WASHINGTON -- Wisconsin is in the midst of dramatically restructuring a health care program for low-income women, attributing the move to the Affordable Care Act. The changes have taken women's health advocates by surprise, and they are now trying to convince the state that setting a six-month timeline to dramatically alter the program is unnecessary and could leave many women without services for breast and cervical cancer.
The Wisconsin Well Woman Program provides preventative health screening services to low-income women who are uninsured or underinsured. The program, which has been around for nearly 20 years, is funded by both the state and the federal Centers for Disease Control and Prevention, and has been credited with providing more than 500,000 breast and cervical cancer screenings to more than 70,000 women.
Wisconsin's system is designed to help women locally, with a "coordinating agency" in each of the state's 72 counties aimed at helping women navigate the system of more than 1,000 participating providers.
But on July 1, this entire system is set to change: There will be just 5-10 coordinating agencies in the state and only a handful of health care providers. And although the restructuring is set to go into effect in just a few months, no one knows who those providers will be.
"There are women who are being screened and detected for cancer now who cannot schedule their follow-up appointment because no one knows who the providers will be after July," said Sara Finger, executive director of the Wisconsin Alliance for Women's Health.
The Wisconsin Department of Health Services first announced the change on Dec. 12, when WWWP Director Gale Johnson sent providers a memo telling them about the changes and saying they had six months to get ready. She attributed the downsizing to the fact that the Affordable Care Act now requires employers to fully cover many preventative services, such as mammograms and certain chemoprevention drugs.
"We anticipate that the Centers for Disease Control and Prevention (CDC) funding and the need for WWWP services will diminish in the future as women gain access to expanded health insurance coverage for their more comprehensive health care needs as a result of the Affordable Care Act and recent changes to Wisconsin's BadgerCare Plus [Medicaid] Program. We will no longer be able to support the current service delivery system of over 1000 provider sites," Johnson wrote.
Women's health advocates and agents who spoke with The Huffington Post all said they expected there would be some changes to WWWP due to Obamacare. What they didn't expect was that it would happen so soon and without any input from the people on the ground.
On Feb. 28, Dawn Anderson, executive director of the Wisconsin Breast Cancer Coalition, co-wrote a letter to Gov. Scott Walker (R) expressing concern about the WWWP changes, as first reported by WisPolitics.
"We have not gotten a lot of detail about what motivated this change," Anderson wrote, adding that she hasn't yet heard back from the governor's office. "Why the rush? That is our question. Why the rush? The question to the director has been, 'Do you have projections for how many women are going to fall off and not re-enroll in WWWP?' No, they don't. They don't have data, they don't have numbers. They're just guessing."
Walker's office did not return a request for comment from HuffPost.
In an interview with The Huffington Post on Friday, WWWP Director Johnson confirmed that she did not have any projections on how many women would be leaving WWWP and going into BadgerCare or the federal marketplace.
"That is something that we do not know at this time," she said.
Johnson added that she has been meeting with women's health groups and hearing their concerns, albeit in the last three months -- essentially acknowledging the complaint that these groups were not allowed to give input before the state went forward with its plans.
"We actually made our initial announcement about the proposed changes in December. Since that time, we have talked with different organizations, both in person and via teleconferences," she said.
While some women will likely move away from WWWP and onto the ACA's exchanges, many women will not; a particular concern is undocumented women. And while WWWP will still be there for low-income women, health advocates are worried that the reduced number of providers and agents means services will be less accessible for the individuals who stay with the program.
"If you have to travel really far for a mammogram, you're not going to do it," said Anderson.
Kari Sievert is one of the local coordinating agents with WWWP, serving Madison and Dane Counties.
"We provide case management for every single woman who is enrolled in the program," she said. "Women with limited resources sometimes have significant barriers to care. The case managers help figure out what those barriers are and help them be successful in following through in getting their screenings and/or treatment. ... If a woman has other language or physical needs for her appointment, we help get those arranged. We help with transportation, and we help her figure out the providers she's going to be comfortable with."
"If we take out the piece of case management, women really aren't going to know where to go, and they're going to have a very limited choice of where to go," she added.
Opponents of the restructuring also questioned the state's argument that funding for WWWP may dry up anytime soon. State funding for the program is secured until June 2015, and there are another three years remaining in the agreement with the CDC.
Brittany Behm, a spokeswoman for the CDC, told WisPolitics this week that no future funding decisions have been made yet. In fact, funding for the agency's National Breast and Cervical Cancer Early Detection Program -- which gives WWWP its CDC funding -- actually increased last year.
"CDC and our grantees are monitoring the impact that the ACA may have on the NBCCEDP program as it is implemented over time," a CDC spokesperson added in an email to HuffPost.
On Friday, Johnson repeatedly refused to give a direct answer about why the state chose July 1 as a deadline. Instead, she simply said that July 1 was the beginning of the third year in the five-year agreement with the CDC.
"We are coming up on our third year of our five-year cooperative agreement with CDC. That will begin the first part of July," said Johnson when asked about the timeline. "Secondly, we wanted to make sure that for the women who continue to need the Well Woman Program, that we wanted them to know, we wanted the providers to know, that the program services will be available to them."
When asked if the state approaching the third year of the funding was the reason for the short timeframe, Johnson again simply replied, "What we're saying is we're coming up on the third year of the five-year cooperative agreement. Which means that we have years three, four and five left. For us, the year three will begin July 1."
WWWP has not been without controversy during Walker's tenure. In 2011, his administration ended Planned Parenthood's contract to provide preventative health screenings under the program.
Walker also has been a vocal opponent of Obamacare and was one of the Republican governors who rejected federal funds to expand Medicaid to more residents in the state. But at the same time, he has used the passage of Obamacare to reduce certain state benefits for some of Wisconsin's neediest.
In addition to the significant restructuring of WWWP, Walker has also called for shifting 77,000 low-income adults -- most of them families -- off of BadgerCare and onto the federal marketplace. Instead, Walker wants to open up BadgerCare to 82,000 childless adults, which tends to be a less expensive demographic to cover.
Finger, the Wisconsin Alliance for Women's Health executive director, said that if the state wants more WWWP women to go onto the federal marketplace, it needs to help them do so.
"We need the state to be making a greater effort to identify the women currently served in this program who could now qualify for BadgerCare or the marketplace and actually help them transition into those options," said Finger. "And until they're ready to do that, and until they have the structure in place to help these women, there is no need to be pulling this rug out from underneath them in six short months."
"There's just no bridge being built for these women in the current program to alternatives like the marketplace," she added. "And without that bridge, we cannot get on board with this proposal."