Under current law, if an individual is already receiving a Wisconsin Shares child care subsidy and the individual’s family income exceeds the maximum eligible income of 200 percent of the poverty line, the individual will continue to be eligible for the subsidy until or unless the individual’s family income exceeds 85 percent of the state median income. Until that time when the individual’s income exceeds 85 percent of the state median income, the individual’s copayment minimum for the Wisconsin Shares child care subsidy will increase on a sliding scale based on the amount that the individual’s family income increases.
The bill eliminates this copayment increase structure in order to comply with federal rule 89 FR 15366, effective April 30, 2024, which establishes that copayments for individuals receiving a child care subsidy from the federal Child Care and Development Fund may not exceed 7 percent of family income. Under the bill, in general, if an individual is already receiving a Wisconsin Shares child care subsidy and the individual’s family income exceeds 85 percent of the state median income, the individual is no longer eligible for the Wisconsin Shares child care subsidy.
Wisconsin Shares like-kin update
2023 Wisconsin Act 119 extended kinship care eligibility to like-kin, in addition to relatives of a child. “Like-kin” is defined under current law as an individual who has a significant emotional relationship with a child or the child’s family that is similar to a familial relationship and who is not and has not previously been the child’s licensed foster parent and, for an Indian child, includes individuals identified by the child’s tribe according to tribal tradition, custom or resolution, code, or law. The bill conforms language under the child care subsidy program, Wisconsin Shares, to this change so that references to kinship care are not limited to relatives. Child care quality improvement program
The bill authorizes DCF to establish a program for making monthly payments and monthly per-child payments to certified child care providers, licensed child care centers, and child care programs established or contracted for by a school board. This new payment program is in addition to the current law system for providing child care payments under Wisconsin Shares. The bill requires DCF to promulgate rules to implement the program, including establishing eligibility requirements and payment amounts and setting requirements for how recipients may use the payments, and authorizes DCF to promulgate these rules as emergency rules. The bill funds the program through a new appropriation and by allocating federal moneys, including child care development funds and moneys received under the Temporary Assistance for Needy Families (TANF) block grant program.
The bill eliminates the current law method by which DCF may modify maximum payment rates for child care providers under Wisconsin Shares based on a child care provider’s rating under the quality rating system known as YoungStar.
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.
Expanded Transform Milwaukee Jobs and Transitional Jobs programs
Under current law, DCF administers a temporary wage subsidy program for individuals who meet all of the following qualifications: 1) are at least 18 years old and, if over 25 years old, are the parent or primary relative caregiver of a child; 2) have a household income below 150 percent of the federal poverty line; 3) have been unemployed for at least four weeks; 4) are ineligible to receive unemployment insurance benefits; 5) are not participating in a Wisconsin Works employment position; and 6) satisfy applicable substance abuse screening, testing, and treatment requirements. Under current law, funding is directed first to the program as established in Milwaukee County, called the Transform Milwaukee Jobs program, and next, if funding is available, to the program as established outside of Milwaukee County, called the Transitional Jobs program.
The bill provides funding for and requires DCF to establish the Expanded Transform Milwaukee Jobs program and Transitional Jobs program, which under the bill must be identical to the Transform Milwaukee Jobs program and Transitional Jobs program except that, to be eligible, an individual is not required to have an annual household income below 150 percent of the federal poverty line and, if over 25 years of age, is not required to be a parent or primary relative caregiver of a child.
Transform Milwaukee Jobs and Transitional Jobs programs
The bill modifies the qualifications for participating in the Transform Milwaukee Jobs and Transitional Jobs programs by removing the requirement that the individual has been unemployed for at least four weeks, and by specifying that anyone who is not receiving unemployment insurance benefits, regardless of their eligibility to receive those benefits, may participate.
Temporary Assistance for Needy Families
Under current law, DCF allocates specific amounts of federal moneys, including child care development funds and moneys received under the TANF block grant program, for various public assistance programs. Under the bill, TANF funding allocations are changed in the following ways, as compared to the funding allocation in the 2023–25 fiscal biennium:
1. For homeless case management services grants, total funding is doubled.
2. For the administration of public assistance programs and collection of public assistance overpayments, total funding is increased by 33 percent.
3. For emergency assistance payments, total funding is increased by 71 percent.
4. For grants to Wisconsin Trust Account Foundation, Inc., for distribution to programs that provide civil legal services to low-income families, funding is increased by 800 percent, from $500,000 per fiscal year to $4,500,000 per fiscal year.
5. For the Transform Milwaukee and Transitional Jobs programs, total funding is increased by 31 percent.
6. For the Jobs for America’s Graduates program, total funding is doubled.
7. For direct child care services, child care administration, and child care improvement programs, total funding is increased by 14 percent.
8. For the support of the dependent children of recipients of supplemental security income, funding is increased by 75 percent per fiscal year from the funding in fiscal year 2024–25.
9. For kinship care and long-term kinship care payments and kinship care administration, total funding is increased by 47 percent.
10. For grants to the Boys and Girls Clubs of America, funding is increased by 239 percent, from $2,807,000 in each fiscal year to $9,507,000 in each fiscal year.
11. For the earned income tax credit supplement, total funding is increased by 60 percent.
12. For all other programs under TANF, funding is continued with a funding change of 6 percent or less.
The bill additionally allocates $3,472,000 in fiscal year 2025–26 and $6,944,000 in fiscal year 2026–27 for a child support debt reduction program and eliminates an allocation of $500,000 per fiscal year for skills enhancement grants.
Civil legal services grants
Under current law, DCF provides funding to the Wisconsin Trust Account Foundation, Inc. (the foundation), to provide civil legal services to TANF-eligible individuals in two ways:
1. DCF provides up to $100,000 in each fiscal year in matching funds to the foundation for the provision of civil legal services to eligible individuals. This grant does not specify what types of civil legal services may be provided.
2. DCF provides a $500,000 grant in each fiscal year to the foundation to provide grants to programs, up to $75,000 each, that provide certain legal services to eligible individuals. The legal services provided through this grant are limited to legal services in civil matters related to domestic abuse or sexual abuse or to restraining orders or injunctions for individuals at risk.
The bill removes the grant that requires matching funds and increases the grant to provide certain legal services to eligible individuals to $4,500,000 per fiscal year. Under the bill, the foundation may additionally use this funding to provide to eligible individuals civil legal services related to eviction. The bill removes the $75,000 cap on grants provided by the foundation to individual programs.
Child support debt reduction
The bill creates a program administered by DCF to provide debt reduction for child support. Under the bill, if a noncustodial parent completes an eligible employment program, as determined by DCF by rule, and the custodial parent agrees to a reduction, the noncustodial parent is eligible for child support debt reduction in an amount up to $1,500. Under the bill, a parent may not qualify for the debt reduction more than once in any 12-month period.
Child care water safety grant program
The bill requires DCF to award a grant each fiscal year to Community Water Services, Inc., to help child care providers access safe drinking water.
Grants for services for homeless and runaway youth
The bill increases the limit on the amount that DCF may award in each fiscal year to support programs that provide services for homeless and runaway youth from $400,000 to $2,872,800.
Tribal family services grants and funding for out-of-home-care placements by tribal courts
Current law uses Indian gaming receipts to fund tribal family service grants and unexpected or unusually high-cost placements of Indian children by tribal courts in foster homes, group homes, or residential care centers for children and youth, in the homes of a relative other than a parent, or in a supervised independent living arrangement (out-of-home care). The bill appropriates GPR moneys for those purposes as well.
Healthy eating incentive pilot program
The bill modifies certain provisions of the healthy eating incentive pilot program. The bill defines an eligible retailer, for purposes of the program, to be a retailer authorized to participate in the federal Supplemental Nutrition Assistance Program, also known as the federal food stamp program. Under current law, DHS must select, through a competitive selection process, one or more nonprofit organizations to administer the program statewide. The bill modifies that requirement, instead requiring only that DHS select one or more third-party organizations through the competitive selection process. Current law requires DHS to seek any available federal matching moneys from the Gus Schumacher Nutrition Incentive Program to fund the program. The bill specifies that DHS must require any organization chosen to administer the program to fulfill that requirement to seek federal matching funds. Under the bill, a third-party organization chosen to administer the program may retain for administrative purposes an amount not to exceed 33 percent of the total contracted amount or the applicable cap found in federal law or guidance, whichever is lower.
Electronic benefit transfer processing program
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 state food stamp program, which is known as FoodShare. Under the bill, the vendor that processes the electronic benefit transfer and credit and debit card transactions must also process any local purchasing incentives.
Eliminating FSET drug testing requirement
2015 Wisconsin Act 55 required DHS to promulgate rules to develop and implement a drug screening, testing, and treatment policy, which DHS promulgated as 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 (FSET). FoodShare provides financial assistance to purchase food items to individuals who have limited financial resources. 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 work requirement
Current law requires DHS to require all able-bodied adults, with some limited exceptions, who seek benefits from the FoodShare program to participate in the FoodShare employment and training program, known as FSET, unless they are already employed. The bill eliminates that requirement for able-bodied adults with dependents while retaining the requirement for able-bodied adults without dependents.
Eliminating FSET 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 the FoodShare employment and training program, known as FSET. DHS must 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.
Emergency services
Emergency medical services funding assistance
Under current law, DHS must annually distribute grants for vehicles, supplies, equipment, medication, or training to certain emergency medical responder departments and certain ambulance service providers under a funding formula consisting of an identical base amount plus a supplemental amount based upon the population of the primary service area or contract area. Under the bill, the funding formula must consist of a base amount based on provider type and a supplemental amount based upon the population or other relevant factors of the primary service area or contract area. Currently, grant recipients may not expend more than 15 percent of a grant on nondurable or disposable medical supplies or equipment and medications. The bill removes the limitation for equipment.
In addition, current law requires DHS to distribute grants to emergency medical responder departments and certain ambulance service providers to pay for certain training, licensure, and certification requirements, including administration of the licensure examination for emergency medical technicians. Under the bill, the grants may be used to pay for administration of the licensure examination for any type of emergency medical services practitioner, not just emergency medical technicians.
Emergency medical services grant funding
The bill requires DHS to award grants each fiscal year to municipalities to improve or expand emergency medical services and creates an appropriation for that purpose. From the moneys appropriated each fiscal year, DHS must award 25 percent to municipalities to support the development of 24-7 paid service models in accordance with criteria developed by DHS. DHS must award the remainder using a formula consisting of a base amount, determined by DHS, for each municipality, plus a supplemental amount based on the municipality’s population.
Medical Assistance
Medicaid expansion; elimination of childless adults demonstration project
BadgerCare Plus and BadgerCare Plus Core are programs under the state’s Medical Assistance program, which provides health services to individuals who have limited financial resources. The federal Patient Protection and Affordable Care Act allows a state to receive an enhanced federal medical assistance percentage payment for providing benefits to certain individuals through a state’s Medical Assistance program. The bill changes the family income eligibility level to up to 133 percent of the federal poverty line for parents and caretaker relatives under BadgerCare Plus and for childless adults currently covered under BadgerCare Plus Core and for those who are incorporated into BadgerCare Plus in the bill. The bill requires DHS to comply with all federal requirements and to request any amendment to the state Medical Assistance plan, waiver of Medicaid law, or other federal approval necessary to qualify for the highest available enhanced federal medical assistance percentage for childless adults under the BadgerCare Plus program.
Under current law, certain parents and caretaker relatives with incomes of not more than 100 percent of the federal poverty line, before a 5 percent income disregard is applied, are eligible for BadgerCare Plus benefits. Under current law, childless adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent of the federal poverty line, before a 5 percent income disregard is applied; and 3) are not otherwise eligible for Medical Assistance, including BadgerCare Plus, are eligible for benefits under BadgerCare Plus Core. The bill eliminates the childless adults demonstration project, known as BadgerCare Plus Core, as a separate program on July 1, 2025.
Current law, as created by 2017 Wisconsin Act 370, requires that DHS implement the BadgerCare Reform waiver as it relates to childless adults as approved by the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) effective October 31, 2018. The 2015–17 and 2017–19 biennial budget acts required DHS to submit a waiver request to the federal Department of Health and Human Services authorizing DHS to take certain actions, including imposing premiums on, requiring a health risk assessment of, and limiting the time of eligibility for recipients of BadgerCare Plus under the childless adults demonstration project waiver. Act 370 required DHS to implement the childless adults BadgerCare Reform waiver by no later than November 1, 2019. If JCF determines that DHS has not complied with the implementation deadline, has not made sufficient progress in implementing the BadgerCare Reform waiver, or has not complied with other requirements relating to approved waiver implementation, Act 370 allows JCF to reduce from moneys allocated for state operations or administrative functions DHS’s appropriation or expenditure authority, whichever is applicable, or change the authorized level of full-time equivalent positions for DHS related to the Medical Assistance program. In April 2021, CMS withdrew approval of the community engagement requirements that had previously been approved in the October 31, 2018, BadgerCare Reform waiver. The 2018 waiver was set to expire December 31, 2023, but CMS approved a temporary extension to December 31, 2024. As part of the approval of that extension, CMS removed authority for certain elements of the demonstration project, including disenrollment lockout periods, monthly premiums, health behavior assessments, health risk assessments, and the requirement for beneficiaries to answer questions about substance use treatment needs in order to remain eligible. On October 29, 2024, CMS approved DHS’s request for an extension of the BadgerCare Reform waiver through December 31, 2029, subject to the same limitations set forth in the 2023 temporary extension. 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.
Postpartum Medical Assistance coverage
The bill requires DHS to seek approval from the federal Department of Health and Human Services to extend until the last day of the month in which the 365th day after the last day of the pregnancy falls Medical Assistance benefits to women who are eligible for those benefits when pregnant. Currently, postpartum women are eligible for Medical Assistance benefits until the last day of the month in which the 60th day after the last day of the pregnancy falls. 2021 Wisconsin Act 58 required DHS to seek approval from the federal Department of Health and Human Services to extend these postpartum Medical Assistance benefits until the last day of the month in which the 90th day after the last day of the pregnancy falls. On June 3, 2022, DHS filed a Section 1115 Demonstration Waiver application with the federal Centers for Medicare & Medicaid Services to extend postpartum coverage for eligible Medical Assistance recipients, as required by 2021 Wisconsin Act 58. Determination of eligibility for Medical Assistance 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 must, 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 Medical Assistance 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 federal Patient Protection and Affordable Care Act. The bill specifies that DHS may not use any information provided to determine that the individual is ineligible to enroll in the Medical Assistance program.
Medical Assistance waiver for health-related social needs
The bill directs DHS to request a waiver from the federal Department of Health and Human Services to provide reimbursement for services for health-related social needs under the Medical Assistance program. Under the bill, DHS must provide reimbursement for those services if the waiver is granted.
Payment for school medical services
Under current law, if a school district or a cooperative educational service agency elects to provide school medical services and meets certain requirements, DHS is required to reimburse the school district or cooperative educational service agency 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, cooperative educational service agencies, 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, cooperative educational service agency, 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, cooperative educational service agency, 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.
Certified peer specialist services
The bill requires DHS to provide as a benefit and reimburse services provided by certified peer specialists under the Medical Assistance 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 Medical Assistance program a certified peer specialist service that meets all of the following criteria: the recipient of the certified peer specialist service is in treatment for or recovery from mental illness or a substance use disorder; 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 the certified peer specialist completes the training requirements specified by DHS.
Medical Assistance coverage of doula services
The bill requires DHS to request any necessary waiver or amendment to the state Medical Assistance plan to allow Medical Assistance reimbursement for doula services and, if any necessary waiver or amendment is approved, directs DHS to reimburse certified doulas for doula services provided to Medical Assistance recipients. Doula services consist of childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.
Medical Assistance coverage for incarcerated individuals
The bill authorizes DHS to submit a request to the secretary of the federal Department of Health and Human Services for a waiver of federal Medicaid law to conduct a demonstration project allowing prerelease coverage to incarcerated individuals for certain services under the Medical Assistance program for up to 90 days before release if the individual is otherwise eligible for coverage under the Medical Assistance program. The bill provides that if the waiver is approved, DHS may provide reimbursement under the Medical Assistance program for both the federal and nonfederal share of services, including case management services, provided to incarcerated individuals under the waiver.
Medical assistance coverage of nonsurgical treatment for TMJ disorder
Under current law, the Medical Assistance program provides coverage for certain dental services. Under the bill, this coverage includes nonsurgical treatment of temporomandibular joint disorder, commonly known as “TMJ disorder.”
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
