April 8, 2025 - Introduced by Representatives Penterman, Brooks, Duchow, Allen, Tucker, Kreibich, Knodl and Murphy, cosponsored by Senators Stafsholt, Nass and Kapenga. Referred to Committee on Public Benefit Reform.
AB163,1,4
1An Act to renumber and amend 49.823; to create 49.45 (2) (a) 3m., 49.471 2(4d), (4j) and (4p) and 49.823 (2) of the statutes; relating to: redeterminations
3of eligibility for the Medical Assistance program and database confirmation
4for public assistance program eligibility. Analysis by the Legislative Reference Bureau
This bill makes various changes to eligibility determinations for the Medical Assistance program. Currently, the Department of Health Services administers the Medical Assistance program, a joint federal and state program that provides health services to individuals who have limited financial resources.
The bill prohibits DHS from automatically renewing the eligibility of a recipient under the Medical Assistance program. DHS must determine an individual’s eligibility every six months under the bill. DHS is also prohibited from using prepopulated forms or otherwise supplying information, except for name and address, to a recipient under the Medical Assistance program that has been supplied to DHS. Additionally, any recipient under the Medical Assistance program that fails to report to DHS or its designee any change that may affect eligibility within 10 days following such a change is ineligible for benefits for six months from the date DHS discovers the failure to report the change. Under current law, knowingly concealing or failing to disclose any event that an individual knows affects the initial or continued right to a Medical Assistance benefit is subject to a forfeiture of not less than $100 nor more than $15,000 for each concealment or failure. If DHS determines that it is necessary to obtain permission from the federal Department of Health and Human Services to implement any portion of the bill with respect to the Medical Assistance program, the bill requires DHS to request any state plan amendment, waiver of federal law, or other federal approval necessary to implement that portion of the bill.
The bill requires DHS to enter into data-sharing agreements with any agency that maintains a database of financial or personal information about residents of this state. DHS must confirm the information of an applicant for a public assistance program against the information contained in those databases. The bill also requires DHS to share data for the purpose of confirming eligibility for public assistance programs. Current law requires DHS and the Department of Children and Families to compare each department’s respective databases against the databases of death records to identify deceased participants.
The bill directs DHS to complete a redetermination of eligibility for all recipients of Medical Assistance and immediately remove from Medical Assistance any recipient who is ineligible before January 1, 2026. For all such individuals removed from the Medical Assistance program, the bill directs DHS to inform them of the availability of coverage under a qualified health plan that is offered through an American health benefit exchange and that they may be eligible for premium assistance.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
AB163,1
1Section 1. 49.45 (2) (a) 3m. of the statutes is created to read: AB163,2,4249.45 (2) (a) 3m. Remove immediately from eligibility for the Medical 3Assistance program under sub. (23) or s. 49.471 any individual who has been 4determined to be ineligible. AB163,25Section 2. 49.471 (4d), (4j) and (4p) of the statutes are created to read: AB163,3,6649.471 (4d) Redetermination of eligibility. The department may not 7automatically renew the eligibility of a recipient of Medical Assistance benefits 8under this section or s. 49.45 (23). The department shall redetermine eligibility for
1the Medical Assistance program under this section or s. 49.45 (23) for each 2individual every 6 months. In collecting information from a recipient of Medical 3Assistance benefits or an applicant, the department may not use any form that is 4prepopulated with, or otherwise provide to the recipient or applicant, information 5that has been supplied to the department except for the recipient’s or applicant’s 6name and address. AB163,3,127(4j) Failure to report. Any recipient of Medical Assistance benefits under 8this section or s. 49.45 (23) who fails to report to the department or an entity 9designated by the department any change that may affect the recipient’s eligibility 10for benefits within 10 days following such a change shall be ineligible for benefits 11under this section or s. 49.45 (23) for 6 months following the date that the 12department discovers the failure to report the change. AB163,3,1913(4p) Federal approval. If the department determines that it is necessary to 14obtain permission from the federal department of health and human services to 15implement sub. (4d) or (4j), the department shall request any state plan 16amendment, waiver of federal law, or other federal approval necessary to implement 17subs. (4d) and (4j). If federal approval is necessary under this subsection but not 18obtained, the department is not required to implement any portion of sub. (4d) or 19(4j) for which federal approval is not obtained. AB163,320Section 3. 49.823 of the statutes is renumbered 49.823 (1) and amended to 21read: AB163,4,82249.823 (1) The department of health services and the department of children 23and families shall, at least once every 3 months month, perform a comparison of 24each department’s respective public benefit database information against
1nationally recognized databases that contain information on death records, 2including the federal social security administration’s Death Master File, to identify 3participants in public benefit programs that are deceased. If a department 4determines during a review under this section subsection that a participant is 5deceased, the department shall designate that individual as ineligible for benefits 6in any applicable database. The requirements under this section subsection do not 7apply to the department of children and families with regard to child care subsidies 8under s. 49.155. AB163,49Section 4. 49.823 (2) of the statutes is created to read: AB163,4,211049.823 (2) The department of health services shall enter into a data-sharing 11agreement with the department of children and families, the department of 12workforce development, and any other agency that maintains a database of 13financial or personal information about residents of this state. The department of 14health services, through the data-sharing agreement, shall confirm the information 15submitted by an applicant for a public assistance program with the information 16contained in other databases held by other agencies, including all available prison 17records, death records, wage and employment records, lottery and gaming 18winnings, and out-of-state benefits received under the federal food stamp program 19under 7 USC 2011 to 2036. The department of health services shall share data 20with other agencies for the purposes of confirming eligibility for public assistance 21programs. AB163,522Section 5. Nonstatutory provisions. AB163,4,2323(1) Medical Assistance eligibility redeterminations. AB163,5,2
1(a) In this subsection, “Medical Assistance” means the program under subch. 2IV of ch. 49. AB163,5,83(b) Beginning on the day after the effective date of this paragraph, the 4department of health services shall redetermine the eligibility of all recipients of 5Medical Assistance and immediately remove from Medical Assistance any recipient 6who is ineligible. The department of health services shall complete 7redeterminations of eligibility for all recipients of Medical Assistance before 8January 1, 2026. AB163,5,139(c) The department of health services shall inform any individual who is 10removed from Medical Assistance under par. (b) of the availability of coverage 11under a qualified health plan, as defined in 42 USC 18021 (a), that is offered 12through an American health benefit exchange, as described in 42 USC 18031, and 13that the individual may be eligible for premium assistance under 26 USC 36B.
