Wisconsin Shares is a part of the Wisconsin Works program under current law,
which DCF administers and which provides work experience and benefits for
low-income custodial parents who are at least 18 years old. Under current law, 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 on the basis of the child care provider's
quality rating under the Young Star system.
Child support debt reduction
The bill creates a new program administered by DCF to provide debt reduction
for overdue child support. Under the bill, if a noncustodial parent completes an
eligible employment program as determined by DCF, and the custodial parent agrees
to a reduction, the noncustodial parent is eligible for child support debt reduction in
the amount of $1,500. Under the bill, a parent may not qualify for the debt reduction
more than once in any 12-month period.
Assistance for survivors of domestic abuse
Under the bill, DCF may allocate up to $14,000,000 per fiscal year to establish
and administer the Living Independently through Financial Empowerment
program. Under that program, DCF may provide short-term assistance to
individuals who are survivors of domestic abuse. The bill allows DCF to contract
with Wisconsin Works agencies to administer the program.
Early childhood education center
The bill requires DCF to provide $1,680,000 to Wellpoint Care Network to
establish an early childhood education center in the city of Milwaukee.
Boys and Girls Clubs of Wisconsin
The bill appropriates funding annually to the Boys and Girls Clubs of
Wisconsin, in addition to TANF funding for that purpose.
Healthy eating incentives program
Subject to certain conditions, the bill requires DHS to establish and implement
a statewide healthy eating incentives Double Up Food Bucks pilot program under the
Gus Schumacher Nutrition Incentive Program, which is a federal grant program
administered by the National Institute of Food and Agriculture of the U.S.
Department of Agriculture. Under the program, DHS matches amounts spent by
FoodShare recipients under the program on fruits and vegetables from participating
retailers. For every dollar a FoodShare recipient spends on fruits and vegetables at
a participating retailer, the recipient gets an additional dollar to spend on fruits and
vegetables. 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. DHS administers the FoodShare program. Under the bill, DHS must, on
a schedule it determines appropriate, seek any necessary federal approval and
sufficient funding, including from the Gus Schumacher Nutrition Incentive
Program, to support the program. If the U.S. Department of Agriculture does not
approve the program, or if DHS is unable to obtain sufficient funding to support the
program, DHS may not implement the program.
Eliminating FSET drug testing requirement
2015 Wisconsin Act 55 required DHS to promulgate administrative rules to
develop and implement a drug screening, testing, and treatment policy, which DHS
promulgated as ch. DHS 38, Wis. Adm. Code.
2017 Wisconsin Act 370 incorporated
into statutes ch. DHS 38, relating to drug screening, testing, and treatment for
recipients of the FoodShare employment and training program, known as 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.
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 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 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.
EBT equipment grants
The bill requires DHS to provide electronic benefit transfer and credit and debit
card processing equipment and services to farmers' markets and farmers who sell
directly to consumers as a payment processing program. The bill specifies that the
electronic benefit transfer processing equipment and services must include
equipment and services for the FoodShare program. Under the bill, the vendor that
processes the electronic benefit transfer and credit and debit card transactions must
also process any local purchasing incentives.
Medical Assistance
Medicaid expansion; elimination of childless adults demonstration project
BadgerCare Plus and BadgerCare Plus Core are programs under the Medical
Assistance (MA) program, which provides health services to individuals who have
limited financial resources. The federal Patient Protection and Affordable Care Act
(ACA) 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 MA 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 MA, 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, 2023.
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 MA 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 MA 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. Under current law created by
2017 Wisconsin Act 370, DHS is required to
submit to JCF under its passive review process any proposed MA state plan
amendment and any proposed change to a reimbursement rate for or supplemental
payment to an MA 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 MA state plan amendments, changes to
reimbursement rates, or supplemental payments.
Eliminating legislative oversight over federal law waivers
Current law, as created by
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,
current law created by Act 370 requires DHS to submit an implementation plan to
JCF and submit its final proposed request to JCF for approval. Current law also
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, DHS must submit its final implementation plan to JCF for approval.
Under current law created by Act 370, JCF may reduce from moneys allocated for
state operations or administrative functions DHS's appropriation or expenditure
authority or change the authorized level of full-time equivalent positions for DHS
related to the program for which the request is required to be submitted if JCF
determines that DHS 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
as required under current law created by Act 370.
Postpartum MA coverage
The bill requires DHS to seek approval from the federal Department of Health
and Human Services to extend MA benefits to women who are eligible for those
benefits when pregnant until the last day of the month in which the 365th day after
the last day of the pregnancy falls.
2021 Wisconsin Act 58, the 2021-23 biennial
budget act, directed DHS to apply for any amendment to the state plan or any waiver
of federal law necessary to extend the time that women who are eligible for MA when
pregnant continue to be eligible under MA from the last day of the month in which
the 60th day after the last day of the pregnancy falls to the last day of the month in
which the 90th day after the last day of the pregnancy falls. On June 3, 2022, DHS
submitted a demonstration waiver to the federal Department of Health and Human
Services pursuant to section 1115 of the federal Social Security Act to implement Act
58 that is currently pending approval.
Coverage of doula services under MA
The bill requires DHS to request any necessary waiver or amendment to the
state MA plan to allow MA reimbursement for doula services and, if any necessary
waiver or amendment is approved, directs DHS to reimburse certified doulas for
doula services provided to MA recipients. Doula services consist of childbirth
education and support services, including emotional and physical support provided
during pregnancy, labor, birth, and the postpartum period.
Payment for school medical services
Under current law, if a school district or a cooperative educational service
agency (CESA) elects to provide school medical services and meets certain
requirements, DHS is required to reimburse the school district or CESA for 60
percent of the federal share of allowable charges for the school medical services that
they provide. If the Wisconsin Center for the Blind and Visually Impaired or the
Wisconsin Educational Services Program for the Deaf and Hard of Hearing elects to
provide school medical services and meets certain other requirements, DHS is also
required to reimburse DPI for 60 percent of the federal share of allowable charges
for the school medical services that the Wisconsin Center for the Blind and Visually
Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of
Hearing provide. Further, under current law, DHS is required to reimburse school
districts, CESAs, and DPI, on behalf of the Wisconsin Center for the Blind and
Visually Impaired or the Wisconsin Educational Services Program for the Deaf and
Hard of Hearing, for 90 percent of the federal share of allowable school medical
services administrative costs.
The bill increases the amount that DHS is required to reimburse a school
district, CESA, and DPI, on behalf of the Wisconsin Center for the Blind and Visually
Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of
Hearing, for provided school medical services to 100 percent of the federal share of
allowable charges for the school medical services. The bill also increases the amount
that DHS is required to reimburse a school district, CESA, and DPI, on behalf of the
Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational
Services Program for the Deaf and Hard of Hearing, to 100 percent of the federal
share of allowable school medical services administrative costs.
Community-based psychosocial services
Currently, community-based psychosocial services provided to MA 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 MA 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 must be both the federal and nonfederal share
based on a fee schedule that is determined by DHS. Under the bill, for a county that
elects to provide community-based psychosocial services to MA recipients, DHS
must reimburse the county only for the amount of the allowable charges for those
services under the MA program that is provided by the federal government. For a
county that elects to provide the services through the MA program on a regional basis
according to requirements established by DHS, however, DHS must reimburse the
county for the federal and nonfederal amount of allowable charges under the MA
program.
Certified peer specialist services
The bill requires DHS to provide as a benefit and reimburse services provided
by certified peer specialists under the MA program. The bill also adds services
provided by certified peer specialists to a DHS program to coordinate and continue
care following a substance use overdose. A “certified peer specialist,” as defined in
the bill, is an individual who has experience in the mental health and substance use
services system, who is trained to provide support to others, and who has received
peer specialist or parent peer specialist certification.
The bill requires DHS to reimburse under the MA program a certified peer
specialist service that meets all of the following criteria: 1) the recipient of the
certified peer specialist service is in treatment for or recovery from mental illness or
a substance use disorder; 2) the certified peer specialist provides the service under
the supervision of a competent mental health professional and in coordination and
accordance with the recipient's individual treatment plan and treatment goals; and
3) the certified peer specialist completes the training requirements specified by DHS.
Determination of eligibility for MA or subsidized health insurance coverage
by indicating interest on an individual income tax return
The bill requires DOR to include questions on an individual income tax return
to determine whether the taxpayer or any member of the taxpayer's household does
not have health care coverage under a health insurance policy or health plan. If the
taxpayer indicates that the taxpayer or any member of the taxpayer's household does
not have health care coverage, DOR shall, at the taxpayer's request, forward the
taxpayer's response to DHS to have DHS evaluate whether the taxpayer or a member
of the taxpayer's household is eligible to enroll in the MA program or whether the
taxpayer or a member of the taxpayer's household is eligible for subsidized health
insurance coverage through a health insurance marketplace for qualified health
plans under the ACA. The bill specifies that DHS may not use any information
provided to determine that the individual is ineligible to enroll in the MA program.
MA program coverage for detoxification and stabilization services
The bill requires DHS to provide reimbursement for detoxification and
stabilization services under the MA program. The bill requires DHS to submit to the
federal government any request for federal approval necessary to provide the
reimbursement for detoxification and stabilization services under the MA program,
and makes reimbursement contingent upon any needed federal approval. The bill
defines “detoxification and stabilization services” as adult residential integrated
behavioral health stabilization service, residential withdrawal management
service, or residential intoxication monitoring service.
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 MA program. 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 an MA benefit if the federal Department of Health and Human Services does not
provide federal financial participation for the services.
Primary care reimbursement under MA
The bill requires DHS to increase the rates paid in the MA program for primary
care services. The increase is $21,110,400 in fiscal year 2023-24 and $43,040,400 in
fiscal year 2024-25 as the state share of the increase, and, in addition, DHS must
provide the matching federal share of payments. The bill provides, however, that the
increases may apply only if DHS expands eligibility under the MA program pursuant
to the ACA.
MA program coverage of acupuncture services
The bill includes acupuncture that is provided by a certified acupuncturist as
a reimbursable benefit under the MA 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 MA program.
Community dental health coordinators
The bill requires DHS to award grants to support community dental health
coordinators. Community dental health coordinators are individuals who help
facilitate oral health care for families and individuals, particularly in underserved
communities.
Community support program
Currently, mental health and psychosocial rehabilitative services provided by
a community support program are a benefit provided by the MA program. Under
current law, for these services, a county pays the nonfederal share of the MA
reimbursement and DHS reimburses the service provider for the federal share of the
MA reimbursement. Under the bill, DHS reimburses the service provider for both
the federal and nonfederal share of the allowable charges for mental health and
psychosocial rehabilitative services provided by a community support program.
Pediatric inpatient supplement
The bill establishes in statute reference to supplemental funding totaling
$2,000,000 to be distributed by DHS to certain acute care hospitals located in
Wisconsin that have a total of more than 12,000 inpatient days in the hospital's acute
care pediatric units and intensive care pediatric units, not including neonatal
intensive care units. In addition, under the bill, DHS may distribute additional
funding of $10,000,000 in each fiscal year to hospitals that are free-standing
pediatric teaching hospitals located in this state that have a Medicaid inpatient
utilization rate greater than 45 percent.
Coverage of substance abuse treatment room and board under MA
The bill directs DHS to pay allowable charges on behalf of MA recipients for
room and board for residential substance use disorder treatment.
Hospital assessment
Currently, each hospital, including each critical access hospital, must pay an
assessment for the privilege of doing business in this state. 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 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 MA program, including the federal and state share of MA, 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 MA 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 44.21 percent, thus
increasing the amount of payments that must be made to critical access hospitals and
other hospitals under the MA program.
MA hospital reimbursement
The bill requires DHS to increase the reimbursement rates paid to hospitals
under the MA program in fiscal years 2023-24 and 2024-25 if the state implements
the Medicaid expansion under the ACA. DHS must limit the payments made with
these increases to the upper payment limit set forth under federal law. The increase
is $7,605,400 in fiscal year 2023-24 and $15,506,100 in fiscal year 2024-25 as the
state share of the increase, and in addition, DHS must provide the matching federal
share of payments.
Health information exchange pay-for-performance system
The bill requires DHS to develop and implement for non-hospital providers in
the MA program, including physicians, clinics, health departments, home health
agencies, and post-acute care facilities, a payment system based on performance to
incentivize participation in the health information exchange as specified in the bill.
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.
Graduate medical education grants
The bill extends from three years to five years the maximum term for grants
awarded by DHS to assist rural hospitals and groups of rural hospitals in procuring
infrastructure and increasing case volume to develop accredited graduate medical
training programs. The bill also increases the maximum amounts that DHS may
award each fiscal year in grants to hospitals to support existing graduate medical
training programs. Under current law, DHS may not distribute more than $225,000
to a particular hospital or more than $75,000 to fund an individual position in an
existing graduate medical training program during a given fiscal year. The bill
increases those limits to $450,000 and $150,000 per fiscal year, respectively.
Children
Tribal administration of subsidized guardianships
Under current law, a county department of human services or social services
(county department) or DCF in a county having a population of 750,000 or more must
provide monthly subsidized guardianship payments to the guardian of a child who
has been adjudged to be in need of protection or services (CHIPS) if certain conditions
have been met, including the conditions that 1) the child, if 14 years of age or over,
has been consulted regarding the guardianship arrangement; 2) the guardian has a
strong commitment to caring for the child permanently; 3) the guardian is licensed
as the child's foster parent, which licensing includes an inspection of the guardian's
home under administrative rules promulgated by DCF; 4) the guardian and all adult
residents of the guardian's home have passed a criminal background investigation;
and 5) prior to being named as guardian of the child, the guardian entered into a
subsidized guardianship agreement with the county department or DCF. Under
current law, a county department is reimbursed by DCF for the subsidized
guardianship payments it makes, including guardianships of children ordered by
tribal courts under a law substantially similar to the state's guardianship law (tribal
guardianship law).
The bill allows DCF to enter into an agreement with the governing body of an
Indian tribe to allow that governing body to administer subsidized guardianships
ordered by a tribal court under a tribal guardianship law. Under such an agreement,
the Indian tribe must comply with all requirements for administering subsidized
guardianship that apply to counties and DCF, including eligibility. Under the bill,
DCF reimburses Indian tribes for subsidized guardianship payments in the same
way that it reimburses county departments under current law. The bill also specifies
that a county department may provide subsidized guardianship payments for
guardianships of children ordered by a tribal court if the county department has
entered into an agreement with an Indian tribe to do so.
Kinship care eligibility expansion and placement options
Under current law, a juvenile court may place a child in certain placements that
provide out-of-home care under the Children's Code and the Juvenile Justice Code.
Under current law, those placements include specific types of licensed facilities, a
licensed foster home, or the home of a relative other than a parent. Under current
law, a relative other than a parent does not typically need to acquire a license in order
to receive a relative child. The bill allows a juvenile court to similarly place a child
with unlicensed individuals who qualify as “like-kin” under the Children's Code and
the Juvenile Justice Code.
The bill defines “like-kin” for the purposes of such a placement to be a person
who has a significant relationship with a child or the child's family if that person 1)
prior to the child's placement with the person, had an existing relationship with the
child or child's family that is similar to a familial relationship; 2) during the child's
placement with the person, developed a relationship with the child or child's family
that is similar to a familial relationship; or 3) for an Indian child, is identified by the
child's tribe as kin or like-kin according to tribal tradition, custom or resolution,
code, or law. Under the bill, “like-kin” does not include a current or former foster
parent of a child for placement purposes.
Under current law, a relative other than a parent who is providing care and
maintenance for a child under a court order (kinship care provider) may receive
monthly kinship care payments from DCF or a county department. The bill includes
as kinship care providers first cousins once removed and like-kin persons.
Under current law, for the purposes of permanency planning, a family
permanency team may include like-kin. The current law definition of “like-kin,” for
the purpose of determining the family permanency team, is similar to the definition
of “like-kin” for placement purposes in the bill, except that the current law definition
1) does not exclude a current or former foster parent and 2) does not include
individuals identified by the child's tribe if the child is an Indian child. Under the
bill, the definition of “like-kin” for determining a family permanency team does not
exclude a current or former foster parent but does include individuals identified by
the child's tribe if the child is an Indian child.
Kinship care flexible support
The bill creates flexible support for a kinship care provider. Support provided
under the bill may include additional flexible payments or services to a kinship care
provider who DCF determines qualifies. Under the bill, DCF may promulgate
administrative rules to specify qualifying costs and services and eligibility criteria
for the flexible support.
Foster care and kinship care rates and payments
The bill changes the monthly basic maintenance rates that the state or a county
pays to foster parents certified to provide level one care and to all kinship care
providers, which under current law are $300 per month for a child of any age, to be
the same as the age-based monthly basic maintenance rates paid to foster parents
providing higher than level one care. The bill also increases these age-based
monthly basic maintenance rates by 5 percent. Beginning on January 1, 2024, the
monthly rates are $441 for a child under five years of age, $483 for a child 5 to 11 years
of age, $548 for a child 12 to 14 years of age, and $572 for a child 15 years of age or
over.
The bill provides that, in addition to the monthly rates currently paid to a
kinship care provider, DCF or, with DCF's approval, a county department may make
emergency payments for kinship care to a kinship care provider if any of the
following conditions are met:
1. The governor has declared a state of emergency, or the federal government
has declared a major disaster, that covers the locality of the home of the kinship care
provider (home).
2. This state has received federal funding to be used for child welfare purposes
due to an emergency or disaster declared for the locality of the home.
3. DCF has determined that conditions in this state or in the locality of the
home have resulted in a temporary increase in the costs borne by foster homes and
kinship care providers, including a pandemic or other public health threat, a natural
disaster, or unplanned school closures of five consecutive days or more.
The bill provides that DCF must determine the amount of an emergency
payment based on available funding and may promulgate administrative rules
governing the provision of the payments.
The bill changes the statutes and the administrative code to make kinship care
providers and foster homes certified to provide level one care eligible to receive
exceptional payments to enable siblings or a minor parent and minor children to
reside together and to receive an initial clothing allowance. Under current law, these
payments are only available to foster homes certified to provide higher than level one
care.
Grants for youth services
