Liability of relatives; enforcement.
Assistance grants exempt from levy.
In this chapter:
"Child care provider" means a child care provider that is licensed under s. 48.65 (1)
, certified under s. 48.651
or established or contracted for under s. 120.13 (14)
"Essential person" means any person defined as an essential person under federal Title XVI.
"Federal Title XVI" means Title XVI of the federal social security act.
"Municipality" means any town, city or village.
"Poverty line" means the poverty line as defined and revised annually under 42 USC 9902
"Prisoner" means any person who is either arrested, incarcerated, imprisoned or otherwise detained in excess of 12 hours by any law enforcement agency of this state, except when detention is pursuant to s. 51.15
, 51.45 (11) (b)
or 55.06 (11) (a)
or ch. 980
. "Prisoner" does not include any person who is serving a sentence of detention under s. 973.03 (4)
unless the person is in the county jail under s. 973.03 (4) (c)
"Residence" means the voluntary concurrence of physical presence with intent to remain in a place of fixed habitation. Physical presence is prima facie evidence of intent to remain.
"Voluntary" means according to a person's free choice, if competent, or by choice of a guardian if incompetent.
"Wisconsin works agency" means a person under contract under s. 49.143
to administer Wisconsin works under ss. 49.141
. If no contract is awarded under s. 49.143
, "Wisconsin works agency" means the department of workforce development.
RELIEF BLOCK GRANTS
It is the declared legislative policy that a county receiving a relief block grant is the payer of last resort in all cases, except those cases involving crime victim awards under s. 949.06
, where a benefit is covered by relief funded by a relief block grant in a county and where a dispute may arise over payment for costs associated with providing health care services to recipients of relief funded by a relief block grant.
As used in this subchapter:
"American Indian" means a person who is recognized by an elected tribal governing body in this state as a member of a federally recognized Wisconsin tribe or band of Indians.
"Department" means the department of health and family services.
"Dependent person" means an individual who is eligible for relief under s. 49.015
"Health care services" means such emergency and nonemergency medical, surgical, dental, hospital, nursing and optometric services as are reasonable and necessary under the circumstances, as determined by the county or tribal governing body. "Health care services" does not include services described under s. 51.42 (3) (ar) 4.
"Relief" means assistance that is provided to a dependent person and funded by a relief block grant.
"Relief agency" means the following if a county or tribal governing body operates a relief program funded by a relief block grant:
A county department under s. 46.215
or an agency under contract with a county department to administer relief.
A tribal governing body or an agency under contract with the governing body to administer relief.
"Secretary" means the secretary of health and family services.
"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 Winnebago tribe, 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.
"Tribal governing body" means an elected tribal governing body of a federally recognized American Indian tribe.
Relief eligibility. 49.015(1)(1)
General eligibility requirements.
Except as provided in subs. (1m)
, an individual is eligible for relief if the individual meets all of the following conditions:
Except as provided in sub. (3) (a)
, the individual resides in a county, or on tax-free land, in which the county or tribal governing body operates a program funded by a relief block grant.
The individual authorizes any program or resource for which he or she is determined to be eligible to reimburse the relief agency for health care services provided to the individual if the program or resource permits reimbursement for the services provided.
The individual qualifies under written criteria of dependency under s. 49.02 (1) (b)
established by the relief agency in that county or on that tax-free land.
In this subsection, "close relative" means the person's parent, grandparent, brother, sister, spouse or child.
No individual is eligible for relief unless the individual has resided in this state for at least 60 consecutive days before applying for relief. This requirement does not apply if the individual resides in this state and meets any of the following conditions:
The individual has, in the past, resided in this state for at least 365 consecutive days.
The individual came to this state to join a close relative who has resided in this state for at least 180 days before the arrival of the individual.
The individual came to this state to accept a bona fide offer of employment and the individual was eligible to accept the employment.
(2) Recipients of other aid.
Except as provided in sub. (3)
, an individual is not eligible for relief for a month in which the individual has received aid to families with dependent children under s. 49.19
or supplemental security income under 42 USC 1381
or has participated in a Wisconsin works employment position under s. 49.147 (3)
or in which aid to families with dependent children, supplemental security income benefits or a Wisconsin works employment position is immediately available to the individual.
(2m) Ineligibility due to medical assistance divestment.
Any person found ineligible for medical assistance because of the divestment provisions under s. 49.453
is ineligible for relief funded by a relief block grant for the same period during which ineligibility exists under s. 49.453
(3) Waiver of certain eligibility requirements. 49.015(3)(a)(a)
A relief agency may waive the requirement under sub. (1) (a)
for an individual receiving health care services from a trauma center that meets the criteria established by the American College of Surgeons for classification as a Level I trauma center. If the county waives the requirement under sub. (1) (a)
for an individual, the county may seek reimbursement from the individual's county of residence if that county operates a program funded by a relief block grant.
A relief agency may waive the requirement under sub. (2)
in case of unusual misfortune or hardship. Each waiver shall be reported to the department. The department may make a determination as to the appropriateness of the waiver under rules promulgated by the department under s. 49.02 (7m) (d)
States may deny benefits to those who fail to prove they did not quit job in order to obtain benefits. Lavine v. Milne, 424 US 577.
Constitutional law: residency requirements. 53 MLR 439.
Relief block grant administration. 49.02(1)
Eligibility for relief block grants.
A county or tribal governing body is eligible to receive a relief block grant if all of the following conditions are met:
The county board or tribal governing body adopts a resolution applying for a relief block grant.
The county or tribal governing body establishes written criteria to be used to determine dependency and reviews these written criteria at least annually.
The county or tribal governing body submits to the department a plan for the provision of services to be funded by the relief block grant. The plan shall include all of the following:
How the county or tribal governing body will determine eligibility and how these eligibility determinations may be appealed. The procedures for determining eligibility and for notice, fair hearing and review shall be consistent with rules promulgated by the department under sub. (7m)
How the county or tribal governing body will determine which health care services are needed by a dependent person.
The cost containment mechanisms that will be used, including what limitations will be placed on the inappropriate use of emergency room care and what limitations will be placed on payments to providers contracted for under sub. (2)
In the case of a county submitting a plan for a relief block grant under s. 49.027
, whether the county will provide services other than health care services and, if such services are offered, how the county will determine what services will be provided to a dependent person.
The department has approved the plan under par. (c)
. The department shall approve or disapprove the plan within a reasonable period of time after the plan is submitted.
(1e) Relief agencies.
If a county or tribal governing agency is eligible to receive a relief block grant, the county or tribal governing body shall establish or designate a relief agency to administer relief under this section.
(2) Contracting with private health care providers.
A relief agency may use a relief block grant to provide health care services directly or, if the conditions in this subsection are met, by contracting with private health care providers, or by a combination of contracting with private health care providers and providing services directly. A relief agency may contract with a private health care provider to provide health care services under this subsection only if all of the following conditions are met:
The relief agency enters into a contract with the private health care provider to provide specified health care services.
The contract between the relief agency and the private health care provider provides that all records of the health care provider relating to the administration and provision of the health care services shall be open to inspection at all reasonable hours by authorized representatives of the county and the department.
The contract between the relief agency and the private health care provider provides that any payments under s. 49.45 (6y)
made to the health care provider shall be used to offset the liability of the relief agency for the costs of the health care services provided under the contract.
The contract limits payment for services under the contract to the amount payable by medical assistance for care for which a medical assistance rate exists.
The contract does not provide for payment for hospitalization or care provided as uncompensated services required under 42 USC 291c
The contract prohibits the health care provider from holding an individual recipient of health care services funded under this section liable for the difference between the costs of the health care services and the amount paid to the health care provider by the county for the services.
(5) Liability for health care services. 49.02(5)(b)(b)
A relief agency is not liable for health care services provided to a dependent person if the hospital provides the health care services to the person as uncompensated services required under 42 USC 291c
A relief agency shall limit its liability for health care services funded by a relief block grant to the amount payable by medical assistance under subch. IV
for care for which a medical assistance rate exists.
(6g) Liability of recipients.
No individual who receives health care services funded by a relief block grant may be liable for the difference between the costs of the services charged by the health care provider and the amount paid by the relief agency.
(7) Notification requirement.
Whenever the department or a relief agency has reason to believe that a person receiving relief is engaging in conduct or behavior prohibited in ch. 944
or ss. 940.225
the department or relief agency shall promptly notify the law enforcement officials of the county thereof, including facts relating to such person's alleged misconduct or illegal behavior.
The department shall promulgate rules regarding use of relief block grants. The rules shall include all of the following:
Procedures that relief agencies shall follow in making eligibility determinations.
Procedures for appealing eligibility determinations under s. 49.015
. These procedures shall provide for notice, fair hearing and review.
Procedures that relief agencies shall follow to obtain relief block grants under sub. (1)
(11) Department of transportation records.
A relief agency may use vehicle registration information from the department of transportation in determining eligibility for relief.
Relief block grants to counties with a population of 500,000 or more; medical relief.