Wisconsin Legislature: 2019-07-03 Assembly Journal

These sections remove the deposit of revenues from earnings associated with the Board of Commissioners of Public Lands' management of the common school fund, normal school fund, university fund and agricultural college fund (trust funds) and other revenues associated with management of lands under the board's jurisdiction to the board's trust lands and investments – general program operations appropriation. The provisions also remove the board's ability to deduct or make payments of expenses from these revenues.

I am partially vetoing section 282j and vetoing sections 335g, 335h, 335i, 335j, 335k, 335L, 335m, 335n, 335p, 335q, 335r, 335s and 335t because I object to limiting the board's ability to utilize interest and other earnings for the management of the trust funds and lands. With this veto, I am restoring these provisions to ensure that the board may request additional expenditure authority if needed to effectively manage the trust funds and lands to maximize earnings that are distributed to support library services.

36. Milwaukee County Shared Revenue Reduction for Child Welfare Services

Section 522m

This section modifies Milwaukee County's financial contribution for child welfare services provided by the Department of Children and Families' Division of Milwaukee Child Protective Services. The modification increases Milwaukee County's total contribution from $58,893,500 per fiscal year to the greater of that amount or the amount in the chapter 20 schedule for the child welfare services aids appropriation for Milwaukee County. As a result, Milwaukee County's shared revenue payment would be reduced by an additional $6,824,500 GPR in fiscal year 2020-21.

I am vetoing this section because I object to this reduction to Milwaukee County's shared revenue payment, which does nothing to improve the lives of children and their families. The immediate and only result of this reduction in shared revenue will be cuts to vital government services provided by Milwaukee County, and this leaves the county little time to prepare for these cuts. Furthermore, the budget bill as written will not accomplish the legislative intent because the additional shared revenue funds from Milwaukee County would be deposited in a sum certain program revenue child welfare appropriation, which was not increased. As a result, the related GPR child welfare appropriation will be fully spent, and no lapse to the general fund will occur from that appropriation or the shared revenue appropriation.

37. Child Care YoungStar Bonuses

Section 9106 (5f)

This section directs the Department of Children and Families to increase YoungStar bonuses under the Wisconsin Shares child care program to 15 percent for four-star child care providers and to 30 percent for five-star child care providers for the duration of the 2019-21 biennium, after which the department would have the authority to set the amount of the YoungStar bonuses in the future.

I object to this section as it unnecessarily infringes upon the department's management of this program. Therefore, I am vetoing this section to remove this requirement. The department has sufficient authority and funding under current law such that it has already announced that it increased YoungStar bonuses to these levels on July 1, 2019.

38. Elections Commission Materials and Services Lapse

Section 9212 (1c)

This section requires the Elections Commission to lapse $9,700 from the program revenue appropriation under s. 20.510 (1) (h) to the general fund in fiscal year 2019-20.

I am vetoing this section because I object to reducing the balance in the Elections Commission's materials and services appropriation. This appropriation is meant to fund certain administrative processes, such as publications and mailings, and the commission can still make use of these funds in the manner for which they were intended.

39. Wisconsin Employment Relations Commission Program Revenue Lapse

Section 9214 (1c)

This section requires the Wisconsin Employment Relations Commission to lapse to the general fund any unencumbered balance exceeding 10 percent of annual expenditures from the program revenue appropriation under s. 20.425 (1) (i) at the end of each fiscal year during the 2019-21 biennium.

I am vetoing this section because it is administratively burdensome, and I object to reducing the commission's flexibility to spend program revenue on labor relations functions.

D. HEALTH SERVICES AND INSURANCE

40. FoodShare Employment and Training for Able-Bodied Adults with Dependents

Section 126 [as it relates to s. 20.865 (4) (a)]

This provision retains the requirement that able-bodied adults with school age dependents must meet a work requirement to receive FoodShare benefits. One way to meet that requirement is through participation in the FoodShare Employment and Training program. This provision provides funding in the Joint Committee on Finance GPR supplemental appropriation to fund the increased utilization of the FoodShare Employment and Training program.

I am partially vetoing section 126 [as it relates to s. 20.865 (4) (a)] by lining out the amounts under s. 20.865 (4) (a) and writing in smaller amounts that reduce the appropriation by $4,893,300 GPR in fiscal year 2019-20 and by $15,659,800 GPR in fiscal year 2020-21. I object to subjecting able-bodied adults with school age dependents to a work requirement, which does not appropriately balance the needs for parental involvement in children's lives, the demands of the workforce and the costs of expenses like child care. The additional barriers that some parents face in meeting work requirements should be taken into account, and children's health, safety and well-being should be our priority. Furthermore, if the Legislature believes this is a priority, it should budget the funding in the Department of Health Services in separate legislation. I am directing the Department of Health Services to maintain the FoodShare Employment and Training program for able-bodied adults without dependents with the funding appropriated under ss. 20.435 (4) (bp) and 20.435 (4) (np). I am further directing the Department of Health Services to exempt able-bodied adults with school age dependents from sanctions under the work requirement in s. 49.79 (9) (a) 1g., as allowed under 7 CFR 273.7 (d) (4) (v). This partial veto is part of a larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds.

41. FoodShare Employment and Training Drug Screening Funding

Section 126 [as it relates to ss. 20.435 (4) (b), 20.435 (4) (bn), 20.435 (4) (nn) and 20.435 (4) (o)]

This provision retains the drug screening requirement for able-bodied adults without dependents, who intend to meet a work requirement through the FoodShare Employment and Training program.

I object to subjecting individuals receiving food assistance in the FoodShare program to drug screening as the costs of this type of program outweigh the benefits, and there is no reason to treat recipients of this type of state aid differently than Wisconsinites who use any other type of state program or assistance. I am, therefore, partially vetoing section 126 [as it relates to ss. 20.435 (4) (b), 20.435 (4) (bn), 20.435 (4) (nn) and 20.435 (4) (o)] by lining out the amounts under s. 20.435 (4) (b) and writing in smaller amounts that reduce the appropriation by $23,700 GPR in fiscal year 2019-20 and $31,400 GPR in fiscal year 2020-21; lining out the amounts under s. 20.435 (4) (bn) and writing in smaller amounts that reduce the appropriation by $4,100 GPR in fiscal year 2019-20 and $5,500 GPR in fiscal year 2020-21; by lining out the amounts under s. 20.435 (4) (nn) and writing in smaller amounts that reduce the appropriation by $4,100 PR-F in fiscal year 2019-20 and $5,400 PR-F in fiscal year 2020-21; and by lining out the amounts under s. 20.435 (4) (o) and writing in smaller amounts that reduce the appropriation by $34,500 PR-F in fiscal year 2019-20 and $46,200 PR-F in fiscal year 2020-21. This partial veto is part of a larger write-down of the Income Maintenance appropriations and the Medical Assistance appropriations. I am requesting the Department of Administration secretary not to allot these funds.

42. Disproportionate Share Hospital Payments

Section 9119 (10p)

This section requires the Department of Health Services to pay hospitals that serve a disproportionate share of low-income patients an additional $30,000,000 GPR and associated federal match in each year of the 2019-21 biennium only for Disproportionate Share Hospital supplemental payments, and increases the maximum allotment any one hospital may receive under this program to $9,600,000 in the 2019-21 biennium only.

While I am supportive of funding hospitals for uncompensated care, I object to using the Disproportionate Share Hospital supplemental payment mechanism as a primary way to do so without the infusion of federal tax dollars and resulting state savings from Medicaid expansion that would have allowed us to make these investments. Expanding Medicaid to individuals up to 138 percent of the poverty line not only ensures access to affordable, quality healthcare for Wisconsinites, it would have allowed a robust investment in our provider networks here in Wisconsin. However, in the absence of these critical federal dollars and resulting state savings, the Department of Health Services will need flexibility to prioritize the needs of patients.

I am, therefore, partially vetoing this section to allow an increase to the maximum per hospital payment under this program and broaden the language to allow the Department of Health Services the flexibility to determine the amount of additional funding under the Disproportionate Share Hospital supplemental payments to hospitals that serve low-income individuals. In addition, my partial veto will give the Department of Health Services additional flexibility in determining other potential supplemental payments to hospitals that serve low-income individuals as limited resources may allow. Further, I am directing the Department of Health Services to develop a methodology which ensures that after the new, higher cap is applied, eligible hospitals will receive no less under the Disproportionate Share Hospital supplemental formula than they would have under the current law cap.

43. Mendota Juvenile Treatment Center

Sections 9104 (6) (a) and 9319 (1)

This provision increases authorized general fund supported borrowing for the project identified as "Expansion of the Mendota Juvenile Treatment Center — Madison" from $15,000,000 to $43,994,000.

I am partially vetoing this provision because I object to the Legislature not providing sufficient borrowing authority for the building of an appropriately-sized facility. The Department of Health Services has indicated the need for $59 million to complete the project, and the Legislature's proposal provides only $44 million. Insufficient borrowing authority would result in a reduction in the number of beds the department is able to construct for juvenile treatment and impede the department's ability to provide the Mendota Juvenile Treatment Center's mental health treatment services by not providing adequate space to accommodate juveniles who are at different stages in their treatment progression. This veto results in total of $58,994,000 of general fund supported borrowing being available for this project.

44. Medicaid Reestimate

Section 126 [as it relates to s. 20.435 (4) (b)]

Broadly, this provision increases funding under the Medical Assistance program.

I am partially vetoing section 126 [as it relates to s. 20.435 (4) (b)] by lining out the amounts under s. 20.435 (4) (b) and writing in smaller amounts that reduce the appropriation by $15,000,000 in each fiscal year.

I object to the appropriation of these funds as it is no longer necessary based upon updated expenditure projections from the Department of Health Services. This partial veto is part of a larger write-down of the department's Medical Assistance appropriation. I am requesting the Department of Administration secretary not to allot these funds.

45. Physician and Behavioral Health Funding

Section 126 [as it relates to s. 20.865 (4) (a)]

This provision increases funding in the Joint Committee on Finance GPR supplemental appropriation by $5,000,000 GPR in both fiscal years for Medicaid reimbursement rate increases for physicians and behavioral health providers.

Wisconsin is facing a behavioral health provider shortage, and I object to the removal of funding from the Department of Health Services to address this issue while the Legislature retains the funding to potentially use for other purposes. I am directing the department to proceed as soon as is practical with vital rate increases for physicians and behavioral health professionals from its base level resources.

This partial veto is part of larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds.

46. Crisis Intervention Services

Section 681

This provision allows the Department of Health Services to reimburse counties for crisis intervention services provided to Medical Assistance recipients, if the county delivers crisis intervention services on a regional basis and provides a maintenance of effort payment. This provision defines crisis intervention services as services for the treatment of mental illness, intellectual disability, substance abuse and dementia. Under the provision, counties are required to maintain a maintenance of effort equal to 75 percent of the annual average of the county's expenditures for crisis intervention services in calendar years 2016, 2017 and 2018.

I am partially vetoing this provision to remove the reference to calendar years 2016, 2017 and 2018. I object to specifying the maintenance of effort calculation in statute, and I am directing the Department of Health Services to set the county maintenance of effort for crisis intervention services in a manner it determines is appropriate and equitable.

47. Qualified Treatment Trainee Grants

Sections 126 [as it relates to s. 20.435 (1) (be)], 187m and 1763m

This provision requires the Department of Health Services to distribute a total of $500,000 GPR in each fiscal year to a hospital, or affiliate of a hospital, or an entity qualified under 42 USC 1395x (aa) (4) that establishes and maintains a qualified treatment trainee program. A qualified treatment trainee program must provide clinically supervised practice for qualified graduate students seeking licensure or certification as a social worker, counselor, marriage and family therapist, or psychologist. The grant recipient must match the grant amount. The grant recipient shall use the awarded funding for clinical supervision, training, and salaries and benefits for trainees and clinical supervisors.

I am partially vetoing this provision to remove the overly prescriptive requirements for these funds. I am broadly supportive of measures to increase qualified health care providers in the state. However, I object to the specificity outlined in the provision. I am directing the Department of Health Services to develop grant criteria, seek applicants and award the grants.

48. Telehealth Expansion

Section 126 [as it relates to s. 20.865 (4) (a)]

This provision increases funding in the Joint Committee on Finance GPR supplemental appropriation by $1,088,200 GPR in fiscal year 2019-20 and $1,692,900 GPR in fiscal year 2020-21 to fund anticipated increases in the use of Medicaid services rendered through telehealth technology.

49. Physical Health Service Provider Reimbursement

Section 126 [as it relates to s. 20.865 (4) (a)]

This provision increases funding in the Joint Committee on Finance GPR supplemental appropriation by $500,000 GPR in both fiscal years for Medicaid reimbursement rate increases for physical health providers.

I am partially vetoing section 126 [as it relates to s. 20.865 (4) (a)] by lining out the amounts under s. 20.865 (4) (a) and writing in smaller amounts that reduce the appropriation by $500,000 GPR in each fiscal year. I object to the appropriation of these funds without the infusion of federal tax dollars and resulting state savings from Medicaid expansion that would have allowed us to make investments like this. Expanding Medicaid to individuals up to 138 percent of the poverty line not only ensures access to affordable, quality coverage for Wisconsinites, it would have allowed a robust investment in our providers in Wisconsin. However, in absence of these critical federal dollars and resulting state savings, the limited resources that remain must be invested in expanding patient care first before we can increase payments to health providers. This partial veto is part of a larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds.

50. Hub-and-Spoke Mental Health and Substance Abuse Treatment Model

Section 126 [as it relates to s. 20.865 (4) (a)]

This provision requires the Department of Health Services to develop a hub-and-spoke treatment model for substance abuse using the Medicaid home health benefit. However, the funding was placed in the Joint Committee on Finance GPR supplemental appropriation and the Department of Health Services must request the funding under s. 13.10.

I am partially vetoing section 126 [as it relates to s. 20.865 (4) (a)] by lining out the amount under s. 20.865 (4) (a) and writing in a smaller amount that reduces the appropriation by $89,900 GPR in fiscal year 2020-21. I object to the Joint Committee on Finance restricting the use of these funds. I am directing the Department of Health Services to develop a hub-and-spoke treatment model for substance abuse using the Medicaid home health benefit with $89,900 GPR of existing funds. The crisis facing many Wisconsin families because of substance use disorders is too important to delay with an additional step in the process to be able to move forward with this critical program. This partial veto is part of a larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds.

51. Racine County Nursing Home Labor Region

Section 664r

This provision would move Racine County from its current labor region to the Milwaukee labor region, which includes Milwaukee, Ozaukee, Washington and Waukesha counties, for purposes of calculating Medical Assistance reimbursement to nursing homes. It would require the Department of Health Services to adjust Medical Assistance payments to nursing homes so that the direct care cost targets of facilities in Milwaukee, Ozaukee, Washington and Waukesha counties are not reduced as a result of including facilities in Racine County in this labor region.

I am vetoing this provision in its entirety because I object to including a provision that would result in reductions in direct care funding to nursing homes in all other labor regions in the state. The department has worked with nursing home providers across the state to develop a labor region methodology and will continue to review labor regions and recommend changes when necessary.

52. Suicide Prevention Grant

Section 9119 (6f)

This provision requires the Department of Health Services to award a one-time grant of $100,000 GPR in fiscal year 2019-20 to the Wisconsin United Coalition of Mutual Assistance Association, Inc., to support suicide prevention activities conducted by the coalition.

I am partially vetoing this provision to remove the Wisconsin United Coalition of Mutual Assistance Association, Inc., as the recipient because I object to the Legislature earmarking a specific recipient. The experts at the Department of Health Services are best positioned to develop a grant program and ensure that recipients provide evidence-based care and treatment. I am directing the Department of Health Services to seek applicants for this grant and award funding to the most qualified applicant.

53. FoodShare Employment and Training Administrative Funds

Section 126 [as it relates to ss. 20.435 (4) (bn) and 20.435 (4) (nn)]

This provision increases funding available for the FoodShare Employment and Training program and Medicaid administration of eligibility requirements. Specifically, it includes income maintenance funding related to the FoodShare Employment and Training drug screening requirement, the work requirement for able-bodied adults with school age dependents, provisions of the Medicaid childless adult waiver and the Medicaid health savings account.

I am partially vetoing this provision because I object to the burdensome requirements the Legislature has imposed on the state's low-income individuals. In addition, in so imposing these requirements, the Legislature has set unrealistic timelines for implementation of these provisions and does not give the Department of Health Services sufficient time to complete the required systems changes.

I am, therefore, partially vetoing section 126 [as it relates to ss. 20.435 (4) (bn) and 20.435 (4) (nn)] in the following ways: by lining out the amount under s. 20.435 (4) (bn) and writing in a smaller amount that reduces the appropriation by $547,800 GPR in fiscal year 2019-20; and by lining out the amount under s. 20.435 (4) (nn) and writing in a smaller amount that reduces the appropriation by $1,229,600 PR-F in fiscal year 2019-20.

This partial veto is part of a larger write-down of the Income Maintenance appropriations. I am requesting the Department of Administration secretary not to allot these funds.

54. FoodShare Employment and Training Cost-to-Continue

Section 126 [as it relates to s. 20.435 (4) (bp)]

This provision increases funding available for FoodShare Employment and Training program services for childless adults in the Medicaid program.

I am partially vetoing section 126 [as it relates to s. 20.435 (4) (bp)] by lining out the amounts under s. 20.435 (4) (bp) and writing in smaller amounts that reduce the appropriation by $1,000,000 GPR in both fiscal years. I object to burdensome requirements imposed on Medicaid recipients in order to receive health insurance. I am requesting the Department of Administration secretary not to allot these funds.

55. Authority to Reallocate Positions

Section 9119 (10)

This provision directs the Department of Health Services to utilize 5.0 FTE existing positions to create an infant mortality prevention program. The department shall report the reallocation of these positions in its 2021-23 budget request.

I object to the Legislature directing the reallocation without accounting for the need for staffing of other priority health programs, such as oral health. I am partially vetoing this provision to allow the department to reallocate positions to create the infant mortality prevention program and provide positions to the oral health program. I am directing the department to reallocate from existing positions sufficient FTE position authority to create and staff an infant mortality prevention program, sufficient FTE position authority to expand services provided by the oral health program, and sufficient FTE position authority to staff other programs within the department. I am directing the Department of Health Services to submit a plan for any reallocations under this section to the Department of Administration for review and approval prior to implementing any reallocation.