Tami Jackson of the Wisconsin Board for People with Developmental Disabilities describes how unpaid family caregivers could be affected by proposed Medicaid cuts in the Republican budget reconciliation package in Washington, D.C. Janet Zander of the Greater Wisconsin Agency on Aging Resources, seated at right, also spoke. (Photo by Erik Gunn/Wisconsin Examiner)

Among the many people whose health care could be in jeopardy from possible Medicaid cuts, one group may be even less visible than the rest.

“Medicaid is the primary thing that supports family caregivers,” said Tami Jackson, policy analyst for the Wisconsin Board for People with Development Disabilities (BPDD), in a presentation to social workers Thursday in Dodgeville. 

The person under the caregiver’s care could be living at home, but will probably still require long-term support of some kind — support covered by Medicaid, Jackson said. Medicare provides coverage only for a limited time, such as when a person has come home after being hospitalized.

Private long-term care insurance plans “are unaffordable and they have not been workable for many years,” she added. “So Medicaid is it — and we happen to have a lot of people who need long-term care.”

Jackson and Janet Zander of the Greater Wisconsin Agency on Aging Resources met with Iowa County social workers in Dodgeville Thursday to explain the likely effect of Medicaid cuts that are part of the budget reconciliation bill that has passed the U.S. House and is now in the Senate.

The GOP majorities of both houses want to pass the legislation so they can extend tax cuts enacted in 2017, when President Donald Trump was in his first term. Those tax cuts have been found to heavily benefit wealthy Americans. Without action they will expire at the end of 2025.

Cutting Medicaid, hiking other costs

Medicaid is the single largest source of federal funds in the state budget — about $9 billion a year.

Under the U.S. House version of the budget reconciliation bill, the Wisconsin Department of Health Services (DHS) has projected between 71,000 and 111,000 Wisconsinites would lose Medicaid coverage, including more than 3,800 people with disabilities and 2,400 older adults. The state’s federal Medicaid revenues would be cut by $501 million to $663 million.

The Medicaid cuts on the scale of those in current iterations of the bill “are too large to not cause states to have to cut many things in their state budget,” Jackson said.

The bill’s Medicaid cuts as well as changes it would make to the Affordable Care Act’s health insurance marketplace — including ending subsidies that have made marketplace plans more affordable for lower-income people — would increase the number of uninsured Americans by 16 million in the next decade, according to the Congressional Budget Office.

“Whether you’re a caregiver, whether you’re on Medicaid, whether you’re working for somebody who’s on Medicaid,” everyone will be affected by 16 million more uninsured people, Zander said.

With more uncompensated care for hospitals and providers, she predicted that the cost for other payers will increase.

“We’re going to see premiums for any kind of [health] insurance skyrocket — the employer’s portion, the employee’s portion,” Zander said.

Reduced Medicaid care, more unpaid care

Family caregivers feel Medicaid’s impact in several ways. For many people who are elderly or have disabilities it enables them to get paid, professional care at home. If that care is cut back, that means more work for the unpaid family member.

“Those paid caregivers — they’re paid for by Medicaid dollars and there aren’t enough of them. There haven’t been enough of them for years,” Jackson said.

 If Medicaid cutbacks reduce the pay for those caregivers, the workforce that is already underpaid is likely to be even harder to find — making access to paid care even more difficult, she added, to the point where “it’s either the unpaid caregiver or nothing.”

Family caregivers who take on more unpaid care responsibilities may have to cut back on their own paid jobs.

“The amount of people who are reducing, limiting [work hours or] leaving the workforce because there isn’t a stable, paid caregiving workforce to provide what they need is huge,” Jackson said.

A BPDD survey found that for unpaid family caregivers in Wisconsin providing or coordinating care or filling in for missing care workers took 80% of their time. Two-thirds said caregiving had a negative impact on their family finances and 50% said they left jobs or reduced hours to provide care because there were no care workers to hire.

Unpaid caregivers who leave the workforce not only lose income but reduce the earnings that contribute to their Social Security retirement, Jackson said.

Kristin Voss, a Madison public school teacher for 24 years, had to retire to help manage and care for her 23-year-old daughter. Her daughter has epilepsy, autism and an intellectual disability and “functions at about anywhere from 6 to 12 years old,” Voss said in a panel discussion that was part of Thursday’s presentation.

Until her daughter was 21, she was entitled to public education, where she got “tons of support” including in her transition period that started when she was 18, Voss said. At 21, those supports were no longer available, however.

Her daughter enrolled in the state’s self-directed long-term care program called IRIS. The program includes a caseworker, but Voss also has responsibility as her daughter’s family caregiver, helping to manage day-to-day changes in her daughter’s placement and activities.

“I don’t mind doing these things, but there’s things that I don’t always know about and I’m not always prepared for,” Voss said. “And so, no, I couldn’t do this and be a public school teacher.”

Instead, she has put together a collection of part-time positions that give her flexibility that she needs — although none of them have health insurance, Voss said.

Unpaid caregivers ‘untangling the mess’

Some unpaid caregivers who leave the workforce may also turn to Medicaid for their health coverage because they can’t afford health insurance or work at a job that doesn’t provide insurance.

“About 4 million people nationally are unpaid caregivers who are in Medicaid themselves,” Jackson said.

Among the changes proposed for Medicaid is a requirement for participants in the program to prove every six months that they are still eligible for the program, instead of once a year, the current standard. Another change proposed is to add a work requirement for certain Medicaid participants.

Both of those changes will mean more paperwork. “Unpaid caregivers are the folks that are keeping people who are in Medicaid programs already,” Jackson said — by filling out the forms that are required to prove the person is still eligible.  

“Often these processes are so complex,” Jackson said. And when something goes wrong, because of an error in an eligibility form or a billing mistake, family caregivers “are the people who are untangling the mess.”

The current version of the bill in the Senate gives caregivers an exemption from the work requirement — but Jackson said the definition has raised concerns.

The current proposal limits the exemption to people who are caring for a person under the age of 14. National advocates have said that “really narrows that caregiver exemption and doesn’t quite fit with the reality that most unpaid caregivers are providing care for people with disabilities and older adults,” Jackson said.

Including exemptions in the proposed work requirement provisions also doesn’t necessarily reduce the paperwork.

“You either have to prove you’re meeting the work requirements, or you have to prove that you’re exempt for those requirements,” Jackson said. “And if you’re a caregiver who’s in Medicaid, you have to do that for yourself and probably the person you’re supporting.”

Green Bay Conservation Corps workers, from left, Emily Swagel, Zak King and Cailie Kafura, plant native shrubs in Fireman's Park. The work is part of installing a pollinator corridor and a larger land restoration project across Green Bay. (Photo courtesy of Green Bay Conservation Corps)

Jake White says he was lucky.

A University of Wisconsin-Madison graduate with a global health major, White was in his second year of an AmeriCorps placement in the Sawyer County Public Health Department, where he helped out with department reports and outreach to the community. Then AmeriCorps pulled the plug at the end of April — cancelling its grants to agencies all across the country.

White was in the middle of working with a team assigned to produce a community health assessment for the county when he got the news. Sawyer County kept him on so he could stick with the project, converting his position to a  limited-term employee (LTE) through the end of June, when White starts medical school in Wausau.

The reprieve also gave him a chance to hand over a second project, on substance abuse prevention, to another community member, White said. The future of that work was one of his biggest worries about AmeriCorps’ sudden shutdown.

His AmeriCorps experience at the county “really gave me the foundation for the skills and knowledge I will carry into my role as a physician,” White told the Wisconsin Examiner.

The aftermath of the AmeriCorps shutdown didn’t go as  smoothly for Maxwell Robin. He was placed with the St. Vincent DePaul charitable pharmacy in Madison.

“I did whatever needed to be done,” Robin said — working on computer projects at the pharmacy, filling prescriptions, serving as an interpreter for Spanish-speaking patients.

When the AmeriCorps cancellation notice arrived, the projects he was working on “got thrown into chaos,” Robin said a week after the notification.

Now a federal judge has ordered AmeriCorps to restore its grants and reinstate its volunteers. But all of that remains up in the air.

“Things are just very confusing now,” Robin said Friday.

Despite that, Robin has been able to move on. He is waiting to hear back from several job applications.

And he still volunteers part-time at the pharmacy, where he developed a strong interest in working in the nonprofit sector.

“We were able to take people who, for whatever reason, had been kicked to the side,” Robin said.

But program administrators still don’t know for sure what will happen and when.

“We are still waiting for official notification from AmeriCorps,” said Jeanne Duffy, the executive director of Serve Wisconsin, in an email message Friday.

Serve Wisconsin, based in the Wisconsin Department of Administration, is the state administrator for AmeriCorps.

Wisconsin has 25 AmeriCorps programs operating in more than 300 locations across the state — volunteers who are paid a stipend and who work in health care, help with environmental projects, assist in school classrooms and carry out  other projects.

When the Trump administration canceled AmeriCorps grants April 25, the action caught participants in the program as well as officials responsible for coordinating its work by surprise.

Wisconsin Gov. Tony Evers and Attorney General Josh Kaul joined the federal lawsuit brought by 25 states to challenge the AmeriCorps shutdown.

Thursday’s order, by U.S. District Judge Deborah L. Boardman in Maryland, found that the Corporation for National Community Service, the agency that operates AmeriCorps, and its administration “likely violated the Administrative Procedure Act by failing to engage in notice-and-comment rulemaking before making significant changes to service delivery, that the plaintiffs will be irreparably harmed if this injunction does not issue, and that the balance of the equities and the public interest favor an injunction.”

The cancellation affected programs all over Wisconsin that have worked with AmeriCorps, some of them for years, and the volunteers who have flocked to AmeriCorps looking for experience through community service work.

“It’s a tragedy,” said state Rep. Supreme Moore Omokunde (D-Milwaukee), who spent two years as an AmeriCorps participant 15 years ago. “AmeriCorps is about volunteerism. We have limited resources and we have this unlimited need.”

In Green Bay, AmeriCorps helped staff the Green Bay Conservation Corps. Founded in 2022, the Conservation Corps has fielded teams of AmeriCorps members each year on projects that have included establishing a pollinator corridor through the city, removing invasive plants, maintaining walking trails and restoring area streams.

“Altogether we’ve seen over 70 AmeriCorps members come through our doors,” said Maria Otto, the Green Bay Conservation Corps coordinator. “They’re the ones getting the work done.”

The Green Bay city council passed a measure covering the rest of the 2025 service year from city funds.

“After two weeks of uncertainty, our entire crew was able to work for the Conservation Corps again” thanks to the funds, said Cailie Kafura, one of the AmeriCorps volunteers. The money will allow the program’s work to keep going through August.

“We were doing a lot of work that people maybe don’t even know is being done,” said Kafura. “I know that the work I’m doing, I want to be doing that kind of work in the future. I want to be using my body and my mind for good out in the world.”

Lynn Walter operates a nonprofit, New Leaf Foods, that promotes access to healthy food and education in the greater Green Bay area. Founded 15 years ago, New Leaf began working with AmeriCorps five years ago through a partnership with Marshfield Clinic. The clinic deploys AmeriCorps participants on health-related projects around the state.

Walter said Friday after the cancellation she was able to retain one of her three AmeriCorps participants this year on a contract basis. A second AmeriCorps member chose to stay on as a volunteer to complete a project she had been working on, while the third needed more paid hours and went to another job.

Even with the court ruling, Walter said, she’s been told that what happens next remains uncertain. And she fears there’s been longer-term damage regardless of what happens in the court case.

“Even if the program starts up again, there won’t be the momentum that there has been in the past,” Walter said. She expects prospective participants to be wary of signing up in the future: “What would you tell a young person?”

In his early 30s, Omokunde joined Public Allies, a leadership development nonprofit, in 2010 and 2011 as an AmeriCorps participant. He called the experience “a tipping point” for him personally and professionally.

“One of the core values is collaboration,” Omokunde said. “It taught me that collaboration is one of the most difficult things to do — but it’s one of the most necessary things to do.”

Omokunde is blunt in his assessment of why AmeriCorps was targeted in President Donald Trump’s second term.

“I think it follows a long tradition of people not valuing the work that is done in certain communities,” Omokunde said. “Donald Trump is a bully. He doesn’t want anything in opposition to him and his agenda.”

Omokunde ticked off a list of colleagues in politics who came up through AmeriCorps and Public Allies: State Rep. Darrin Madison (D-Milwaukee), Milwaukee County Executive David Crowley, former state Rep. David Bowen, and the late Milwaukee alder Jonathan Brostoff, also a former Assembly member.

“When he sees this cadre of individuals who are rooted in community and learning about asset-based community development, diversity and being committed to anti-oppression as well, people who represent all people, he doesn’t want that kind of opposition,” Omokunde said. “He just wants people to go along and do his bidding.”

UW-Madison Engineering Hall. (Photo by Baylor Spears/Wisconsin Examiner)

U.S. Secretary of State Marco Rubio said that international students with ties to the Chinese Communist Party or studying in “critical fields” could have their visas revoked. Rubio didn’t define what those critical fields would be and also provided little detail when he said that the State Department would “enhance scrutiny” on new student visa applications.

The administration has also said it plans to increase the vetting of visa applicants’ social media accounts. The announcement that the administration would be revoking the visas of Chinese students came the same day the State Department announced it had paused scheduling appointments for visa applicants. 

UW-Madison had 3,414 international students from China this spring semester. In recent years, the university has worked to expand its international student body, aiming to increase the international population from 4% to 8% by 2028. The acceptance of international students helps the university increase revenue as state aid has remained flat and inflation has increased costs because international students pay an average of four times the amount of tuition as in-state students. 

The university said Thursday it is monitoring the situation. 

“We are deeply concerned about the impact of such a policy on our Chinese student community,” the university said. 

In a message to its international students, the university advised them to attend visa appointments that are already scheduled and inform university staff if an appointment is canceled. The message also told the students to schedule appointments as quickly as possible once the pause on scheduling is lifted and to enroll in classes for the fall. 

These moves are the latest in the Trump administration’s efforts to attack international student visas. Earlier this spring, the administration deleted visa records for some students over minor traffic infractions and encounters with law enforcement. That effort temporarily canceled the visas of more than two dozen students and alumni at UW schools across the state. 

The Trump administration rolled back that decision and reinstated the visas after a federal judge ruled in favor of a number of students who sued to stop the revocation.

USGS staff install a microsampler in a Milwaukee creek. (Photo by Peter C. Van Metre/USGS)

A field office of the U.S. Geological Survey (USGS) in Rice Lake that serves as part of an expansive national network monitoring water data is set to close next year as part of a Department of Government Efficiency (DOGE) effort to terminate the leases of the agency’s offices. 

The Rice Lake office and an office in Mounds View, Minn., are both operated by the USGS Upper Midwest Water Science Center. They are among the more than two dozen offices across the country DOGE has targeted for closure, according to Public Employees for Environmental Responsibility. 

USGS staff and environmental policy workers across Wisconsin say closing  the office in Rice Lake could harm the quality and quantity of the data available in the state — making it harder for local, county and state governments, as well as private citizens and businesses, to make plans and policies in a region that will be at more risk of both drought and extreme weather events as climate change intensifies. 

The USGS water science centers operate thousands of streamgages across the country, gathering data on stream flows and water quality. That data can be used to help design plans for infrastructure such as bridges and dams; inform research on pollutants such as nitrates and pesticides; help farmers set irrigation plans during droughts; give homeowners information on flood plains and support recreational industries such as whitewater rafting. 

“The Rice Lake office is just a very important but small piece of what they do, and what they do is so fundamental to what so many other people are trying to do across so many sectors in the state of Wisconsin,” says Erin O’Brien, a spokesperson for the Wisconsin Wetlands Association. “They support state agencies and local communities and others doing not just land and water conservation work, but development and transportation planning and all these other sectors.” 

The agency has been operating streamgages in the United States since the 1880s. One of the first 120 gages the agency installed was in Wisconsin in 1899, according to USGS data. That longevity gives scientists an essential resource for tracking Wisconsin’s bodies of water. It’s easier to understand the effect of a 100-year flood when you’re working with more than a century of data. 

Each individual streamgage increases the value of the entire network, and every additional year of data further improves the data. Many practical uses of the data to understand how rivers and watersheds are functioning require 20 years of measurements, according to a 2021 report on the USGS streamgage network by the Congressional Research Service. 

At a field office such as the one in Rice Lake, the staff is responsible for maintaining and repairing the gages. The risk of closing an office is that the staff won’t be close enough to do that work, resulting in lower quality data, according to Paul LaLiberte, who serves as the chair of Wisconsin Green Fire’s Environmental Rules and Water Resources Work Group. LaLiberte worked on water quality issues for 36 years at the state Department of Natural Resources. 

“This flow data is continually recording, and [the field offices are] the ones that install the equipment, maintain the equipment, and, importantly, go out and calibrate it on a schedule and even in response to events,” says LaLiberte, who worked with staff in the Rice Lake office when he was based in Eau Claire with the DNR. 

“By closing the field offices, that’s going to make it a whole lot harder to do this calibration and maintenance and even run as many stations as they do,” he said. “The consequences will probably be some combination of dropping some stations or having the data be less accurate, because due to travel times, they just can’t send the crews out there to recalibrate the stations. So if the data is less accurate, then the predictions are going to be less accurate, and the infrastructure designs associated with that are going to be less accurate.”

One USGS staff member who works outside of Wisconsin, granted anonymity because agency employees have not been authorized to speak to the media, says staff members across the country weren’t aware their offices were being shut down until the General Services Administration told their landlords the leases would not be renewed. 

The staffer says the terminations are “shocking” because these offices are filled with lab equipment that is difficult to move and there are still not yet plans for alternatives. The result is that the data won’t be collected. 

“I guess maybe this is apparent, but leaving these leases was not a strategy for efficiency,” the staffer says. “There’s no plan in place to leave these facilities and find other alternatives. And it’s a huge effort to now create a plan to find alternatives for these facilities when you know these facilities are in full use, and we don’t see any other options. We will not be able to collect the data that we need to fulfill our mission, because we will be reassigning resources to deal with moving that we don’t have.” 

A USGS spokesperson said in a statement the terminated leases will not harm the agency’s mission. 

“USGS remains committed to its congressional mandate as the science arm of the Department of the Interior,” the spokesperson said. “We are actively working with GSA to ensure that every facility and asset is utilized effectively, and where necessary, identifying alternative solutions that strengthen our mission. These efforts reflect our broader commitment to streamlining government operations while ensuring that scientific endeavors remain strong, effective, and impactful. This process is ongoing, and we will provide updates as more information becomes available.”

The Rice Lake office’s lease is set to end July 31, 2026.

The Wisconsin Department of Health Services (DHS) website for enrolling in Medicaid and other state benefits programs. (Screenshot)

Among changes to Medicaid tucked in the federal reconciliation bill that passed the U.S. House last week is one that requires participants in the state-federal health plan for the poor to prove they’re eligible every six months.

Wisconsin advocates said Tuesday the provision is likely to reduce Medicaid enrollment — not because people don’t qualify but because of administrative errors and confusion.

Under current state and federal law, people covered by Medicaid must have their eligibility confirmed every year. Eligibility depends on various factors, chief among them household income. People whose Medicaid services are tied to a disability undergo an annual evaluation to determine whether their disability still qualifies them.

“We already do a really good job about making sure that everybody who’s in Medicaid is already eligible to be there,” Tamara Jackson, policy analyst and legislative liaison for the Wisconsin Board for People with Developmental Disabilities, said in an interview.

Checking eligibility more frequently isn’t likely to uncover more people who are enrolled in Medicaid and don’t qualify, Jackson said: “It will lead to a different result because people who are eligible for the program are losing coverage because they didn’t get the paperwork in on time.”

“It’s going to probably result in kicking people off the program — some of it through error and some of it just benign neglect,” said Bobby Peterson, executive director of ABC for Health. The nonprofit is a public interest law firm that assists people navigating the health care system get coverage and address problems such as medical debt.

“It’s part of a blizzard of paperwork to keep people off the program,” Peterson said of the twice-yearly Medicaid eligibility test. “And it’s not necessarily going to be very effective in maintaining program integrity.”

He said Medicaid participants are already required to report changes in their income that could change whether they’re eligible.  

“It’s calculated to deter people from staying with the [Medicaid] program,” Peterson said. “It’ll leave more people out and less people covered, more people uninsured.”

With fewer people covered by health insurance, that could lead to “higher rates of medical debt, higher rates of uncompensated care, and then the socialization and redistribution of all that medical debt onto everybody else’s [health care] bill,” Peterson said. “So, it’s a lose-lose proposition.”

The House Republican majority drafted the reconciliation legislation in order to extend tax cuts enacted in 2017 during President Donald Trump’s first term.

The bill’s tax cuts largely benefit higher-income households, according to the Congressional Budget Office. The bill’s spending cuts to Medicaid and other programs, including federal nutrition aid, were included to reduce the tax cuts’ impact on the federal deficit.

In Wisconsin, about 1.3 million people are covered by Medicaid, according to the state Department of Health Services (DHS). About 900,000 are enrolled in BadgerCare Plus, which provides primary health care for families and single adults with incomes below the federal poverty guidelines. Another 250,000 are in one of several Medicaid programs for long-term care for people with disabilities or the elderly, and the rest are in other specialized programs.  

The change in how often Medicaid recipients must qualify for the program is just one of many changes in the program under the House reconciliation bill.

In a report produced in late April before the bill’s passage, the state Department of Health Services (DHS) calculated that its proposed Medicaid changes could cost Wisconsin up to $16.8 billion over the next date.

Current federal Medicaid regulations forbid states from determining a person’s eligibility more often than once a year. The House reconciliation bill would effectively override that rule.

A requirement to check every Medicaid recipient’s eligibility twice a year was part of state legislation that Wisconsin Republican lawmakers introduced earlier this year. That bill was met with sweeping criticism at a public hearing in April and has not advanced in the state Legislature.

Supporters of the change have argued that more should be done to reduce fraud in  the Medicaid program. But health care experts contend that the Medicaid cuts in the House bill are unlikely to address genuine fraud.

During the COVID-19 pandemic, the federal government temporarily suspended the annual Medicaid renewal requirement to ensure that people had health coverage and would seek medical help if they felt sick.

“Obviously if there’s a public health emergency, you want to maintain connections and access to health care and coverage,” Peterson said. Some people may have been still covered under Medicaid after they were no longer eligible, he added, and some “didn’t even know they had Medicaid or BadgerCare Plus in addition to some private insurance at various times.”

Nevertheless, “it wasn’t like there was wide-scale fraud” in the Medicaid program, Peterson said. “There’s very little evidence of a lot of consumer-related fraud in the program.”