On Thursday, June 22, the legislative Joint Finance Committee (JFC) wrapped up its work on the 2023-25 state budget, after taking action on final budget matters, including its proposals for UW System funding, a tax cut, and raises for state employees.

Last week, the JFC took action on health services funding, including long-term care reimbursement and other LTC-related items. Please see below for a review of the Committee’s prior action on LTC priorities.

The budget bill now heads to both chambers of the State Legislature, where few changes are expected on the floor. The Legislature is expected to be on the floor next week to take up the budget.

One item of contention between the Republican-held Legislature and Wisconsin’s Democratic Governor Tony Evers relates to UW System funding. The JFC cut $32 million in funding to UW System schools which would have gone toward diversity, equity, and inclusion efforts. Gov. Evers has threatened publicly to veto the entire budget bill if the cut goes through, which would require the legislature to reconvene and work out a solution with the Governor that he would sign into law. It is unclear at this point if the Governor will act on his threat to veto the entire budget.

WHCA/WiCAL is also communicating with both DHS and the Governor’s office to share our support for the long-term care items included in the state budget, as we seek to avoid any line-item vetoes of the LTC provisions by the Governor. WHCA/WiCAL will keep members updated as the budget bill continues through the legislative process.

PREVIOUSLY: JFC Advances Increased LTC Funding in State Budget

On Friday, June 16, the Wisconsin State Legislature’s Joint Finance Committee voted on state budget provisions related to health services, including long-term care funding. WHCA/WiCAL is pleased to report that the Committee included important increases for both skilled nursing Medicaid reimbursement and Family Care funding.

See the JFC motion here.

See WHCA/WiCAL’s press release praising the JFC action here.

WHCA/WiCAL members and staff have been advocating for meaningful investments in both SNF Medicaid and Family Care funding since the Fall of 2022, including through member tours, Joint Finance Committee hearing testimony, in-person meetings with members of the committee and legislative leaders, and additional meetings throughout the first half of 2023. We are pleased to announce that many of our funding priorities were included in the JFC’s health services budget. Please see below for more information on funding levels supported by the Committee for both SNF Medicaid and Family Care.

NURSING HOME REIMBURSEMENT

For skilled nursing providers, the Committee voted in favor of funding [approx. $29 million state funds, known as General Purpose Revenue (GPR), $73 million All Funds, in each year of the biennium] to create a new payment standard for the reimbursement cost center known as Support Services, which includes reimbursement for critical services such as dietary, housekeeping, maintenance, laundry, and security. The approved Support Services payment standard, equal to the median nursing facility cost + 25%, matches the payment standard approved in the 2021-23 budget for costs related to Direct Care-Nursing, a standard which the Committee maintained by including funding for the DHS cost-to-continue in the 2023-25 budget. Together, the two payment standards will enable providers to maintain the high quality of care and high quality of life that our seniors and people living with disabilities so richly deserve.

Additionally, the Committee approved funding (approx. $6 million GPR, $15 million All Funds, in each year of the biennium) so current nursing home incentive payments are actually serving as incentives. Currently, provider incentives are calculated within the total rate for a nursing facility, so if the facility is already nearing the rate ceiling of allowable costs, the facility will not receive the full incentive (and in some circumstances, none at all) despite incurring additional expenses or sacrifices in order to qualify for the incentive(s) in the first place.

For example, there is a provider incentive for costs associated with the care of patients with specific behavioral or cognitive difficulties. These patients often require additional care and services, additional staff, and specialized equipment. Many facilities would not otherwise be able to admit and care for these behaviorally complex individuals without the incentive. Another provider incentive applies to facilities with 50 or fewer beds, helping to ensure access to care in rural communities.

The Committee also added funding to the Nursing Home Ventilator Dependent Rate, providing $4 million GPR ($10 million All Funds) to increase the all-encompassing ventilator-dependent resident reimbursement rate for nursing home care, an important investment to ensure ventilator access across Wisconsin.

FAMILY CARE

The Committee also approved significant increases for Family Care providers, including $15 million GPR ($38.5 million All Funds) over the biennium for the Family Care Direct Care Workforce Fund, as well as about $88.5 million in GPR ($226 million All Funds) over the biennium to maintain a 5% cost-to-continue for home- and community-based services.

WORKFORCE AND COMPLEX PATIENTS

Finally, the Committee made significant investments in two very important areas:  In our long-term care workforce by investing an additional $2 million GPR in the WisCaregiver Careers program and to address the difficulty our hospitals are experiencing in transferring patients to an appropriate post-acute setting who present with complex medical and/or behavioral needs by investing $5 million GPR in a pilot program to enable hospital and nursing facility partners to collaboratively develop appropriate care delivery models.

“By increasing funding in these key areas, Wisconsin can ensure that long-term care providers  will be able to maintain appropriate staffing levels, purchase necessary equipment, and provide quality care and services to their residents,” said Rick Abrams, WHCA/WiCAL CEO. “Providers thank the Joint Finance Committee and other supporters in the Legislature for their commitment to long-term care.”