Statewide contract for dental benefits
The bill requires DHS to submit any necessary request to the federal Department of Health and Human Services for a state plan amendment or waiver of federal Medicaid law to implement a statewide contract for dental benefits through a single vendor under the Medical Assistance program. If the federal government disapproves the amendment or waiver request, the bill provides that DHS is not required to implement the statewide contract.
Medical Assistance coverage for detoxification and stabilization services
The bill requires DHS to provide reimbursement for detoxification and stabilization services 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 detoxification and stabilization services under the Medical Assistance 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.
The bill also requires DHS, through the community grants program it is required to administer, to distribute not more than $500,000 each fiscal year for grants to community-based withdrawal centers, including those certified as a residential intoxication monitoring service, residential withdrawal management service, or adult residential integrated behavioral health stabilization service.
Medical Assistance payments to rural health clinics
The bill modifies the methodology DHS must use for reimbursing rural health clinics for services provided to Medical Assistance recipients. Currently, DHS reimburses rural health clinics for the reasonable costs of the services they provide. Under the bill, for services provided on or after July 1, 2026, DHS must reimburse rural health clinics using a payment methodology based on the federal Medicaid prospective payment system, which directs that reimbursement be provided to a rural health clinic at a rate that is based upon the rural health clinic’s per-visit costs in previous years, adjusted for medical cost inflation and for any change in the scope of services furnished by the rural health clinic.
Elimination of birth cost recovery
Under current law, as a condition of eligibility for benefits under the Medical Assistance program, a person is deemed to have assigned to the state by applying for or receiving benefits under the Medical Assistance program any rights to medical support or other payment of medical expenses from any other person. Current law further provides that if a mother of a child was enrolled in a health maintenance organization or other prepaid health care plan under the Medical Assistance program at the time of the child’s birth, then birth expenses that were incurred by the health maintenance organization or other prepaid health care plan may be recovered by the state. The bill provides that no birth expenses may be recovered by the state under this process.
Eliminating legislative oversight of federal 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 requires DHS to submit an implementation plan to JCF and submit its final proposed request to JCF for approval. Current law 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, current law requires DHS to submit its final implementation plan to JCF for approval. Current law 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 current law created by Act 370. 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. Under current law created by 2017 Wisconsin Act 370, DHS is required 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. Dental reimbursement pilot project reporting requirement
Under current law, DHS must distribute moneys under a dental reimbursement pilot project to increase the reimbursement rate for pediatric dental care and adult emergency dental services provided under the Medical Assistance program in Brown, Marathon, Polk, and Racine Counties and, if certain requirements are met, in any other county, as determined by DHS, where Medical Assistance recipients have the greatest need for pediatric dental care and adult emergency dental services. In addition, current law requires DHS to submit a biennial report on the pilot project to the chief clerk of each house of the legislature, each standing committee of the legislature with jurisdiction over health or public benefits, and JCF. The bill eliminates the reporting requirement.
Community support program
Currently, mental health and psychosocial rehabilitative services provided by a community support program are a benefit provided by the Medical Assistance program. Under current law, for these services, a county pays the nonfederal share of the Medical Assistance reimbursement and DHS reimburses the service provider for the federal share of the Medical Assistance reimbursement. Under the bill, DHS must reimburse a county for both the federal and nonfederal share of the allowable charges for mental health and psychosocial rehabilitative services provided by a community support program.
Hospital assessment
Under current law, certain hospitals must pay an annual assessment that is equal to a percentage of the hospital’s gross patient revenues. Currently, DHS must set the percentage so that the total amount of assessments collected in a fiscal year is $414,507,300. The bill increases this amount to $1,341,839,500. Under current law, institutions for mental disease, certain general psychiatric hospitals, and critical access hospitals are not required to pay the assessment. The bill also exempts rehabilitation hospitals and long-term acute care hospitals from paying the assessment. Currently, DHS must use a portion of the assessments collected to pay for services provided under the Medical Assistance program by the hospitals from which the assessments are collected. Under current law, the payments must equal the amount collected divided by 61.68 percent. The bill increases that percentage to 62.39.
Under current law, a critical access hospital must also pay an annual assessment that is equal to a percentage of the critical access hospital’s gross inpatient revenues. Currently, DHS must use a portion of the assessments collected to pay for services provided by critical access hospitals under the Medical Assistance program. Under current law, the payments must equal the amount collected divided by 61.68 percent. Under the bill, the payments must equal $49,392,400, and moneys from a biennial GPR appropriation for Medical Assistance program benefits may also be used as needed to fund the nonfederal share of payments for the services.
Children’s behavioral health managed care
The bill authorizes DHS to request a waiver from the federal Department of Health and Human Services to administer a children’s behavioral health specialty managed care program under the Medical Assistance program. The bill provides that DHS may administer the children’s behavioral health specialty managed care program if the waiver is granted.
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.
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 $7,500,000 in each state fiscal year to hospitals that are free-standing pediatric teaching hospitals located in Wisconsin that have a Medicaid inpatient utilization rate greater than 45 percent.
Children
Expanding eligibility for subsidized guardianships and kinship care payments
Under current law, a guardian appointed by the juvenile court or tribal court to provide care to a child adjudged to be in need of protection or services or a juvenile adjudged to be in need of protection or services, if the juvenile’s parent or prior guardian is unable or needs assistance to control the juvenile, may receive monthly subsidized guardianship payments from DCF or a county department of human or social services (county department) reimbursed by DCF or an Indian tribe reimbursed by DCF. A guardian may receive such payments only if certain conditions have been met, including that 1) the child, if 14 years of age or over, has been consulted with 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 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 DCF, the county department, or the Indian tribe.
Under the bill, a guardian appointed by the juvenile court or tribal court to a juvenile adjudged to be delinquent or a juvenile adjudged to be in need of protection or services for any reason may receive monthly subsidized guardianship payments from DCF, a county department, or an Indian tribe.
Under current law, a kinship care provider who is providing temporary care to a child or juvenile adjudged to be in need of protection or services may receive monthly kinship care payments from DCF, a county department, or an Indian tribe. Under the bill, a kinship care provider who is providing temporary care to a juvenile alleged to be delinquent may receive such payments.
Under current law, kinship care payments are administered directly by DCF in Milwaukee County. Under the bill, a county department in Milwaukee County may administer kinship care payments and be reimbursed by DCF.
The bill also requires that in a dispositional order placing a juvenile who has been adjudicated delinquent outside his or her home, in addition to the findings required under current law, the court must also find that continued placement in the juvenile’s home would be contrary to the welfare of the juvenile. Under current law, such an order must include a finding that the juvenile’s current residence will not safeguard the welfare of the juvenile or the community due to the serious nature of the act for which the juvenile was adjudicated delinquent.
DCF child support assignment and referrals
The bill removes the assignment to the state of child support orders and arrears existing at the time a child enters foster care. The bill also removes the role of DCF and a county department in providing child support referrals and collecting child support for families with children in out-of-home care except if DCF or a county department determines that such a referral is appropriate under rules to be promulgated by DCF. The bill eliminates from the Juvenile Justice Code requirements that the juvenile court order child support, except for modification of existing orders, and order the parents of a juvenile under DCF supervision to contribute towards the costs of certain sanctions, dispositions, or placements.
The bill also adds language to the “best interests of the child” factor that under current law must be used by the family court when modifying a child support order. The bill specifies that, for a child in out-of-home care under the Children’s Code or the Juvenile Justice Code, this factor includes the impact on the child of family expenditures to improve any conditions in the home that would facilitate the reunification of the child with the child’s family, if appropriate, and the importance of a placement that is the least restrictive of the rights of the child and the parents and the most appropriate for meeting the needs of the child and the family.
Foster care and kinship care rates and payments
The bill eliminates the separate monthly basic maintenance rates that the state or a county pays to foster parents certified to provide level one care so that age-based monthly basic maintenance rates are paid to all foster parents. The bill changes the rates paid to all kinship care providers, which under current law are $375 per month for a child of any age, to be the same as the age-based monthly basic maintenance rates paid to foster parents. The bill also increases these age-based monthly basic maintenance rates by 5 percent. Beginning on January 1, 2026, the monthly rates are $463 for a child under five years of age, $507 for a child 5 to 11 years of age, $575 for a child 12 to 14 years of age, and $601 for a child 15 years of age or over.
The bill provides that, in addition to the monthly rates currently paid to a foster home or a kinship care provider who is providing care and maintenance for a child, DCF or a county department of human services or social services may make emergency payments for kinship care to a kinship care provider or for foster care to a foster home 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 who is providing foster care in the home (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 rules governing the provision of the payments.
The bill changes the statutes and the administrative code to make all foster homes and kinship care providers 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.
Benefits eligibility screening
The bill directs DCF or a county department (the department) to periodically screen each child under the placement and care of the department in out-of-home care, other than children placed with kinship care providers receiving kinship care payments, to determine if the child is eligible for federal or state benefits (benefits). If the department finds that a child is eligible for benefits, the department must do all of the following:
1. Apply for the benefits for which the child is eligible on behalf of the child.
2. Ensure that the child, the child’s guardian ad litem, and the child’s parent, guardian, or Indian custodian receive proper and timely notice of any application for benefits, the results of an application for benefits, and any appeal of a denial of benefits that could be or is filed on behalf of the child.
3. Provide the child with training covering financial literacy and maintaining benefit eligibility prior to the child aging out of out-of-home care.
If the department is appointed as representative payee for a child receiving benefits under the bill, the department must conserve the child’s benefits in protected accounts that avoid asset limitations for federal and state programs, consistent with the best interests of the child; provide a periodic accounting to the child, the child’s attorney or guardian ad litem, and the child’s parent, guardian, or Indian custodian regarding the conservation and use of the child’s benefits while the child is in the department’s care; and work with the child and the appropriate federal agency to return remaining funds to the child or another fiduciary once the child exits the department’s care.
The department may contract with a public or private agency to fulfill the requirements of the bill. The department may not use benefits received on behalf of a child to pay for the costs of caring for the child in out-of-home care, but may use the child’s federal benefits for the child’s unmet needs beyond what the agency is obligated to, is required to, or has agreed to provide.
The bill requires DCF to promulgate rules to implement the bill and authorizes DCF to promulgate emergency rules for the period before permanent rules take effect.
Representation of parents in CHIPS proceedings
Under current law, a parent is generally not entitled to representation by a public defender in a proceeding under the Children’s Code in which a child is alleged to be in need of protection or services. However, a pilot program that began in 2018 requires the SPD to assign counsel to any nonpetitioning parent in these cases in Brown, Outagamie, Racine, Kenosha, and Winnebago Counties. This five-county pilot program is set to expire after June 2025. The bill extends the expiration date of the pilot program to December 31, 2026.
Independent living services eligibility expansion
The bill expands a current program under which DCF must distribute $231,700 each fiscal year for the purpose of assisting individuals who reach the age of 18 while residing in out-of-home care to make the transition from out-of-home care to a successful adulthood. The bill expands this program to also assist an individual who resided in out-of-home care, including in the home of like-kin or in the home of a person who is not a relative or like-kin, for at least six months after his or her 16th birthday; an individual who was placed under a guardianship as a child in need of protection or services on or after his or her 16th birthday; and an individual who was adopted on or after his or her 16th birthday following time in out-of-home care. The bill also allows the services funded by this program to be offered until age 23, and allows the funding to be distributed to Indian tribes and private and public agencies and organizations. The bill also removes the requirement that DCF distribute a minimum of $231,700 in each fiscal year for the program.
Specialized congregate care payments
The bill grants DCF the authority to expend funds to provide payments for specialized services to children with high acuity needs in congregate care facilities. “Congregate care facilities” means group homes, shelter care facilities, and residential care centers for children and youth.
Children and family services
Under current law, DCF must distribute $101,551,400 in fiscal year 2023–24 and $101,939,600 in fiscal year 2024–25 to counties for children and family services. The bill updates those amounts to $104,969,500 in fiscal year 2025–26 and $110,869,200 in fiscal year 2026–27.
Child care partnership grant program
The bill authorizes DCF to establish a grant program to award funding to businesses, nonprofits, or governmental entities (businesses) that provide or wish to provide child care services for their employees. The bill allows such a grant to be used to reserve child care placements for local business employees, pay child care tuition, and other costs related to child care. Under the bill, a grant recipient with 50 or fewer employees must provide at least 10 percent matching funds and a grant recipient with more than 50 employees must provide at least 15 percent matching funds. The bill allows DCF to promulgate rules to administer the grant program, including to determine eligibility for a grant, and authorizes DCF to promulgate these as emergency rules.
Child care access program
The bill requires DCF to contract with Wonderschool, Inc., and Wisconsin Early Childhood Association, Inc., to increase access to high-quality child care. The bill requires DCF to enter into a $4,500,000 contract with Wonderschool to 1) increase the child care workforce by launching an online software platform that is linked to DCF’s website to connect child care providers with child care workers and a pool of substitute child care workers and 2) build child care capacity in this state. The bill also requires DCF to enter into a $5,500,000 contract with Wisconsin Early Childhood Association to provide 1) existing or prospective child care providers with licensing and certification assistance, 2) coaching and other support services, and 3) tax education assistance for child care centers that provide care and supervision for between four and eight children.
Grants for out-of-school time programs
The bill directs DCF to make grants to out-of-school time programs, defined as structured programs or activities that meet all of the following conditions:
1. To the extent practicable, the program or activity is led by adult mentors using evidence-based or evidence-informed practices and is provided to school-age children before school, after school, or during the summer.
2. The program or activity does not supplant instructional services provided by a school or result in academic credit for students.
3. The program or activity relates to improving social, emotional, academic, or career readiness competencies; reducing negative behaviors, including violence and crime, tobacco use, alcohol and substance abuse, disengagement from school, school suspension, truancy, and health-compromising behaviors; providing a safe out-of-school time environment; or engaging in career exploration or formal or informal work-based learning.
The bill requires DCF to promulgate rules to implement the grant program and authorizes DCF to promulgate emergency rules for the period before permanent rules take effect.
Health
Complex patient pilot program
The bill requires DHS to select, using a competitive grant selection process, partnership groups to be designated as participating sites for a complex patient pilot program and then award grants to the partnership groups selected. The bill provides that a partnership group is one or more hospitals in partnership with one or more post-acute facilities. The bill provides that DHS must solicit feedback regarding the pilot program from representatives of health care system organizations, long-term care provider organizations, long-term care operator organizations, patient advocate groups, insurers, and any other organization determined to be relevant by the secretary of health services. Under the bill, DHS must require each partnership group that applies to be designated as a site for the pilot program to address certain issues in its application, including 1) the number of complex patient care beds that will be set aside in a post-acute facility or through implementation of another innovative model of patient care in a post-acute facility to which participating hospitals agree; 2) defined goals and measurable outcomes of the partnership both during and after the pilot program; 3) the types of complex patients for whom care will be provided; 4) an operating budget for the proposed site; and 5) the participant group’s expertise to successfully implement the proposal.
The bill requires DHS to develop a methodology to evaluate the pilot program and contract with an independent organization to complete the evaluation. Under the bill, DHS may pay the organization’s fee from the funding appropriated for the pilot program. The bill requires DHS to give additional weight to partnership groups that would ensure geographic diversity. Upon completion of the required evaluation, the independent organization contracted by DHS to conduct the evaluation must provide the evaluation to DHS.
Health care entity oversight and transparency
The bill creates various requirements and procedures related to health care entity oversight and transparency.
The bill establishes procedures for review of proposed material change transactions involving health care entities. The bill requires DHS to promulgate rules to define, for purposes of the provisions in the bill, what entities are considered to be health care entities and what constitutes a material change transaction. The bill requires, among other things, that before consummating any material change transaction, a health care entity must submit written notice to DHS. Under the bill, DHS must post information about the proposed transaction on its website no less than 30 days before the anticipated implementation of the material change transaction or, if the department is notified less than 30 days before the anticipated implementation, as soon as is practicable. The bill includes procedures for DHS to review and approve, conditionally approve, or disapprove a proposed transaction. The bill provides for post-transaction oversight, including possible enforcement by the attorney general and DHS, as well as monitoring of compliance and required reporting. The bill also prohibits the corporate practice of medicine and requires DHS to promulgate rules to define what conduct constitutes the corporate practice of medicine within the scope of the prohibition.
The bill adds transparency requirements relating to ownership and control of health care entities. Under the bill, with certain exceptions, each health care entity must report certain information relating to ownership and control to DHS annually and upon the consummation of a material change transaction involving the entity, including the legal name of the entity, its business address, and locations of operations, as well as a current organizational chart showing the business structure of the health care entity and the name and contact information of a representative of the entity. Beginning in 2028, the bill requires DHS to post on its publicly available website an annual report based on the health care entity reporting from the previous year. The bill includes enforcement mechanisms, including granting DHS authority to audit and inspect the records of any health care entity that has failed to submit complete reporting information or if DHS has reason to question the accuracy or completeness of the information submitted. The bill requires DHS to conduct annual audits of a random sample of health care entities to verify compliance with and accuracy and completeness of required reporting. The bill includes penalties for failure to submit a required report and for submitting a report containing false information. Health care entities consisting of independent health care providers or provider organizations without any third-party ownership or control entities, with 10 or fewer physicians or less than $10 million in annual revenue, are subject to forfeiture of up to $50,000 for each report not provided or containing false information, and all other health care entities are subject to a forfeiture of up to $500,000 for each report not provided or containing false information.
The bill also includes authority for DHS to promulgate rules to implement the provisions of the bill.
Women’s health block grant
Under current law, DHS must allocate women’s health funds, which are funds received by the state from the federal government under Title V of the federal Social Security Act, to develop and maintain an integrated system of community health services and to maximize the coordination of family planning services. Current law excludes from the definition of “family planning” the performance, promotion, encouragement, or counseling in favor of, or referral either directly or through an intermediary for, voluntary termination of pregnancy but includes in the definition of “family planning” the provision of nondirective information explaining prenatal care and delivery or infant care, foster care, or adoption. Current law provides that DHS must distribute women’s health funds only to public entities. However, current law allows those public entities to provide some or all of the funds received to other public entities or private entities but only if the recipients of the funds do not provide abortion services, make referrals for abortion services, or have an affiliate that provides abortion services or makes referrals for abortion services. The bill continues to allow public entities that receive funds from DHS to provide some or all of the funds to other public or private entities but eliminates the restriction on which public or private entities may receive those funds. The bill also includes in the definition of “family planning” the provision of nondirective information explaining pregnancy termination.
Nursing home bed access
Under current law, DHS licenses nursing home beds and enforces a maximum limit on the number of these licensed beds in the state. The bill reduces that limit from 51,795 to 25,415. The bill also directs DHS to allocate 125 nursing home beds to applicants that agree to prioritize admissions of patients with complex needs and patients who have been unable to find appropriate placement at another facility.
Newborn screening program
In general, under current law, newborns must be tested for certain congenital and metabolic disorders as specified in rules promulgated by DHS. The federal Department of Health and Human Services maintains a list of disorders for which it recommends testing in newborns, known as the federal Recommended Uniform Screening Panel (RUSP).
Under the bill, DHS must evaluate each disorder that is included in the RUSP as of January 1, 2025, to determine whether newborns in this state should be tested for that disorder. This requirement does not apply to any disorder in the RUSP if, as of January 1, 2025, the disorder is already included in the list of disorders for which newborns must be tested in this state. In addition, the bill requires DHS to evaluate any disorder added to the RUSP after January 1, 2025, to determine whether newborns in this state should be tested for that newly added disorder. If DHS determines newborns should not be tested for the disorder, DHS must annually review medical literature and DHS’s capacity and resources to test for the disorder in order to determine whether to reevaluate the inclusion of the disorder in newborn testing in this state. If, in any of these evaluations or reevaluations, DHS determines that a disorder in the RUSP should be added to the list of disorders for which newborns must be tested in this state, the bill requires DHS to promulgate rules to add that disorder.
The requirements for evaluations, reviews, and reevaluations under the bill do not apply to a disorder in the RUSP if DHS is in the process of adding, by rule, the disorder to the list of disorders for which newborns must be tested in this state. However, if the rule-making procedure for that disorder does not result in promulgation of a rule, then DHS must consider the disorder under the review and reevaluation procedures under the bill.
Electrocardiogram screening pilot project for middle school and high school athletes in Milwaukee and Waukesha Counties
The bill directs DHS to develop a pilot program to provide electrocardiogram screenings for participants in middle school and high school athletics programs in Milwaukee and Waukesha Counties. DHS is required to award $4,067,200 in grants in fiscal year 2026–27 to local health departments to implement the program. The bill specifies that participation in the program by participants in middle school and high school athletics programs must be optional.
