Did Wisconsin Cut Women’s Cancer Screening To Avoid Medicaid Expansion?

Wisconsin’s Well Woman Program provides free mammograms, cervical cancer screenings, multiple sclerosis testing and other services to low-income women without insurance. The program, funded through a partnership with the Centers for Disease Control, has provided more than 500,000 breast and cervical exams and diagnostic services to more than 70,000 over the course of 20 years. The program is administered by the Wisconsin Department of Health Services and provides services to 72 Wisconsin counties and 11 tribes via local coordinating agencies.

As of July 1, the program will be restructured, resulting in no more than 10 coordinating agencies and only a handful of providers to cover the entire state.

Earlier this month, the Wisconsin Department of Health Services notified the providers of the restructuring. They were told that as of June 30, 2014, their agreements would be terminated. The memo noted the state’s desire to be more “efficient” in delivering care across the state, due to an anticipated decrease in funds.

Supporters of the Well Woman Program are not convinced that costs are truly the issue.

Funding for the program through the state is secured through June 2015 and the partnership with the CDC still has another three years left. This makes them question the need to do the restructuring so quickly. As the state has given no details about the restructuring, many women receiving care now risk not having a provider for follow up appointments needed after the July 1 deadline.

The answer may be in another reason given for the restructuring: The Affordable Care Act.

Governor Scott Walker is one of several republican governors that have come out against the ACA. Wisconsin is one of 25 states that have refused to expand Medicaid coverage. This means that individuals that do not qualify for federal subsidies (or can afford the plans if they do), but do not meet the state’s requirements for Medicaid may remain uninsured. Wisconsin’s Medicaid program only covers the elderly, blind, disabled or those who qualify for the Well Woman Program.

Since the ACA now requires many of the services provided via the WWWP to be covered in all insurance policies, the state anticipates that more women will now get coverage via the federal exchange, since they will possibly qualify for federal subsidies. The state will also expand coverage for childless adults aged 19-64 via the state’s BadgerCare program, which has provided health services for low income people. As of April 1, 2014, childless adults who make 100 percent of the federal poverty level ($11,680 for an individual) will be able to participate in the program. For states that expand Medicaid, the limit is 133 percent.

BadgerCare, now called BadgerCare Plus, has traditionally covered children, pregnant women and families with children. To offset the costs of more adults in the program, they are decreasing the number of families with children that do not reach a certain income threshold. Beginning April 1, 2014, families must have an income at or below 300% of the federal poverty level, currently at $23,850 for a family of four. This income level applies to families that want to just enroll their child and not the adults. Families that make more than that will have to seek private insurance through the exchange.

WWWP providers expected a change in the program with the implementation of the ACA. They did not, however, expect it to happen so suddenly. Plus, funding for the program was increased this year. Furthermore, the state has given no data as to how many women will be leaving WWWP and going on to the exchange.

So why the restructuring?

Many states that have refused to expand Medicaid are finding they have to scramble to fund the hospitals and providers that rely on Medicaid funds. Furthermore, those that fall into the coverage gap, meaning they don’t qualify for their state’s Medicaid or for federal subsidies for private health insurance, are having to rely on programs like WWWP for certain services. Perhaps it’s not such a coincidence that the provider network for WWWP is being reduced while the state’s program is being expanded – with a full three years of funding left.

The money has to come from somewhere.

The state has not commented on how the WWWP network will be restructured, nor have they given details on how the funding will be redistributed. State officials insist that the program will continue.