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
The bill consolidates certain DCF youth services programs into a new youth services grant program. Under current law, the following DCF programs provide youth services: grants for services for homeless and runaway youth, treatment and services for children who are the victims of sex trafficking, grants for children’s community programs, and the Brighter Futures Initiative. Under the bill, these programs are consolidated into the youth services grant program, under which DCF must distribute grants to public agencies, nonprofit corporations, and Indian tribes to provide programs that accomplish one or more of the following purposes:
1. Increasing youth access to housing.
2. Increasing youth self-sufficiency through employment, education, and training.
3. Increasing youth social and emotional health by promoting healthy and stable adult connections, social engagement, and connection with necessary services.
4. Preventing sex trafficking of children and youth.
5. Providing treatment and services for documented and suspected victims of child and youth sex trafficking.
6. Preventing and reducing the incidence of youth violence and other delinquent behavior.
7. Preventing and reducing the incidence of youth alcohol and other drug use and abuse.
8. Preventing and reducing the incidence of child abuse and neglect.
9. Preventing and reducing the incidence of teen pregnancy.
The bill allocates $500,000 in Temporary Assistance for Needy Families funding to the grants for youth services that under current law is allocated for the Brighter Futures Initiative for programs to provide evidence-based programs and practices for substance abuse prevention to at-risk youth and their families.
Under current law, DHS transfers amounts to DCF for the Brighter Futures Initiative. Under the bill, DHS transfers those amounts to DCF for the grants for youth services. The bill maintains a requirement, currently under the Brighter Futures Initiative, that DCF distribute $55,000 in each fiscal year to Diverse and Resilient, Inc., to provide youth services as part of the new youth services grant program.
Youth aids; allocations
Under current law, DCF is required to allocate to counties community youth and family aids (youth aids) funding. Youth aids funding comes from various state and federal moneys and is used to pay for state-provided juvenile correctional services and local delinquency-related and juvenile justice services. The bill updates the allocation of youth aids funding that is available to counties for the 2023-25 fiscal biennium.
The bill eliminates a current law provision that allocates some of the youth aids funding to reimburse counties that are purchasing community supervision services from DOC for juveniles, and some for alcohol and other drug abuse treatment programs.
