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The U.S. Department of Health and Human Services confirmed Thursday that changes to Wisconsin’s SeniorCare prescription drug program proposed by Gov. Scott Walker would require federal approval. It’s not clear, however, if the department would grant that approval. Wisconsin Senator Herb Kohl, a Democrat, and members of the state’s congressional delegation vowed earlier this week to block it.

The program – the only one of its kind in the country – is funded by state and federal Medicaid dollars and rebates from drug companies. About 91,000 seniors are enrolled in it. Bi-partisan negotiations created SeniorCare in 2001 under Republican Gov. Scott McCallum. It was later extended under Democratic Gov. Jim Doyle.

(photo illustration by Adrian Palomo)

In 2009, Federal Health Secretary Kathleen Sebelius extended Wisconsin’s waiver allowing the state to operate the program until the end of 2012.

Walker’s proposed 2011-13 state budget would require seniors who enroll in the state’s SeniorCare program, which provides prescription drug coverage based on income, to also buy private Medicare Part D plans, which would lower the state’s costs. This would then become the seniors’ primary insurance for prescription drugs, and SeniorCare could only be used to supplement it.

Walker’s budget attributes savings of $15 million to SeniorCare changes “effective January 1, 2012.” The governor’s budget summary says the new policies will ensure “Wisconsin seniors still have access to the best prescription drug coverage in the country.”

On Thursday, Walker spokesman Cullen Werwie declined to comment on the need for federal approval but said, “The Governor’s budget preserved SeniorCare and made it fiscally sustainable into the future while preserving all existing benefits.” Democrats and some senior groups have argued the budget reduces benefits by requiring seniors to buy the Medicare Part D plans.

Kathleen Sebelius

Earlier this week, Kohl and Democratic congressional representatives Gwen Moore, Ron Kind and Tammy Baldwin wrote in a letter to Walker that his budget “would effectively remove the many benefits that seniors like about the program, such as quick enrollment, straight-forward benefits and a generous drug formulary.”

They say they’ll “urge Secretary Sebelius to reject” the changes to SeniorCare proposed by the governor.

“When asked, Secretary Sebelius confirmed that the changes to SeniorCare envisioned by your budget would not be permissible during this waiver period without federal approval,” the letter says.

Asked to confirm this claim, Mary Kahn, spokeswoman for the U.S. Department of Health and Human Services, said in an e-mail, “Any changes that the state wants to make to the currently approved terms and conditions would require federal approval as the Secretary said.  That would typically be in the form of a waiver amendment.”

Kahn declined to comment on whether the department would approve the changes proposed by Walker.

Wisconsin could also pursue a new waiver including the governor’s changes after the current one expires at the end of 2012, according to Kahn, but that would also be subject to the department’s approval.

“We would not comment on how we might act on a waiver at that time,” she said.

Democrats in the Wisconsin State Assembly are said to be circulating petitions in their districts to “save SeniorCare.”

Two Republican state senators, Alberta Darling (R-River Hills), one of the co-chairs of the Joint Finance Committee now considering Walker’s budget, and Randy Hopper (R-Fond du Lac), have been vocal opponents of Walker’s SeniorCare plan.

“We will find a way to preserve SeniorCare,” Darling said in a statement. “We need to be sensitive to (seniors’) needs, and preserving SeniorCare is something seniors tell me they need.”

Walker’s health secretary, Dennis Smith, said in a March interview with the Wisconsin State Journal, “SeniorCare obviously is very politically popular.” He left the door open to scrapping the plan, saying, “There could be other ways” to save the $15 million.

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