Some of the people most clearly affected by Gov. Scott Walker's proposed changes in Wisconsin's Medicaid program are those with a prescription drug plan unique to the state: SeniorCare.

The plan, which started in 2002 and covers 91,000 low-income seniors, is an alternative to Medicare Part D, a federal drug benefit that began four years later. Under Walker's budget, SeniorCare recipients who qualify for the federal plan would have to sign up for it in January, saving the state $15 million over two years.

The move is part of $500 million in cuts in the biennial budget to Medicaid, the state-federal health program for the poor. Medicaid covers 1.2 million people in Wisconsin, or one in five residents, through SeniorCare, BadgerCare Plus, Family Care and other services.

Nearly everyone on SeniorCare would have to enroll in Medicare Part D, which has options costing $15 to $110 a month, with an average of $58 a month, said John Hendrick, government affairs director of the Coalition of Wisconsin Aging Groups.

SeniorCare costs $30 a year, plus co-pays and other expenses depending on income level. Supporters of the plan say it's simpler than Medicare Part D and more cost effective because it's supported by drug company rebates.

Medicare Part D would become people's primary drug coverage, Hendrick said, with SeniorCare a secondary plan covering some expenses, such as co-payments and the federal plan's "donut hole," a gap in coverage. It's unclear how many people would want to pay for both plans.

"This is not eliminating the SeniorCare program, but it's taking a big chunk out of it," Hendrick said. "It certainly undermines the program."

A summary of Walker's budget, released Tuesday, said seniors would still "have access to the best prescription drug coverage in the country."

Other Medicaid cuts include $110 million to Family Care, which provides long-term care for people who are elderly or disabled. Payments would be reduced for about 2,000 patients with end-stage kidney disease, and $48 million would be saved by centralizing Medicaid eligibility at the state level, cutting 270 county workers.

Details on many of Walker's other Medicaid cuts remain sketchy. His budget repair bill for this year, introduced last month, would give the state Department of Health Services new powers to reshape the program with less legislative input than required now.

If the federal government doesn't let the state make certain changes to Medicaid enrollment this year, the bill would direct the health department to drop at least 50,000 higher-income people from the program next year, saving the state $57 million a year or more.

The biennial budget "doesn't tell us very much about their plans," said Jon Peacock, research director for the Wisconsin Council on Children and Families. "But it confirms that it will be the responsibility of the health department secretary, not the legislature, to cut $500 million."

Capital W: Plug in to Wisconsin politics

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