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Wisconsin plans to drug test Medicaid recipients. Here’s why it’ll be a disaster.

Should Wisconsin really test Medicaid enrollees too?

WEST BEND, WI - AUGUST 16: Wisconsin Gov. Scott Walker introduces Republican Presidential Candidate Donald Trump as he gets ready to speak at a rally on August 16, 2016 in West Bend, Wisconsin. (Photo by Darren Hauck/Getty Images)
WEST BEND, WI - AUGUST 16: Wisconsin Gov. Scott Walker introduces Republican Presidential Candidate Donald Trump as he gets ready to speak at a rally on August 16, 2016 in West Bend, Wisconsin. (Photo by Darren Hauck/Getty Images)

Over the past several months, Wisconsin lawmakers have waged a war on the state’s Medicaid program by requesting federal permission to add time-limits, work rules, and drug tests. But new data obtained by ThinkProgress suggests these drug tests are especially costly and virtually ineffective at enabling care. And if the Trump administration green-lights Wisconsin’s request, taxpayers will have to pay for it.

Requiring people who depend on government benefits to pee in a cup isn’t without precedent. At least 15 states, including Wisconsin, drug screen or test public assistance applicants. For three straight years, ThinkProgress collected state data on drug screening and learned that it’s expensive and yields few drug positive tests. This isn’t surprising, as a federal analysis on substance use among government assistance enrollees suggests abuse rates are only somewhat higher than general public. (Studies that report substance abuse rates higher than 15 percent define it to include a broader scope of alcohol and any illicit drug use within the past year rather than past month.)

ThinkProgress reached out to Wisconsin officials for the second consecutive year to learn about how its drug test process for welfare — or Temporary Assistance for Needy Families (TANF) programs — is going, as the state is now looking to expand the requirement to other government programs like Medicaid, public housing, and food stamps.

By way of background, Gov. Scott Walker (R) permitted state officials to drug screen individuals participating in four TANF-funded programs, and the drug testing policy went into effect in July 2016. These requirements only apply to non-custodial parents, and “only a very small subset of [cash welfare] recipients” need to be screened for substance use, according to the communications director for Wisconsin’s Department of Children and Families (DCF).

Even so, the invasive process appears to be unnecessary, as the state’s own data clearly demonstrates.

Between July 2016 and February 2018, a total of 3,799 applicants completed a “Drug Abuse Screening Test.” Applicants filled out this 10-part questionnaire, which asks them point blank “Do you abuse more than one drug at a time?” Of the 83 people who were ultimately referred for drug testing, eight refused to submit a drug test and 12 failed, and were later referred for treatment. Of the 12 who failed the drug test, 10 enrolled in treatment and two refused to be enrolled. Drug tests range in cost from $25 to $100, depending on the testing location. That means the state spent somewhere between $2,075 and $8,300, and only 10 people actually got treatment. The state didn’t incur treatment costs because it’s the payer of last resort, said the DCF official.

CREDIT: Diana Ofosu/ThinkProgress
CREDIT: Diana Ofosu/ThinkProgress

Against this backdrop, Wisconsin is seeking federal permission to add drug screening and tests to the 53-year-old Medicaid program, government-run insurance designed for the poor and individuals with disabilities. The state is trying to require adults without dependents, as a condition of Medicaid eligibility, to complete a drug screening questionnaire. If answers “indicate possible abuse of a controlled substance,” individuals will be tested. Individuals who don’t answer the questionnaire or refuse to submit a drug test will become ineligible for health insurance. As of December 2017, 147,766 childless adults enrolled in Wisconsin’s Medicaid program and could be subject to drug screening.

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This is just one of many restrictions Wisconsin is looking to implement. Altogether, these changes will slow down rising costs of health care spending and improve health outcomes, asserts the state application.

The Department of Health Services recently told ThinkProgress that the state expects to save $49.8 million, as 5,102 are expected to disenroll by year five of implementation. But a recent Milwaukee Journal Sentinel review reported that the administrative costs of transitioning people off of Medicaid won’t be cheap. That doesn’t include the costs linked to drug testing, but given that cash assistance’s enrollment numbers are smaller than Medicaid’s, drug testing people for health care will likely cost the state even more money.

It’s not just about money, as drug tests aim to connect people with treatment. But drug screenings are different from diagnostic instruments, meaning they “cannot tell you if you have addiction,” said Omar Manejwala, Chief Medical Officer of Catasys and a leading expert on addiction and the opioid crisis. These tools are useful in the right context — they primarily identify a group at risk, but will have many false positives.

“In a nutshell, the biggest danger from this is it makes you feel like you are doing something, when you are doing nothing,” said Manejwala.

Jon Peacock, research director for advocacy group Kids Forward, argues that drug tests don’t enable health care, but act as an impediment. Applicants will have to meet with caseworkers more times, and this added red tape to an already arduous process could discourage people, he said.

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“And the funding that will be required for drug screening is better used to access effective treatment programs,” Peacock said.

Historically, Wisconsin’s Medicaid eligibility guidelines have been very generous compared to other state programs. Wisconsin’s insurance program covered some groups with higher incomes: parents up to to 200 percent of the poverty line and up to 300 percent for children and pregnant people. On the other hand, the state is still pretty conservative, said American Enterprise Institute’s Angela Rachidi, so the state government adds requirements like drug tests on the principle that the government isn’t being taken advantage of if it’s willing to supply support.

“It’s more of an issue of ensuring that if you have a generous system of support, that you’ve implemented it properly,” Rachidi, who studies public assistance from a conservative perspective, told ThinkProgress.

Rachidi believes states should be allowed to experiment with Medicaid programs and once Wisconsin, for example, drugs tests beneficiaries, the public can rigorously evaluate the outcomes. An assessment would determine if the program, as supporters argue, connects individuals with substance use disorder to treatment. But a recent Government Accountability Office (GAO) report concluded that federal evaluations so far on state Medicaid projects provide meager oversight and, as such, are inconclusive.

So far, Wisconsin data collected from cash welfare suggests that the state spends a lot of money for minimal health improvements, as only 10 enrolled in treatment. Moreover, with Medicaid, it’ll be difficult to know who was deterred from seeking coverage due to the possibility of testing positive. Will drug testing enrollees be worth it on principle alone?


This post has been updated to include comments from Omar Manejwala.