jon's photo.jpg By Jon Peacock, Wisconsin Council on Children and Families 

It hasn’t gotten much attention yet, but at an April 11 meeting in Madison, Secretary Sebelius delivered some great news for children in Wisconsin and across the nation.  Following a small meeting about benefits of the health care reform law for women, Sebelius met with a few reporters and was asked whether the Department of Health and Human Services (HHS) would waive the Affordable Care Act’s maintenance of effort (MOE) requirements for Wisconsin.  Sebelius responded that HHS will NOT approve MOE waivers for any states:

“That isn’t something that will happen in Wisconsin or any place else,” she said. “We are eager to work with states for ways to save money but also to keep the most vulnerable people with the health care that they need.  Short-term money saving often ends up with a less productive workforce with folks coming in through the doors of the emergency room with no payment system at all. That leads to more uncompensated care and higher cost for disease.  It’s a lose-lose situation.”  (Source: Tim Stumm, Wisconsin Health News, April 12)

The question arose here because the Walker Administration submitted an MOE waiver request late last year that would have resulted in more than 64,000 people losing their BadgerCare coverage, including over 29,000 children. (See my previous blog post for details.)  It’s been pretty clear for several months that HHS was not going to approve most of the proposed changes affecting kids, but the Secretary’s statement on Wednesday removes any lingering doubts about the department’s interpretation that the health care reform law prevents states from weakening current eligibility standards and enrollment practices for all children, and also for adults below 133 percent of the poverty level.

Wisconsin will still be allowed to make some of the other changes to BadgerCare.  HHS has made it clear that they will grant plan amendments allowing the state to raise premiums for adults over 133 percent of the federal poverty level (FPL) and to deny eligibility to those adults if they have an offer of employer coverage with premiums that are less than 9.5 percent of family income.   Those changes, which do not require an MOE waiver (because the state has certified that it has a deficit), are expected to result in roughly 17,000 adults losing their BadgerCare eligibility or dropping out of the program because of higher costs.

Although we are still very concerned about the changes that Wisconsin’s Department of Health Services will be allowed to make, it’s a huge relief that this set of changes won’t apply to children and will preserve BadgerCare coverage for about half of the parents who would have lost that coverage if the state’s original waiver request had been approved.  And the Secretary’s remarks Wednesday are tremendous news for children and parents in other states where policymakers are contemplating similar changes.

As we celebrate the ways that the ACA has already improved access to health care, let’s not forget the extremely important contribution of the law’s MOE requirements.   They have ensured a stable source of affordable health care coverage for America’s children during tough economic times and helped bring the uninsured rate for children down to a historic low.

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