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Sarah and Karen drinking

Sarah Rosenthal, a UW-Madison student and personal care worker, helps Karen Foxgrover eat, drink and take medication, along with bathing, toileting and other daily activities, in this photo from 2017. Foxgrover receives personal care through Medicaid, the state-federal health program that Gov. Tony Evers wants to expand in his budget.

Wisconsin would join most states in adopting a full Medicaid expansion under Democratic Gov. Tony Evers’ budget, using an estimated $320 million in state savings gained by bringing in more federal money to better fund hospitals, mental health services and nursing homes.

The plan to insure about 82,000 more low-income adults, almost completely using federal tax dollars, is certain to face opposition in the Republican-controlled Legislature. GOP lawmakers previously joined former Republican Gov. Scott Walker in rejecting the Medicaid expansion allowed under the Affordable Care Act, saying the federal money could fall through.

Eric Borgerding, CEO of the Wisconsin Hospital Association, a powerful lobby, said “improving Medicaid reimbursement and expanding access to care are bipartisan issues.”

Evers’ budget calls for repealing work requirements, premiums, co-pays and mandatory health screens for childless adults on Medicaid, measures approved by President Donald Trump’s administration shortly before Evers narrowly defeated Walker in November.

Evers would also get rid of a work requirement for adults receiving FoodShare if they have children.

Among other health issues targeted by the budget released Thursday is lead poisoning, a significant problem among children in rental properties, especially in southeastern Wisconsin. A fund would be created to test and get rid of lead in 2,250 homes.

In an effort to address soaring drugs costs, the state would allow the importation of generic drugs and require drug makers to report and justify price increases.

Increased funding would eliminate a wait list for the Children’s Long-Term Support program, which serves children with disabilities.

The budget would end transfers from veterans homes to the Veterans Trust Fund, and allocate nearly $16 million to the fund, which provides various benefits to veterans.

Highlighting Evers’ health proposals is an increase of $580 million over two years to Medicaid providers, paid in part through the $320 million in anticipated savings from Medicaid expansion.

Hospitals serving a large share of Medicaid patients would get about $262 million more, and an additional $69 million would be invested in mental health services, in part to address the state’s opioid epidemic.

Nearly $15 million would be added to the Family Care program, aimed at direct care workers, and rates would go up 2.5 percent for nursing homes and 1.5 percent for personal care workers, each year.

The Affordable Care Act let states expand Medicaid, the state-federal program for the poor, to people who make up to 133 percent of the federal poverty level. The federal government initially paid 100 percent for those newly covered and later 90 percent, instead of its regular share of 60 percent.

Walker and the Legislature limited coverage to people at or below the poverty line. That shifted about 63,000 adults with higher incomes off Medicaid and allowed about 130,000 childless adults onto the program, with the state paying its regular 40 percent share for them.

By fully expanding Medicaid, the state can cover 82,000 more people and save $320 million because the federal government would pay 90 percent instead of 60 percent.

However, a study last month by the conservative Wisconsin Institute for Law and Liberty and UW-Madison’s Center for Research on the Wisconsin Economy said Medicaid expansion would carry a net cost of $600 million a year. Providers would increase prices to offset low Medicaid rates and pent-up demand among people joining Medicaid would lead to expensive emergency room visits, the report said.

Donna Friedsam, health policy programs director for UW’s Population Health Institute, said the study didn’t consider the better health outcomes and related cost savings that could arise from Medicaid expansion.

Many people joining Medicaid would come from existing Obamacare marketplace coverage, so their pent-up demand could be minimal, Friedsam said. Medicaid expansion could reduce private prices by removing needier patients from the marketplace, she said.

Wisconsin is one of 14 states that haven’t adopted Medicaid expansion. Among them, it’s the only one with no gap in coverage for residents below the poverty level. Medicaid programs in the other states, including Florida, Georgia and Texas, don’t cover adults up to the poverty line.

Evers’ budget also includes initiatives previously announced, such as legalizing medical marijuana and decriminalizing recreational use of marijuana for amounts of 25 grams or less. State residents could use CBD oil, a non-hallucinogenic derivative of marijuana, without a doctor’s certification.

Evers also wants to invest $43 million more in dental care, including nearly $39 million to boost Medicaid payments to dentists. He would spend $1.5 million on training programs for dental therapists, mid-level providers that can fill cavities and pull teeth, opposed by the Wisconsin Dental Association.

Evers’ budget includes an additional $28 million for women’s and infant health, primarily to extend Medicaid coverage for women after birth from 60 days to a year. It would restore funding for Planned Parenthood that was blocked by Walker, which Republican leaders have said they won’t support.

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