The bill also specifies that, during a national emergency declared by the U.S.
president or a state of emergency declared by the governor, a family is considered to
be facing impending homelessness if it cannot make rent, mortgage, or property tax
payments regardless of whether the family has received notice that it will be evicted
if the payments are not made immediately.
Definition of “domestic abuse” in the emergency assistance program
Under the emergency assistance program, a family is considered to be homeless
or facing impending homelessness if certain conditions apply, including if a member
of the family was a victim of domestic abuse. Under the program, “domestic abuse”
has the same definition as under the statute establishing arrest and prosecution
procedures for domestic abuse incidents.
Also under current law, however, DCF is required under the Wisconsin Works
(W-2) program to promulgate rules for screening victims of domestic abuse, and
those rules must specify the evidence that is sufficient to establish that an individual
is or has been a victim of domestic abuse or is at risk of further domestic abuse. Under
current law, the W-2 program provides, among other things, work experience and
benefits for low-income custodial parents who are at least 18 years old.
The bill eliminates the definition of domestic abuse in the emergency assistance
program. Instead, it provides that evidence that is sufficient under the W-2 domestic
abuse screening program to establish that an individual is or has been a victim of
domestic abuse is also sufficient for that purpose under the emergency assistance
program.
Child care quality improvement program
Under Wisconsin Shares, which is a part of the W-2 program, an individual
who is the parent of a child under the age of 13 or, if the child is disabled, under the
age of 19, who needs child care services to participate in various education or work
activities, and who satisfies other eligibility criteria may receive a child care subsidy
for child care services under Wisconsin Shares. Under current law, DCF sets the
maximum payment rates for child care providers who provide services under
Wisconsin Shares and may modify an individual child care provider's payment rate
in the following manner on the basis of the child care provider's quality rating under
the Young Star system: a provider who receives a one-star rating may be denied
payment; a provider who receives a two-star rating may have the maximum
payment rate reduced by up to 5 percent; a provider who receives a three-star rating
may receive up to the maximum payment rate; a provider who receives a four-star
rating may have the maximum payment rate increased by up to 15 percent; and a
provider who receives a five-star rating may have the maximum payment rate
increased by up to 30 percent.
The bill eliminates the current law method by which DCF may modify
payments to child care providers under Wisconsin Shares based on a child care
provider's rating under the quality rating system known as Young Star. The bill
instead authorizes DCF to establish a program for making monthly payments and
monthly per-child payments to certified child care providers, licensed child care
centers, and child care programs established or contracted for by a school board. The
bill allows DCF to promulgate rules to implement the program, including
establishing eligibility requirements and payment amounts and setting
requirements for how recipients may use the payments. The bill funds the program
through a new appropriation and by allocating federal moneys, including child care
development funds and moneys received under the Temporary Assistance for Needy
Families block grant program.
Temporary Assistance for Needy Families
Under current law, DCF allocates specific amounts of federal moneys, including
child care development funds and moneys received under the Temporary Assistance
for Needy Families (TANF) block grant program for various public assistance
programs. Under the bill, TANF funding allocations are changed in the following
ways, as compared to the funding allocation in the 2019-21 fiscal biennium:
1. For Wisconsin Works benefits, agency contracts, and job access loans, the
total funding is increased by 20 percent.
2. For emergency assistance payments, funding is increased by 73 percent.
3. For grants to Wisconsin Trust Account Foundation, Inc., for distribution to
programs that provide civil legal services to low-income families, funding is doubled.
4. For the Transform Milwaukee and Transitional Jobs programs, funding is
increased by 49 percent.
5. For direct child care services, child care administration, and child care
improvement programs, total funding is decreased by 7 percent.
6. For kinship care payments, safety and out-of-home placement services, and
child abuse and neglect prevention services, total funding is increased by 10 percent.
7. For grants to the Boys and Girls Clubs of America, funding is increased by
5 percent.
8. For the earned income tax credit supplement, funding is increased by 34
percent.
9. For the support of the dependent children of recipients of supplemental
security income, funding is decreased by 27 percent.
10. For all other programs under TANF, funding is continued with a funding
change of less than 5 percent.
The bill additionally allocates $500,000 of TANF funding in each fiscal year to
fund the Jobs for America's Graduates programs to improve social, academic, and
employment skills of youth who are eligible to receive TANF.
Also, the bill specifies that, with respect to a TANF-funded contract for
services, “allocation” means the amount under the contract that DCF is obligated to
pay.
Grants for homelessness case management services
Under current law, DOA may award 10 annual grants from TANF funds of up
to $50,000 to homeless shelter facilities to provide case management services for
homeless families. The bill increases the annual limit on grants to a shelter facility
from $50,000 to $75,000 and eliminates the restriction that limits DOA to making
no more than 10 grants in total each year.
Civil legal services grants
Under current law, DCF is directed to allocate in each fiscal year specific
amounts of money, including federal moneys received under the TANF block grant
program, for various public assistance programs. Under current law, DCF provides
funding to the Wisconsin Trust Account Foundation, Inc. (the Foundation), to
provide civil legal services to TANF-eligible individuals in two ways:
1. DCF provides up to $100,000 in each fiscal year in matching funds to the
Foundation for the provision of civil legal services to eligible individuals. This grant
does not specify what types of civil legal services may be provided.
2. DCF provides a $500,000 grant in each fiscal year to the Foundation to
provide grants to programs, up to $75,000 each, that provide certain legal services
to eligible individuals. The legal services provided through this grant are limited to
legal services in civil matters related to domestic abuse or sexual abuse or to
restraining orders or injunctions for individuals at risk.
The bill removes the grant that requires matching funds and increases the
grant to provide certain legal services to eligible individuals to $1,000,000 per fiscal
year. Under the bill, the Foundation may additionally use this funding to provide
to eligible individuals civil legal services related to eviction. The bill removes the
$75,000 cap on grants provided by the Foundation to individual programs.
Internet assistance program
The bill requires DCF to establish an Internet assistance program, under which
it makes payments to Internet service providers on behalf of low-income individuals
to assist with paying for Internet service. The bill requires that other assistance
program options be exhausted before assistance is provided under this program. The
bill allows DCF to contract for the administration of the program. The bill requires
DCF to promulgate rules to implement the program, including a requirement that
the family income of a recipient not exceed 200 percent of the federal poverty line.
Under the bill, the new program is funded through an appropriation from the general
fund and from $10,000,000 that the bill requires DCF to allocate from federal
moneys, including moneys received under the TANF block grant program.
Foster care youth driver's licensing
The bill requires DCF to establish or contract for a driver education program
for individuals who are 15 years of age or older and in out-of-home care. The bill
requires the program to assist those individuals with identifying and enrolling in an
appropriate driver education course and obtaining an operator's license. The bill
authorizes DCF to pay, for any individual in the program, any fees required to enroll
in a driver education course or to obtain an operator's license.
Offender reentry demonstration project
Under current law, DCF was required to establish a five-year offender reentry
demonstration project in the 2017-18 fiscal year. The project focuses on noncustodial
fathers in the city of Milwaukee. Under current law, DCF was to conduct an
evaluation of the project by June 30, 2023. The bill extends the demonstration
project to six years and the deadline for an evaluation to June 30, 2024.
Transferring Head Start state supplement to DCF
The bill transfers the Head Start state supplement from DPI to DCF. The bill
transfers from the state superintendent to the secretary of children and families the
responsibilities of determining whether agencies are eligible for designation as Head
Start agencies under the federal Head Start program to provide comprehensive
health, educational, nutritional, social, and other services to economically
disadvantaged children and their families, and of distributing federal Head Start
funds to those eligible agencies.
Option to purchase public health coverage
The bill requires DHS, OCI, or DHS in consultation with OCI to conduct an
analysis and actuarial study of the creation of an option to purchase coverage that
is publicly provided or administered. In its analysis, DHS or OCI must incorporate
input from a variety of interested persons or entities and an analysis of any other
health care affordability initiatives. The bill allows DHS or OCI to submit any
requests for federal approval, including Medical Assistance state plan amendments
and waiver requests, necessary to implement the public option or other health care
affordability initiative. If federal approval is not necessary or if federal approval is
granted and DHS or OCI determines that the public option or affordability initiative
is feasible, DHS or OCI shall implement the public option or other initiative before
January 1, 2025, or if the insurance market provisions of the federal Patient
Protection and Affordable Care Act are not longer enforceable, by January 1, 2022,
or as soon as possible.
Electronic benefit transfer processing and funding for farmers; healthy
eating incentive pilot program
The bill allows DHS to expend general purpose revenue to provide electronic
benefit transfer processing equipment and services to farmer's markets and farmers
who sell directly to consumers. The electronic benefit transfer system is the method
used by DHS to deliver FoodShare benefits to recipients. FoodShare, also known as
the food stamp program and the federal Supplemental Nutrition Assistance
Program, provides a monetary benefit to individuals who have limited financial
resources for the purpose of purchasing food products.
The bill also limits the amount of general purpose revenue DHS may expend
on the healthy eating incentive pilot program to $425,000 per fiscal year. The
purpose of the healthy eating incentive pilot program is to provide discounts on fresh
produce and other healthy foods to FoodShare recipients. The bill also eliminates the
time limit under current law for DHS to expend funds to contract with an entity to
administer the healthy eating incentive program. Under current law, DHS could not
expend any money for the program after December 31, 2019, except for amounts
already encumbered on or before that date.
FSET requirement
Current law requires DHS to require all able-bodied adults, with some limited
exceptions, who seek benefits from the FoodShare program to participate in the
FoodShare employment and training program, known as FSET, unless they are
already employed. The bill eliminates that requirement for able-bodied adults with
dependents while retaining the requirement for able-bodied adults without
dependents.
Eliminating FSET drug testing requirement
2015 Wisconsin Act 55 required DHS to promulgate rules to develop and
implement a drug screening, testing, and treatment policy, which DHS promulgated
as DHS 38, Wis. Adm. Code.
2017 Wisconsin Act 370 incorporated into statutes DHS
38, relating to drug screening, testing, and treatment for recipients of FSET. The bill
eliminates the requirement to implement a drug screening, testing, and treatment
policy and removes from the statutes the language incorporated by Act 370.
Eliminating FSET pay-for-performance requirement
Current law requires DHS to create and implement a payment system based
on performance for entities that perform administrative functions for FSET. DHS
is required to base the pay-for-performance system on performance outcomes
specified in current law. The bill eliminates the requirement for DHS to create a
pay-for-performance system for FSET vendors.
Medical Assistance
Medicaid expansion; elimination of childless adults demonstration project
BadgerCare Plus and BadgerCare Plus Core are programs under the state's
Medical Assistance program, which provides health services to individuals who have
limited financial resources. The federal Patient Protection and Affordable Care Act
allows a state to receive an enhanced federal medical assistance percentage payment
for providing benefits to certain individuals through a state's Medical Assistance
program. The bill changes the family income eligibility level to up to 133 percent of
the federal poverty line for parents and caretaker relatives under BadgerCare Plus
and for childless adults currently covered under BadgerCare Plus Core and who are
incorporated into BadgerCare Plus in the bill. The bill requires DHS to comply with
all federal requirements and to request any amendment to the state Medical
Assistance plan, waiver of Medicaid law, or other federal approval necessary to
qualify for the highest available enhanced federal medical assistance percentage for
childless adults under the BadgerCare Plus program.
Under current law, certain parents and caretaker relatives with incomes of not
more than 100 percent of the federal poverty line, before a 5 percent income disregard
is applied, are eligible for BadgerCare Plus benefits. Under current law, childless
adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent
of the federal poverty line, before a 5 percent income disregard is applied; and 3) are
not otherwise eligible for Medical Assistance, including BadgerCare Plus, are
eligible for benefits under BadgerCare Plus Core. The bill eliminates the childless
adults demonstration project, known as BadgerCare Plus Core, as a separate
program on July 1, 2021.
2017 Wisconsin Act 370 requires by statute that DHS implement the
BadgerCare Reform waiver as it relates to childless adults as approved by the federal
Department of Health and Human Services effective October 31, 2018. The 2015-17
and 2017-19 biennial budget acts required DHS to submit a waiver request to the
federal Department of Health and Human Services authorizing DHS to take certain
actions, including imposing premiums on, requiring a health risk assessment of, and
limiting the time of eligibility for recipients of BadgerCare Plus under the childless
adults demonstration project waiver. Act 370 required DHS to implement the
childless adults BadgerCare Reform waiver by no later than November 1, 2019. If
JCF determines that DHS has not complied with the implementation deadline, has
not made sufficient progress in implementing the BadgerCare Reform waiver, or has
not complied with other requirements relating to approved waiver implementation,
Act 370 allows JCF to reduce from moneys allocated for state operations or
administrative functions DHS's appropriation or expenditure authority, whichever
is applicable, or change the authorized level of full-time equivalent positions for
DHS related to the Medical Assistance program. The bill eliminates the statutory
implementation requirement for the BadgerCare Reform waiver, including the
deadline and penalties, eliminates the statutory requirement for DHS to seek the
waiver, and allows DHS to modify or withdraw the waiver.
Eliminating legislative review of Medicaid state plan amendments
The Medical Assistance program is the state's Medicaid program and is jointly
funded by the state and federal governments through a detailed agreement known
as the state plan.
2017 Wisconsin Act 370 requires DHS to submit to JCF under its
passive review process any proposed Medical Assistance state plan amendment and
any proposed change to a reimbursement rate for or supplemental payment to a
Medical Assistance provider that has an expected fiscal effect of $7,500,000 or more
from all revenue sources over a 12-month period. The bill eliminates this
requirement to submit for JCF review Medical Assistance state plan amendments,
changes to reimbursement rates, or supplemental payments.
Eliminating legislative oversight over federal law waivers
2017 Wisconsin Act 370 prohibits DHS from submitting a request to a federal
agency for a waiver or renewal, modification, withdrawal, suspension, or
termination of a waiver of federal law or rules or for authorization to implement a
pilot program or demonstration project unless legislation has been enacted
specifically directing the submission of the request. For any legislation that requires
submission of a request that has not yet been submitted, Act 370 requires DHS to
submit an implementation plan to JCF and submit its final proposed request to JCF
for approval. Act 370 requires DHS to take certain actions and submit monthly
progress reports to JCF once a request has been submitted to the federal agency.
When the federal agency has approved the request in whole or in part and the request
has not been fully implemented, Act 370 requires DHS to submit its final
implementation plan to JCF for approval. Act 370 allows JCF to reduce from moneys
allocated for state operations or administrative functions the agency's appropriation
or expenditure authority or change the authorized level of full-time equivalent
positions for the agency related to the program for which the request is required to
be submitted if JCF determines that the state agency has not made sufficient
progress or is not acting in accordance with the enacted legislation requiring the
submission of the request. The bill eliminates the requirement that legislation be
enacted in order for DHS to submit a request for a waiver or renewal, modification,
withdrawal, suspension, or termination of a waiver of federal law or rules or for
authorization to implement a pilot program or demonstration project. The bill also
eliminates the legislative review procedure for requests for waivers, pilot programs,
or demonstration projects required by Act 370.
Postpartum Medical Assistance coverage
The bill extends the time that women who are eligible for Medical Assistance
when pregnant continue to be eligible under Medical Assistance to the last day of the
month in which the 365th day after the last day of the pregnancy falls. Under current
law, postpartum women are eligible for Medical Assistance benefits until the last day
of the month in which the 60th day after the last day of the pregnancy falls. The bill
directs DHS to apply for any amendment to the state plan, any waiver to federal law,
or any approval of a demonstration project necessary to implement the expansion of
Medicaid coverage for pregnant women. However, the bill instructs DHS to
reimburse providers for acceptable costs to pregnant women who meet eligibility
standards regardless of whether any amendment, waiver, or demonstration project
is accepted.
Coverage of doula services under Medical Assistance
The bill requires DHS to request any necessary waiver or amendment to the
state Medical Assistance plan to allow Medical Assistance reimbursement for doula
services and, if any necessary waiver or amendment is approved, directs DHS to
reimburse certified doulas for doula services provided to Medical Assistance
recipients. Doula services consist of childbirth education and support services,
including emotional and physical support provided during pregnancy, labor, birth,
and the postpartum period.
Community health worker services
The bill requires DHS to request any necessary waiver or amendment to the
state Medical Assistance plan to allow Medical Assistance reimbursement for
community health services. Under the bill, community health services are those
services provided by a community health worker. A community health worker is one
who serves as a liaison between health and social services and the community to
facilitate access to services and improve the quality and cultural competence of
service delivery, and who builds individual and community capacity by engaging in
a range of activities such as outreach, community education, informal counseling,
social support, and advocacy.
Services that contribute to determinants of health
The bill includes nonmedical services, as determined by DHS, that contribute
to the determinants of health as a benefit under the Medical Assistance program.
The Medical Assistance program is a joint federal and state program that provides
health services to individuals who have limited financial resources. The bill requires
DHS to seek any necessary state plan amendment or request any waiver of federal
Medicaid law to provide the services but does not require DHS to provide the services
as a Medical Assistance benefit if the federal Department of Health and Human
Services does not provide federal financial participation for the services.
Coverage of group physical therapy under Medical Assistance
The bill directs DHS to promulgate rules by July 1, 2022, to include group
physical therapy as one of the physical therapy services authorized for
reimbursement under the Medical Assistance program. The bill allows DHS to
promulgate emergency rules to authorize group physical therapy for reimbursement
under the Medical Assistance program.
Coverage of substance abuse treatment room and board under Medical
Assistance
The bill directs DHS to pay allowable charges on behalf of recipients of Medical
Assistance for room and board for residential substance use disorder treatment.
Community-based psychosocial services
Currently, community-based psychosocial services provided to Medical
Assistance recipients are reimbursed only when the federal government agrees to
provide its financial participation for the services, when the recipient's needs require
more than outpatient level services but less than provided by a community support
program, when the recipient's county has made the services available, when the
provider is certified by DHS under its rules, and when any other requirements
established by DHS by rule are met. The bill allows DHS to also provide
community-based psychosocial services to Medical Assistance recipients and
provide reimbursement for those services through providers other than those made
available by a county. Reimbursement to providers that are not county-based will
be both the federal and nonfederal share based on a fee schedule that is determined
by DHS. For a county that elects to provide the services, DHS must reimburse the
county for the federal and nonfederal amount of allowable charges under the Medical
Assistance program.
Medical Assistance program coverage of acupuncture services
The bill includes acupuncture that is provided by a certified acupuncturist as
a reimbursable benefit under the Medical Assistance program. The bill requires
DHS to submit to the federal government any request for federal approval necessary
to provide the reimbursement for an acupuncture benefit under the Medical
Assistance program.
Children's long-term support waiver program
The bill requires DHS to ensure that any eligible child who applies for the
disabled children's long-term support waiver program receives services under that
program. The disabled children's long-term support waiver program provides
services to children who have developmental, physical, or severe emotional
disabilities and who are living at home or in another community-based setting.
Acuity-based billing in nursing homes and community-based residential
facilities
Under current law, payment for health care provided in a nursing home or a
community-based residential facility under the Medical Assistance program is
determined by prospective payment systems updated annually by DHS. DHS is
required to implement an acuity-based payment rate system for determining
payments to nursing homes and community-based residential facilities for all
allowable, nonbillable services of a registered nurse, licensed practical nurse, or
nurse aide. The bill makes several changes to the acuity-based payment rate system
implemented by DHS to allow DHS to align the state's rate-setting methodology
with an updated Patient Driven Payment Model established by the federal Centers
for Medicare and Medicaid Services. Currently, DHS follows a Resource Utilization
Groupings model. Further, the bill allows DHS to use data from calendar years other
than calendar year 2020 or calendar year 2021 if DHS determines that either or both
of those years are inappropriate bases for prospective rate setting due to fluctuations
in costs caused by the COVID-19 pandemic.
Statewide minimum rate band for home and community-based long-term
health care supports
The bill directs DHS to develop a statewide rate band that would establish
equitable and sustainable minimum rates for home and community-based
long-term care supports. Home and community-based long-term care supports are
Medical Assistance programs designed to deliver long-term care to patients in their
own home or other community-based setting, rather than a nursing home or other
institutional setting. The bill also requires DHS to include in its 2023-25 biennial
budget request a proposal to implement the statewide rate band.
Payments for direct care in nursing and intermediate care facilities
The bill requires DHS to increase Medical Assistance payments, from the
increase in reimbursement for nursing facilities, also known as nursing homes, and
intermediate care facilities for persons with an intellectual disability, by an amount
specified in the bill, including the state and federal shares, to support staff who
provide direct care to residents of those facilities.
Hospital assessment
Currently, each hospital, including each critical access hospital, must pay an
assessment for the privilege of doing business in Wisconsin. The percentage of gross
patient revenues that each hospital must pay is adjusted so that the total amount
of assessments collected for all hospitals that are not critical access hospitals totals
$414,507,300 in each state fiscal year. The same percentage of gross patient
revenues is also assessed on critical access hospitals, though the amount is collected
separately from and deposited into a separate fund from that of other hospitals.
Current law requires DHS to use a portion of this total to pay for services provided
by hospitals under the Medical Assistance program, including the federal and state
share of Medical Assistance, in a total amount that equals the amount collected from
hospitals divided by 61.68 percent. Similarly, current law requires DHS to use a
portion of the amount collected from critical access hospitals to make payments to
critical access hospitals for Medical Assistance services in a total amount that equals
the amount collected from critical access hospitals divided by 61.68 percent. The bill
decreases the 61.68 percent to 53.69 percent if the state adopts the Medicaid
expansion, thus increasing the amount of payments that must be made to critical
access hospitals and other hospitals under the Medical Assistance program. The
Medicaid expansion, as authorized under the Patient Protection and Affordable Care
Act, allows a state to provide benefits under the Medicaid program to individuals who
have an income up to 133 percent of the federal poverty line and who were previously
ineligible for Medicaid, and in exchange, the Affordable Care Act then provides that
the federal government pays an increased percentage of the cost of the benefits for
those newly eligible individuals.
Medical Assistance reimbursement rates for direct care in personal care
agencies
The bill requires DHS to increase the reimbursement rates paid for direct care
under the Medical Assistance program to agencies that provide personal care
services to support staff in those agencies that provide direct care. For purposes of
Medical Assistance, “personal care services” are defined as medically oriented
activities that assist recipients with activities of daily living that are necessary to
maintain the individual in his or her residence in the community, such as eating,
bathing, dressing, meal preparation, or shopping for food.
Disproportionate share hospital payments
Current law requires DHS to make payments under the Medical Assistance
program to hospitals that serve a disproportionate share of low-income patients.
These hospitals are referred to as “disproportionate share hospitals,” and the
payments are known as DSH payments. DHS must pay $27,500,000 in each fiscal
year, cumulatively, as the state share of DSH payments and must also pay to the
disproportionate share hospitals the amounts contributed by the federal
government. For a hospital to receive a DSH payment under current law, the
hospital must be a Wisconsin hospital providing a wide array of services that meets
applicable requirements under federal law and for which at least 6 percent of all total
inpatient days at the hospital are Medical Assistance recipients' inpatient days.
Current law provides mechanisms for determining how DSH payments are
distributed among eligible hospitals and imposes some limits on payments,
including that no single hospital may receive more than $4,600,000 per fiscal year.
The bill increases, if the state adopts the Medicaid expansion, the state share of the
cumulative amount of DSH payments in a fiscal year to $47,500,000 and increases
the single hospital limit to $7,950,000. The Medicaid expansion, as authorized under
the Patient Protection and Affordable Care Act, allows a state to provide benefits
under the Medicaid program to individuals who have an income up to 133 percent
of the federal poverty line and who were previously ineligible for Medicaid, and in
exchange, the Affordable Care Act then provides that the federal government pays
an increased percentage of the cost of the benefits for those newly eligible
individuals.
Critical access reimbursement payments to dental providers
The bill requires DHS to provide enhanced reimbursement payments under the
Medical Assistance program to dental providers who meet certain qualifications. In
order to qualify, a provider must meet quality of care standards established by DHS.
In addition, at least 50 percent of individuals served by a nonprofit or public provider
must be without dental insurance or enrolled in the Medical Assistance program for
the provider to qualify for enhanced reimbursement, and a for-profit provider must
have at least 5 percent of patients enrolled in the Medical Assistance program.
