Affordable Care Act (ACA)

Additional proposals would make other changes to how the federal matching rate is calculated or applied and reverse several Biden administration rules that made Medicaid enrollment easier and broadened access to benefits, according to the Georgetown summary.

Medicaid is funded by a combination of federal and state money. Proposals that lower the federal share would require states to pick up a larger share of the cost to avoid reducing coverage.

“The scale of the cuts Congress is contemplating is so large it really will cause fiscal peril for the state,” says Tamara Jackson of the Wisconsin Board for People with Developmental Disabilities.

Medicaid work requirements

The congressional proposals include imposing work requirements for “able-bodied” people as a condition of receiving Medicaid.

The congressional memo specifies that work requirements would not include “pregnant women, primary caregivers of dependents, individuals with disabilities or health-related barriers to employment, and full-time students.” It pegs the savings from a work requirement at $100 billion over 10 years.

According to KFF, a nonpartisan, nonprofit health policy research organization, however, more than two-thirds of Medicaid recipients are working, and those who aren’t would largely fall into the groups the memo says would be exempt.

The first Trump administration approved state Medicaid program waivers that included work requirements, while the Biden administration withdrew its approval. Among them was a requirement in Wisconsin dating from the administration of former Gov. Scott Walker.

The GOP majority in the Wisconsin Legislature passed a bill in 2022 that included a Medicaid work-requirement variation, but it was vetoed by Gov. Tony Evers.

According to KFF, a Congressional Budget Office analysis of a 2023 U.S. House proposal to institute Medicaid work requirements found that while it would save the federal government $109 billion, it would also increase the number of uninsured people by 600,000 without increasing employment. An Arkansas work requirement instituted in 2018 but later found unlawful by a federal court led 18,000 people to lose coverage.

“What we know is, even though people are working or would be technically subject to exemptions, there are very significant administrative burdens on enrollees to prove that or be found ineligible,” says Richelle Andrae, associate director of government relations for the Wisconsin Primary Health Care Association. The organization represents federally qualified health centers that serve low-income patients, including those on BadgerCare Plus and those who are uninsured.

“More time-sensitive paperwork and steps that are hard for people to understand or do and lots of people trying to complete administrative tasks at the same time are a recipe for mistakes, by individuals and government agencies that must do the work,” says Jackson. “That is how policies like work requirements and more frequent eligibility checks save money. Eligible people lose coverage or struggle to get in.”

Block grants

Currently Medicaid pays states at least 50% of all Medicaid costs, with states paying the balance.

In President Donald Trump’s first term, his administration attempted to replace that long-standing guarantee with a block grant — a fixed amount of money per Medicaid beneficiary in the state, regardless of the actual cost.

That per-patient cap on federal funds “would instead radically restructure Medicaid financing,” according to the Georgetown summary.

The cost would be felt across the board, from long-term care in nursing homes or in the community home care to primary health care through BadgerCare Plus, health care providers say, to the detriment of patients.

“Whatever the proposals are that are at the federal level — changing the formula, [per-patient] caps, at the end of the day they they’re all aimed at reducing funding for the Medicaid program, and it really is a vital lifeline for long-term care services and support,” says Lisa Davison, executive director of LeadingAge Wisconsin. The organization represents nursing homes and assisted living providers in the nonprofit, publicly owned and for profit sectors.

Reducing support would send some patients who now have Medicaid coverage back into the pool of uninsured people, says Patricia Sarvela, chief development officer for Partnership Community Health Center, a federally qualified health center in the Fox Valley that serves uninsured people as well as BadgerCare recipients.

Lacking health insurance, people are likely to put off addressing symptoms until their condition worsens enough for them to go to the emergency room, Sarvela says.

Directly or indirectly, taxpayers will likely wind up having to cover the cost of that care, however. “There might be short-term federal savings but ultimately at the end of the day it’s going to cost the taxpayers a lot more because patients will then not have health insurance,” Sarvela says.

Changes to federal match

Several proposed changes relate to the amount of the federal Medicaid match or how it’s calculated.

A proposal published by the Paragon Institute in July 2024 calls for reducing the federal match below 50% of the costs. The Paragon Institute has close ties to the Heritage Foundation, which produced Project 2025, the 900-page document that, although disavowed by Trump last year, has been echoed in numerous actions since he took office.

In 10 states the federal match is at the minimum and would likely be lowered, the Georgetown summary says, adding: “These states would likely have to make deep cuts to their Medicaid programs in response.”

The states are California, Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Washington and Wyoming.

Other states receive a higher federal match; Wisconsin gets 60% of its costs covered. It’s not clear whether those states’ matches would also be reduced under the proposal or other Medicaid reduction proposals.

Medicaid expansion

Another likely cut would be to reduce the additional federal match for Medicaid recipients whose incomes are between 100% and 138% of the federal poverty line.

The additional match was included in the Affordable Care Act, enacted in 2010. Originally Medicaid expansion was mandatory under the act, but a subsequent U.S. Supreme Court ruling that upheld the ACA made Medicaid expansion voluntary.

States that have accepted the expansion got a 90% federal match for the added beneficiaries. The Congressional memo proposes ending the higher match, and some states that have expanded are already considering ending expansion if that happens.

Wisconsin never accepted Medicaid expansion, however, so that change would not directly affect the state. Although Evers first ran in 2018 on a vow to accept Medicaid expansion after Walker rejected it, he’s been blocked from doing so by the GOP majority in the Legislature.

As he has with every budget he’s proposed since taking office, Evers has included accepting Medicaid expansion in his 2025-27 budget proposal.

In an interview with the Wisconsin Examiner last month after a visit with constituents in Port Washington to promote his budget, Evers said he didn’t consider leaving out Medicaid expansion, despite predictions that it would be pulled back by Republicans.

“First of all, we don’t know if it’s going to go away,” Evers said. Under the current 90% match, he said, Wisconsin would get about $2 billion in additional federal money every two years and the additional people covered in the state “would get better health insurance, so it’s a win-win-win.”

Evers acknowledged that in the current Congress, there’s a risk for sharp reductions in Medicaid.

If that happens, “it would be disastrous,” Evers said. “We have lots of people on Medicaid in the state of Wisconsin.”

Among states, Wisconsin’s Medicaid profile is “pretty average,” he added.

“There are places in the country where Medicaid is a huge, huge player, and if they would get rid of Medicaid, our health care system would implode. There’s just no question about that. That’s the thing that concerns me.”

This story is Part Three in a series.

Read Part One: Wisconsin patients, families are wary as Congress prepares for Medicaid surgery

Read Part Two: How Medicaid fuels an economic engine for caregivers, family members and patients

GET THE MORNING HEADLINES.

SUBSCRIBE

Max Glass-Hui uses an electronic communication device, picking words that the device then speaks to his mother, Tiffany Glass. (Photo by Erik Gunn/Wisconsin Examiner)

Max Glass-Hui is an energetic 14-year-old who romps through the modest home on Madison’s West Side where he lives with his mother.

Born with Down syndrome and diagnosed as autistic, Max can read words and understand what’s spoken to him, but he doesn’t talk. Instead, he communicates with an electronic device about the size of an iPad, pressing words that the machine then speaks on his behalf. “Good-bye,” he tells his mother through the machine one recent morning, as she sits with him in his bedroom.

Tiffany Glass smiles affably, acknowledges her son’s assertion of independence, and steps out of the room.

Their interaction isn’t so different from those any number of parents and children have every day. For this parent and this child, however, it might have seemed unimaginable a generation ago.

Not so long ago, a child like Max was likely to spend his life inside the walls of an institution. Changes in social attitudes, medical ethics, and state and federal policy have made it possible for him to grow up and thrive at home.

One of those policies, says Tiffany Glass, is Medicaid — and without it, she believes Max’s life would have been much worse.

“His medical problems would not have been treated as effectively,” she says. “His quality of life would have been absolutely terrible. He would have been much more excluded from our community than he is now.”

Medicaid is the state-federal health insurance plan launched in the 1960s to provide health care for people living in poverty. In Wisconsin, it’s  best known as BadgerCare Plus, which covers primary health care and hospital care for people living below the federal poverty guideline. But Medicaid touches hundreds of thousands of other Wisconsin residents as well.

More than half of Wisconsin’s nursing home residents are covered by Medicaid after spending down most of their other personal savings and assets. Other Medicaid programs provide long-term skilled care to people living in their own homes or in the community — people who are frail and elderly, but also people living with disabilities.

“I’m not sure people are aware of the lifeline Medicaid is to so many people,” says Kim Marheine, state ombudsman for the Wisconsin Board on Aging and Long Term Care. “Without Medicaid some of these people have no place to go for services.”

Congress is currently rewriting the federal budget in ways that patients, families, health care providers and advocates fear will upend the program dramatically, ending coverage for millions who have few or no alternatives.

Washington budget battle

The Republican majority in the U.S. House wants to find $4.5 trillion in federal funds to pay for renewing tax cuts enacted in 2017 during President Donald Trump’s first term. On Feb. 25, the House, voting along party lines, cleared the way for a budget resolution that carves $880 billion over 10 years from programs under the purview of the House Energy and Commerce Committee.

The text of the bill doesn’t doesn’t specify where those cuts come from — a point Republicans have emphasized to rebut claims that the vote was an attack on people’s health care. Nevertheless, Medicaid “is expected to bear much of the cuts,” according to KFF, a nonpartisan, nonprofit health news and research organization.

“What is in the jurisdiction of that committee? Well, the largest dollar amount is Medicaid,” said U.S. Rep. Mark Pocan (D-Black Earth) at a press conference in Madison Feb. 19. Advocates dismiss Republican denials, treating Medicaid cuts as a foregone conclusion and holding GOP lawmakers responsible.

“The draconian cuts to Medicaid that every single Wisconsin Republican voted for are an absolute wrecking ball,” says Joe Zepecki of Protect Our Care, a national advocacy group for the Affordable Care Act, Medicare and Medicaid. In that wrecking ball’s path, he says, are the state budget, tens of thousands of Wisconsin businesses that bill Medicaid, and more than a million state residents whose health care Medicaid covers.

Medicaid is funded jointly by federal and state governments. Federal law guarantees that the U.S. will pay at least half of the program’s cost, with the state paying for the rest. Wisconsin has a 60% federal contribution; the remaining 40% comes out of the state budget.

For fiscal year 2023, Wisconsin’s Medicaid expenditures totaled $12.5 billion, according to the Medicaid and CHIP Payment and Access Commission, a Congressional agency. The federal government paid just under $8.2 billion of that; Wisconsin paid the remainder, about $4.4 billion.

A Medicaid reduction on the scale that the budget resolution requires “will leave enormous shortfalls for the state heading into the next two years, all so Trump and his MAGA majorities can deliver another tax cut to huge corporations and CEOs like Elon Musk,” Zepecki says. “The federal money disappearing doesn’t mean the needs disappear, which is likely to force everyone else to pay even higher costs for their own health care.”

1 in 5 Wisconsin residents

According to the January 2025 enrollment numbers from the Wisconsin Department of Health Services (DHS), about 1.3 million Wisconsin residents rely on Medicaid for day-to-day health care, long-term care or both — more than 1 out of 5 state residents.

They include more than 900,000 Wisconsinites who are enrolled in BadgerCare Plus. The health insurance plan for people up to age 65 covers doctor’s office visits, preventive care, surgery, hospital stays including childbirth, and other day-to-day health care needs for families living below the federal poverty guidelines. Children are covered in families with incomes up to 300% of the federal guideline; BadgerCare covers one-third of Wisconsin’s children.

Medicaid also covers alcoholism treatment, substance abuse treatment and other forms of care for mental health. “Medicaid is one of the largest payers of mental health care in the state,” says Tamara Jackson, policy analyst for the Wisconsin Board for People with Developmental Disabilities. It is the major funder of county mental health services, whether provided directly by a county agency or in partnership with a community agency, according to the Wiscons Counties Association.

Covering mental health is more than simply covering the cost of medications that may be prescribed. “Depression and anxiety medications are most effective in combination with the use of counseling services,” says Sheng Lee Yang, an Appleton clinical social worker. But if patients prescribed a medication aren’t able to get counseling as well, “their symptoms are only being treated at a 50% rate. That’s not real effective.”

Medicaid is part of health care all across Wisconsin. A study from Georgetown University’s Center for Children and Families released in January found that residents of rural counties in the U.S. are more likely to rely on Medicaid for their health coverage than urban residents. In 27 northern and central Wisconsin rural counties, the share of children on Medicaid is higher than the state average, the study found.

Medicaid’s reach doesn’t stop there, however. Through nearly 20 different programs, Medicaid covers the health care of more than 260,000 additional Wisconsin residents.

For about 10,800 frail, elderly people who could not otherwise afford nursing home care, Medicaid pays the cost — about 60% of the state’s nursing home population.

Medicaid has also expanded beyond primary health care or nursing home care. Programs launched over the last several decades now allow eligible people who need long-term care to get the same services through Medicaid at home or in the community that they would receive in a nursing home.

To join those programs states apply to the federal government with proposals that would waive standard Medicaid rules. The idea is that if someone who needs long-term care can remain at home or in another homelike setting, the overall cost of care will be far lower than in a nursing home, stretching the Medicaid dollar farther.

More than 43,000 frail elderly or disabled adults in Wisconsin receive long-term care at home or in the community — in assisted living, for instance — under Medicaid waivers. Family Care began piloting in individual Wisconsin counties about 25 years ago as a nursing home alternative. It has since gone statewide, joined by allied programs that allow people to customize their care plans.

For elderly relatives who needed the intensive level of care offered by a nursing home, Family Care “gave them a tremendous alternative to skilled nursing care,” says Janet Zander, the advocacy and public policy coordinator for the Greater Wisconsin Agency on Aging Resources.

“A lot of work Wisconsin has been doing, and other states as well, has been shifting how we provide care to people’s homes,” says Jackson.

Care at home instead of an institution

Beth Barton’s daughter, Maggie, was born 25 years ago with cerebral palsy. She doesn’t talk and is not able to move about on her own, and for her whole life she’s needed complex medical care, Barton says.

One of Medicaid’s earliest waiver programs is named for Katie Beckett, a child from Iowa whose story led the Reagan administration in the 1980s to authorize long-term health care at home for children with disabilities instead of only in a hospital or nursing home. In Wisconsin, there are about 13,500 children enrolled in the state’s Katie Beckett waiver program.

When Maggie was a child, the Katie Beckett waiver enabled the Barton family to care for her at home. The family’s health care comes through the company plan where Beth Barton’s husband works. Medicaid served as a secondary insurer for Maggie, covering insurance copayments and for her care that the family insurance didn’t pay for.

Growing up, Maggie was able to attend Lakeland School, a public Walworth County school for children with disabilities. School “was difficult” her mother says, but it also provided rewarding interaction for her daughter. The school’s therapeutic pool became part of Maggie’s daily routine, where “she could be free,” Barton says, able to enjoy sensory experiences outside her wheelchair.

After Maggie turned 18, she was enrolled in IRIS — a Medicaid-funded long-term care program. While Family Care works though contracts with managed care providers, IRIS, a more recent variation, allows people to make their own arrangements for services, including home health care and personal care.

IRIS Medicaid funding helps pay for a social worker who visits four times a year and respite care when Barton can’t be at home. It also covers home modifications, such as an accessibility ramp.

Without the support Medicaid has provided throughout Maggie’s life, Barton believes her daughter might well have ended up in an institution. She’s not optimistic about that option.

“Her unique needs are best met one-one,” Barton says. “If we didn’t have private duty nursing, if we didn’t have Medicaid to meet those needs, I honestly don’t think she’d be with us.”

Children’s long-term support

Another Medicaid waiver covers certain purchases children with disabilities need as they grow up.

Danielle Bauer’s 3-year-old son, Henry, was born with Down syndrome and has also been diagnosed with autism. The family lives in Wausau, and Wisconsin’s Children’s Long-term Support waiver helped cover the cost of a sensory chair that offers Henry “a quiet retreat to prevent meltdowns,” Bauer says. The family also got coverage for a specialized high chair that will grow with him as he gets older.

“It has made a huge difference in his quality of life,” Bauer says of her son. “He is capable of so much more, but without these supports, families don’t have resources to help kids like him.”

Until Jessica Seawright’s son was born nine years ago, she and her husband had no inkling their child would have a disability, let alone a serious one. Because of a chromosome abnormality, he has cerebral palsy and uses a wheelchair.

“We didn’t have anything show up in terms of prenatal testing,” Seawright says. “This came out of the blue.”

The Children’s Long-term Support waiver helped the family purchase a wheel-chair van to transport their son. It also helped cover the cost of widening a doorway in their home on the South Side of Milwaukee so he can get into the bathroom using his chair.

Seawright is a social worker and therapist. Her employer provides the family’s primary insurance, with the couple paying about $300 a month toward the premium as well as covering their own medical and dental copayments.

The Katie Beckett waiver has made it possible for Medicaid, through BadgerCare, to pick up her son’s medical costs, Seawright says. He often has to go to the emergency room and has other complex medical needs. He has recurring seizures, and he has trouble swallowing and needs a gastric tube. He’s been prescribed various medications and formula supplements as well.

Without that support, she says it’s likely that the family would burn through the $5,000 annual cap on their out-of-pocket health care costs.

“We would be making really tough choices — what can we afford out of pocket each year? It would be a question of how often we pay for foot braces when he outgrows them,” Seaward says — along with the medications, supplements and formula he needs.

“It’s not that we don’t want to pay for our fair share, but with the cost of his care it’s not possible to keep up with,” she says.

Moving past ‘a dark part of our history’

Tiffany Glass is a University of Wisconsin research scientist, studying why children with Down syndrome often have trouble eating, drinking and swallowing. She was in the process of deciding what direction she wanted her research career to take when her son Max was born; his diagnosis pointed the way.

“Up until the mid-1980s in the United states, a lot of children with Down syndrome and other disabilities were institutionalized, because their communities didn’t have the resources to accommodate them,” Glass says.  

UW medical ethicist Dr. Norman Fost wrote in a 2020 journal article that as recently as the late 1970s it wasn’t unheard of for parents to allow newborns with Down syndrome to die without medical intervention.  

“It’s a really dark part of our history,” Glass says.

Medicaid changed that for Max — supporting him for his medical care, communication (it has paid in the past for an electronic tablet that speaks for him), and activities of daily living.

“He needs help with all of those things,” Glass says. “It adds up to needing skilled care 24 hours a day, seven days a week. For his whole life he’s required that type of care, and he probably always will.”

In addition to providing resources for Max’s care at home, Medicaid has also enabled Glass to pursue her scientific calling. Without it, her research career might have stopped before it started, she says.

Regular child care centers are unlikely to take someone whose disabilities are as severe as his, she has found, but the children’s long-term support waiver has covered the cost of respite care.

“That has allowed me to work outside the home for a decade as a research scientist,” says Glass. “If Medicaid hadn’t been there, I probably would not have been able to develop my research career. I would have had to stay home — to the detriment of scientific research.”

Now, however, she and countless others who have come to rely on the program — adults and children, people with disabilities and caregivers for elderly relatives — have grown anxious about whether they will still be able to count on the care that Medicaid has made possible.  

“Those arrangements are still very fragile,” Glass says. “We’re all very worried that if funding for Medicaid is reduced or eliminated, that could have really terrible implications for our families.”

This story is Part One in a series. 

This report was updated to correct the spelling of Max’s last name. 

GET THE MORNING HEADLINES.

SUBSCRIBE

Assembly Speaker Robin Vos (R-Rochester) speaks at a WisPolitics event. Photo by Baylor Spears/Wisconsin Examiner.

Assembly Speaker Robin Vos (R-Rochester) criticized much of Gov. Tony Evers’ budget proposal on Tuesday, saying Republicans wouldn’t get behind the spending increases and taxation proposals. He said Republican lawmakers are starting the process of coming up with their own proposals, including for a broad tax cut plan.

Evers’ 2025-27 state budget proposal dedicates $4 billion to K-12 and higher education, cuts nearly $2 billion in taxes and raises income taxes for the state’s wealthiest residents. Evers said during a Wisconsin Counties Association conference on Tuesday that his proposal was “realistic” and that he hopes the Legislature will agree. 

Vos said the plan was unrealistic, however, because it would increase state spending by about 20% and included plans to raise taxes. He also complained Evers presented his plans without speaking with lawmakers first.

Wisconsin has an estimated budget surplus of about $4 billion. Democrats are seeking greater investments in the state’s public services while Republicans want to limit state spending. 

Vos told the audience at the WisPolitics event people are thinking about the budget surplus the wrong way.

“People believe we have this huge surplus, which is true on one-time money, but we have very little money for the government to be able to expand or increase funding for programs,” Vos said.

Wants broad tax cuts

Vos said the last state budget was “really disappointing” because Republicans met Evers’ goals by increasing spending on education, but Evers vetoed most of Republicans’ tax cut proposals. In the upcoming session, Republicans will seek to focus on using the budget surplus for cutting taxes. 

Evers proposed an array of tax cuts in his budget including eliminating taxes on cash tips, sales taxes on electricity and gas for Wisconsin homes and on over-the-counter medications. Vos compared tax cuts to “chocolate cake,” saying they are all good. However, he said his caucus will likely look at doing broader tax cuts and that he wants cuts that “people can actually feel.”

“My preference is something that is ongoing and meaningful to families,” Vos said. 

Vos said that lawmakers will work to pass a tax cut bill package before the end of the budget process. 

“Hopefully that’ll get signed, but if not, unfortunately, the budget will probably have to wait until we can find consensus on that tax cut,” Vos told reporters after the event.

Evers also proposed a new tax bracket with a marginal rate of 9.8% for the state’s wealthiest residents — those making above $1 million for single filers and married joint filers. The current top tax bracket has a 7.65% rate and applies to single filers making $315,310 and joint filers making $420,420.

Vos said Republicans would not support increasing taxes.

Continued no on Medicaid expansion (even postpartum)

Evers for his fourth budget in a row proposed that Wisconsin join the 40 other states in the country that have taken the federal Medicaid expansion, which ensures coverage for people making up to 138% of the federal poverty line. One difference in this budget cycle, however, is that the Trump administration and Republican lawmakers are seeking to cut Medicaid funding in order to help pay for tax cuts. The new reality, Vos said, appears to validate his ongoing opposition to accepting the federal Medicaid expansion.

“Thank goodness we never expanded Medicaid,” Vos said. 

Vos said he would prefer block grants from the federal government, and that it would be better for Wisconsin to get 90% of the money from the federal government without “strings attached” than to get 100% of the money and have to follow federal guidelines for how to spend it.

Vos was also critical of expanding postpartum Medicaid to cover new mothers for the first year after giving birth, casting doubt on a Republican-backed bill that supports Wisconsin joining the 48 other states that have done this. Currently, Wisconsin only covers up to 60 days after birth for eligible mothers. 

Evers included the extension in his budget proposal and a Republican-authored bill that would extend coverage has 23 Senate cosponsors and 67 Assembly cosponsors.

Despite the widespread bipartisan support for extending postpartum Medicaid, Vos said he was not the only person in his caucus who opposes expanding coverage. He said it doesn’t make sense to expand Medicaid coverage because those with incomes up to 100% of the federal poverty line can still keep coverage after the 60 days and those who could lose coverage could seek coverage through Obamacare.

“I am not the only person in the Legislature who is opposed to it. Many Republicans are opposed to expanding welfare, it’s just they are more than happy to let me stand in front of the arrows,” Vos said.

Calls language changes ‘dystopian’

Vos also critiqued changes to the state budget proposed by Evers that would update language to be gender neutral. 

The proposal would change certain words like “father” to “parent” and “husband” to “spouse.” Another section that is about artificial insemination would change “the husband of the mother” to “the spouse of the inseminated person.”

Republicans have locked on the latter phrase to claim that Evers is trying to erase mothers and fathers. 

Evers told reporters Monday that the changes were made to ensure with “legal certainty that moms are able to get the care they need,” noting that same sex couples could have been excluded from coverage under the old language. He accused Republicans of lying about the issue.

“I didn’t know that Republicans were against IVF, but apparently they are because that is what it’s about,” Evers said.

Vos said the change was “dystopian” and said the changes don’t fix any issue and Evers was just coming up with an explanation. He later told reporters that the language made the state a “national embarrassment.” 

Prison reform

Vos also complained about Evers’ process for coming up with a plan to reform the state’s prisons, saying he should have included lawmakers in developing it.

The proposed plan, which would cost over $500 million, would make wide changes to many of the state’s facilities including transitioning Lincoln Hills and Copper Lake youth correctional facilities into adult facilities, updating Waupun Correctional Institution, the state’s oldest prison, and eventually closing Green Bay Correctional Institution.

Vos said it’s known that lawmakers have had an interest in the issue and questioned why they weren’t consulted in developing the plan.

“He chose not to do that because he has one way of operating, which is his way or the highway. Those of us that have some interest in corrections reform will get together and come up with our own package and present it to the governor and say, ‘Here it is,’” Vos said.

DPI and Supreme Court elections

Vos also weighed in on Wisconsin’s upcoming spring elections. 

State Superintendent Jill Underly, the Democratic-backed candidate, is running for a second term in office against education consultant Brittany Kinser, the Republican-backed candidate. 

Vos said that Kinser is “the best candidate” because she supports school choice and appears willing to work with the Legislature. He added that he isn’t sure whether he has ever met with Underly. He also criticized Underly for changes to the evaluation of Wisconsin’s standardized test scores.

He described the recent February primary as “low profile” and said that with a “different electorate” at polls in April, Kinser likely has a chance to win. 

The higher profile spring election is for an open seat on the Wisconsin Supreme Court. The technically nonpartisan race pits Susan Crawford, the liberal candidate against  Waukesha County Judge Brad Schimel, the conservative candidate.

Vos said he thinks that the race will be about the candidates, but it is “possible” that the race could be a referendum on Trump. He noted that Democrats are seeking to turn out voters who  agree with them and billionaire Elon Musk and Trump are trying to bring out Republicans in the race. A group tied to Musk canceled a social media ad this week that featured a photo of the wrong Susan Crawford.

GET THE MORNING HEADLINES.

SUBSCRIBE

Reading Time: 2 minutes

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.

An Eau Claire County farm. (Photo by Henry Redman/Wisconsin Examiner)

Seven western Wisconsin Republican lawmakers did not appear at an event hosted by the Wisconsin Farmers Union in Chippewa Falls Friday as farmers from the area said they were concerned about the effect that President Donald Trump’s first month in office is having on their livelihoods. 

Madison-area U.S. Rep. Mark Pocan (D-Black Earth), state Sen. Jeff Smith (D-Eau Claire) and state Reps. Jodi Emerson (D-Eau Claire) and Christian Phelps (D-Eau Claire) were in attendance. 

U.S. Reps. Tom Tiffany and Derrick Van Orden, state Reps. Rob Summerfield (R-Bloomer), Treig Pronschinske (R-Mondovi) and Clint Moses (R-Menomonie) and state Sens. Jesse James (R-Thorp) and Rob Stafsholt (R-New Richmond) were all invited but did not attend or send a staff member. 

“All four of us want you to know that there are people in elected office who want to fight for you,” Phelps said. “Because I think there’s a lot of fear that comes from the fact that we’re seeing a lot of noise and action from the people who aren’t and some of the people that didn’t show up to this. So I hope that you will also ask questions of them when you get a chance.” 

Multiple times during the town hall, Pocan joked that Van Orden was “on vacation.” 

Emerson, whose district was recently redrawn to include many of the rural areas east of Eau Claire, told the Wisconsin Examiner she had just been at an event held by the Chippewa County Economic Development Corporation where a Van Orden staff member did attend, so she didn’t understand why they couldn’t hear about how Trump’s policies are harming local farmers. 

“I get that a member of Congress can’t be at every meeting all the time, all throughout their district,” Emerson said. With 19 counties in the 3rd District, “it’s a big area. But I hope that they’re hearing the stories of farmers and farm-adjacent businesses, even if they weren’t here. There’s something different to sit in this room and look out at all the farmers, and when one person’s talking, seeing the tears in everybody else’s eyes, and it wasn’t just the female farmers that were crying, the big tough guys, and I think that talks about how vulnerable they are right now, how scary it is for some of these folks.”

Carolyn Kaiser, a resident of the nearby town of Wheaton, said she’s never seen her congressional representative, Van Orden, out in the community. Despite Van Orden’s position on the House agriculture committee, Kaiser said her town needs help managing nitrates in the local water supply and financial support to rebuild crumbling rural roads that make it more difficult for farmers to transport their products.

“When people don’t come, it’s unfortunate,” Kaiser said. 

Emmet Fisher, who runs a small dairy farm in Hager City, said during the town hall that he was struggling with the freeze that’s been put on federal spending, which affected grants he was set to receive through the U.S. Department of Agriculture (USDA).

Fisher told the Examiner his farm has participated in a USDA program to encourage better conservation practices on farms and that money has been frozen. He was also set to receive a rural energy assistance grant that would help him install solar panels on the farm — money that has also been held up.

The result, he said, is that he’s facing increased uncertainty in an already uncertain business.

“We get all our income from our farm, young family, young kids, a mortgage on the farm, and so, you know, things are kind of tight, and so we try to take advantage of anything that we can,” he said. “[The] uncertainty seems really unnecessary and unfortunate, and it’s very stressful. You know, basically, we have no idea what we should be planning for. The reality is just that in farming already, you can only plan for so much when the weather and ecology and biology matter so much, and now to have all of these other unknowns, it makes planning pretty much impossible.”

A number of crop farmers at the event said the looming threat of Trump imposing tariffs on Canadian imports is alarming because a large majority of potash — a nutrient mix used to fertilize crops — used in the United States comes from Canada. Les Danielson, a cash crop and dairy farmer in Cadott, said the tariffs are set to go into effect during planting season.

“How do you offer a price to a farmer? Is it gonna be $400 a ton, or is it gonna be $500 a ton?” he asked. “I’m not even thinking about the fall. I’m just thinking about the spring and the uncertainty. This isn’t cuts to the federal budget, this is just plain chaos and uncertainty that really benefits no one. And I know it’s kind of cool to think we’re just playing this big game of chicken. Everybody’s gonna blink. But when you’re a co-op, or when you’re a farmer trying to figure out how much you can buy, it’s not fine.”

A recent report by the University of Illinois found that a 25% tariff on Canadian imports — the amount proposed by Trump to go into effect in March — would increase fertilizer costs by $100 per ton for farmers.

Throughout the event, speakers said they were concerned that Trump’s efforts to deport workers who are in the United States without authorization  could destroy the local farm labor force, that cuts to programs such as SNAP (commonly known as food stamps) could cause kids to go hungry and prevent farmers from finding markets to sell their products, that cuts to Medicaid could take coverage away from a population of farmers that is aging and relies on government health insurance and that because of all the disruption, an already simmering mental health crisis in Wisconsin’s agricultural community — in rural parts of the state that have seen clinics and hospitals close or consolidate — could come to a boil.

“Rural families, we tend to really need BadgerCare. We need Medicaid. We need those programs, too,” Pam Goodman, a public health nurse and daughter of a farmer, said. “So if you’re talking about the loss of your farming income, that you’re not going to have cash flow, you’re already experiencing significant concerns and issues, and we need the state resources. We need those federal resources. I’ve got families that from young to old, are experiencing significant health issues. We’re not going to be able to go to the hospital. We’re not going to go to the clinic. We already traveled really long distances. We’re talking about the health of all of us, and that is, for me, from my perspective as a nurse, one of my biggest concerns, because it’s all very interrelated.”

Near the end of the event, Phelps said it’s important for farmers in the area to continue sharing how they’re being hurt by Trump’s actions, because that’s how they build political pressure.

“Who benefits from all the chaos and confusion and cuts? Nobody, roughly, but not literally, nobody,” he said. “Because I just want to point out that dividing people and making people confused and uncertain and vulnerable is Donald Trump’s strategy to consolidate his political power.”

“And the people that can withstand the types of cuts that we’re seeing are the people so wealthy that they can withstand them. So they’re in Donald Trump’s orbit, basically,” Phelps said, adding  that there are far more people who will be adversely affected by Trump’s policies than there are people who will benefit.

“And you know that we all do have differences with our neighbors, but we also have a lot of similarities with them, and being in that massive group of people that do not benefit from this kind of chaos and confusion is a pretty big similarity,” he continued. “And so hopefully these types of spaces where we’re sharing our stories and hearing from each other will help us build the kind of community that will result in the kind of political power that really does fight back against it.”

GET THE MORNING HEADLINES.

SUBSCRIBE

Entrance to Senate Chambers in the Wisconsin State Capitol. (Photo by Baylor Spears/Wisconsin Examiner)

The state Senate Health Committee cleared three bills Thursday, two of them on bipartisan votes, advancing them to the full Senate for consideration.

SB 4 allows direct primary care doctors, who charge patients on a monthly subscription, to practice without being regulated as part of the insurance industry. 

The bill passed 3-2, with the Senate committee’s two Democrats, Sens. Jeff Smith and Dora Drake, voting against recommending it for passage.

Drake said she voted against the measure because it lacked non-discrimination language that had been included in a previous version of the bill.

The bill from the 2023-24 legislative session included a non-discrimination section listing a series of civil-rights protections for patients. One of those items, forbidding discrimination on the basis of “gender identity,” led two organizations, Wisconsin Family Action and the Wisconsin Catholic Conference, to oppose the legislation.

Although the legislation passed the Assembly on a voice vote in 2024 and was unanimously endorsed by both the Assembly and Senate health committees, it died after the state Senate failed to take it up.

The current bill states that direct primary care providers “may not decline to enter into or terminate a direct primary care agreement with a patient solely because of the patient’s health status.”

It has replaced language enumerating specific civil rights protections with a more general stipulation that it “shall not be construed to limit the application” of Wisconsin’s civil rights statute to a health care provider’s practice. The civil rights law bars discrimination based on race, sex and sexual orientation, but is silent on gender identity.

“As Chair of the Legislative Black Caucus, I refuse to support a new version of a bill that doesn’t provide protections for Wisconsinites that prevents discrimination from healthcare providers,” Drake told the Wisconsin Examiner via email.

The committee voted unanimously Thursday to recommend the other two bills.

SB 23 would make it possible for women who are covered by Medicaid in childbirth to maintain that coverage for a full year after the child is born. The postpartum Medicaid legislation has broad bipartisan support, but Assembly Speaker Robin Vos (R-Rochester) has opposed extending the coverage, claiming it would expand “welfare.”

SB 14 requires health care providers to obtain a patient’s consent when they teach medical students how to do pelvic exams by having them practice on women under anesthesia. Authors of the bill and advocates have reported that some providers have a history of training students on the procedure with unconscious patients who have not been informed or given consent.

The committee also added a requirement that hospitals institute written policies for informed consent relating to pelvic exams under anesthesia. The amendment replaces language requiring an administrative rule implementing the requirement.

GET THE MORNING HEADLINES.

SUBSCRIBE

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.

Reading Time: 4 minutes

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.” 

‘There’s 132 people in this building. I don’t think we should legislate by one.’

Sen. Mary Felzkowski, R-Tomahawk

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.”

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.

The first issue of 2025 highlights transporting students with special needs and disabilities. Read more about considerations of using non-yellow school bus vehicles, handling student behavior advice from TSD Conference speakers, how transportation can utilize Medicaid reimbursement, how to create a transportation plan for students with special needs and more! Also check out the 2024 TSD Conference Recap.

Read the full January 2025 issue.

Cover Story

Atypical Student Transportation
Using non-school bus vehicles such as vans is nothing new but never so widespread, especially to address increasing rates of students being classified with disabilities and who are experiencing homelessness. Cost savings can be had, but at what price for safety?

Features

It’s All About Communication
TSD Conference attendees learn from experts on what students with disabilities are really saying when exhibiting behaviors on school buses.

Hurricane Response
Student transporters discuss how their operations were pressed into action by Hurricanes Helene and Milton as well as the lessons they learned for the next big storm.

Special Report

School Districts Use Data, Routing For Medicaid Reimbursements
Technology can make the paperwork of tracking Medicaid-eligible transportation services well worth the exercise. But there is much more to the process.

TSD Conference Recap
See some of the action from the industry’s premier event for the transportation of students with disabilities and special needs. Read more about sessions throughout the magazine.

Feedback
Online
Ad Index

Editor’s Take by Ryan Gray
Handle With Care

Thought Leader by Pete Meslin
Celebrate Accomplishments When Transporting Students With Disabilities

Publisher’s Corner by Tony Corpin
Strategies for Attracting And Retaining Staff

The post January 2025 appeared first on School Transportation News.