Chapter DHS 250

Chapter DHS 250

TRIBAL MEDICAL RELIEF PROGRAMS

DHS 250.01   Authority and purpose.

DHS 250.02   Applicability.

DHS 250.03   Definitions.

DHS 250.04   Application for relief block grant.

DHS 250.05   Procedures for eligibility determination.

DHS 250.06   Standards for waiver of certain eligibility requirements.

DHS 250.07   Procedures for permitting appeal of eligibility determinations.

DHS 250.08   Distribution of funds to eligible tribal governing bodies.

Ch. DHS 250 Note Note: Chapter HSS 211 was repealed and recreated as an emergency rule effective January 1, 1996; Chapter HSS 211 as it existed on May 31, 1996 was repealed and a new chapter HSS 211 was created effective June 1, 1996. Chapter HSS 211 was renumbered chapter HFS 250 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register January 2003 No. 565. Chapter HFS 250 was renumbered chapter DHS 250 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 250.01 DHS 250.01 Authority and purpose. This chapter is adopted under the authority of ss. 49.02 (7m) and 49.029 (2), Stats., to provide procedures for a tribal governing body to follow to obtain a tribal relief block grant, procedures for a tribal governing body to follow in making eligibility determinations under s. 49.015, Stats., standards for waiver of an eligibility requirement under s. 49.015 (3) (b), Stats., and procedures for appealing eligibility determinations, and to provide a basis for distributing block grant funds under s. 20.435 (4) (kb), Stats., to eligible tribal governing bodies.

DHS 250.01 History History: Cr. Register, May, 1996, No. 485, eff. 6-1-96.

DHS 250.02 DHS 250.02 Applicability. This chapter applies to tribal governing bodies that choose to have a tribal relief block grant program under subch. II of ch. 49, Stats., and therefore are required to determine eligibility for relief and to implement an appeal procedure for individuals who are denied relief or whose relief benefit is reduced, suspended or terminated.

DHS 250.02 History History: Cr. Register, May, 1996, No. 485, eff. 6-1-96.

DHS 250.03 DHS 250.03 Definitions. In this chapter:

DHS 250.03(2) (2) “American Indian” means a person who is recognized by a tribal governing body in this state as a member of a federally recognized Wisconsin tribe or band of Indians.

DHS 250.03(3) (3) “Department” means the Wisconsin department of health services.

DHS 250.03(4) (4) “Dependent person” means an American Indian residing on tax-free land who is eligible for relief under s. 49.015, Stats.

DHS 250.03(5) (5) “Health care services” means emergency and non-emergency medical, surgical, dental, hospital, nursing and optometric services that are reasonable and necessary under the circumstances, as determined by the tribal governing body. “Health care services” does not include services described under s. 51.42 (3) (ar) 4., Stats.

DHS 250.03(6) (6) “Medical assistance” means the assistance program under ss. 49.43 to 49.475 and 49.49 to 49.497, Stats., and chs. DHS 101 to 108.

DHS 250.03(7) (7) “Medical assistance divestment” means the disposal of an asset for less than its fair market value with the consequence that the individual who does this is ineligible for medical assistance under the provisions of s. 49.453, Stats., and s. DHS 103.065.

DHS 250.03(8) (8) “Relief” means health care services provided to a dependent person and funded by a relief block grant.

DHS 250.03(9) (9) “Relief agency” means a tribal governing body or an agency under contract with the governing body to administer relief.

DHS 250.03(10) (10) “Relief block grant” means a block grant awarded to a tribal governing body under s. 49.029, Stats.

DHS 250.03(11) (11) “Relief of needy Indian persons program” means the assistance program under s. 49.046, 1995 Stats., which was operated by tribal governing bodies or counties until January, 1996, when s. 49.046, Stats., was repealed.

DHS 250.03(12) (12) “SSI” means supplemental security income, the assistance program under section 1613 of title XVI of the Social Security Act of 1935, as amended, and s. 49.77, Stats.

DHS 250.03(13) (13) “Tax-free land” means land in this state within the boundaries of a federally recognized reservation or within the bureau of Indian affairs service area for the Ho-Chunk Nation, which is not subject to assessment or levy of a real property tax either as a general tax or as a payment in lieu of taxes.

DHS 250.03(14) (14) “Tribal governing body” means an elected tribal governing body of a federally recognized American Indian tribe.

DHS 250.03(15) (15) “Wisconsin Works” means the assistance program under ss. 49.141 to 49.161, Stats.

DHS 250.03 History History: Cr. Register, May, 1996, No. 485, eff. 6-1-96; corrections in (6) and (7) made under s. 13.93 (2m) (b) 7., Stats., Register, February, 2001, No. 542, eff. 3-1-01; corrections in (3), (6) and (7) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 637; CR 20-039: r. (1), cr. (15) Register October 2021 No. 790, eff. 11-1-21.

DHS 250.04 DHS 250.04 Application for relief block grant.

DHS 250.04(1) (1) Resolution.

DHS 250.04(1)(a) (a) If a tribal governing body chooses to have a relief block grant program, the tribal governing body shall adopt a resolution to apply for a relief block grant and provide a copy of the resolution to the department.

DHS 250.04(1)(b) (b) If a tribal governing body at any time elects to no longer provide a relief block grant program, the tribal governing body or its designee shall inform the department in writing at least 10 days prior to termination of the program.

DHS 250.04(2) (2) Criteria. The tribal governing body shall establish written criteria for determining dependency, and review these written criteria at least annually for appropriateness.

DHS 250.04(3) (3) Plan. The tribal governing body shall submit to the department for approval a medical relief block grant plan for the provision of health care services to be funded by the tribal relief block grant as specified under s. 49.02 (1) (c), Stats.

DHS 250.04(4) (4) Relief agency. The tribal governing body shall establish or designate a relief agency to administer the tribal medical relief block grant.

DHS 250.04 History History: Cr. Register, May, 1996, No. 485, eff. 6-1-96.

DHS 250.05 DHS 250.05 Procedures for eligibility determination. A tribal relief agency shall do all of the following related to determining eligibility for relief:

DHS 250.05(1) (1) Define and report to the department procedures for verification of eligibility. These shall be sufficient to substantiate the fundamental information upon which a determination of eligibility is based.

DHS 250.05(2) (2) Implement written policies developed by the tribal governing body that define the amounts of income, assets and income and asset disregards allowed for use in determining eligibility. A tribal relief agency, in determining eligibility, shall disregard the following resources:

DHS 250.05(2)(a) (a) Low-income energy assistance benefits authorized under 42 USC 8621 to 8629.

DHS 250.05(2)(b) (b) Food stamp benefits authorized under 7 USC 2011 to 2029.

DHS 250.05(2)(c) (c) Any other resources prohibited by law from being considered.

DHS 250.05(3) (3) Comply with the requirements of s. 49.015, Stats., in determining an individual’s eligibility for relief.

DHS 250.05 History History: Cr. Register, May, 1996, No. 485, eff. 6-1-96.

DHS 250.06 DHS 250.06 Standards for waiver of certain eligibility requirements.

DHS 250.06(1) (1) A tribal relief agency may waive the eligibility requirement under s. 49.015 (2) or (2m), Stats., in accordance with its tribal medical relief block grant plan, as follows:

DHS 250.06(1)(a) (a) Waiver of the prohibition against receiving Wisconsin Works or SSI may be granted in cases of unusual misfortune or hardship as determined by the tribal governing body.

DHS 250.06(1)(b) (b) Waiver of the medical assistance divestment barrier to eligibility may be granted only if all attempts at recovery of the divested property have been made and no other resources or assistance is available to the person and unusual misfortune or hardship exists as determined by the tribal governing body.

DHS 250.06(2) (2) A tribal governing body shall report all waivers to the department in the manner prescribed by the department. The department may make a determination as to the appropriateness of the wavier and submit its determination to the tribal governing body regarding the relief provided as a result of a waiver that the department determines is inappropriate.

DHS 250.06 History History: Cr. Register, May, 1996, No. 485, eff. 6-1-96; CR 20-039: am. (1) (a) Register October 2021 No. 790, eff. 1-1-21.

DHS 250.07 DHS 250.07 Procedures for permitting appeal of eligibility determinations.

DHS 250.07(1) (1) Notice. If a tribal relief agency denies an application for relief, or reduces, suspends or terminates the relief, the tribal relief agency shall provide adequate written notice to the affected individual. The notice shall contain all of the following:

DHS 250.07(1)(a) (a) The effective date of the action.

DHS 250.07(1)(b) (b) The reason for the action.