May 18, 2004 - Introduced by Committee on Assembly Organization. Referred to
Joint Committee on Finance.
AB996,1,8 1An Act to repeal 20.435 (4) (hm), 25.77 (5), 46.40 (9) (d), 49.45 (6t) (b), 49.45 (6tt),
249.45 (6tu), 49.45 (52), 49.45 (53) and 59.53 (24); to renumber 49.45 (6t) (a);
3to amend 20.435 (4) (w), 20.435 (4) (w), 20.435 (4) (w), 20.435 (7) (b), 20.435 (7)
4(b), 46.275 (5) (a), 46.275 (5) (c), 46.495 (1) (d) and 46.495 (1) (d); to create 46.40
5(9) (d), 49.45 (6tu), 49.45 (52) and 49.45 (53) of the statutes; and to affect 2003
6Wisconsin Act 33
, section 9124 (8); relating to: Medical Assistance Program
7and Community Aids Program funding and programs and making
8appropriations.
Analysis by the Legislative Reference Bureau
Under current law, Medical Assistance (MA) is a joint federal-state program
administered by the Department of Health and Family Services (DHFS), under
which persons with low income and few assets are provided health care services. The
health care service providers are reimbursed for their services by a combination of
state general purpose revenues, state segregated revenue from the MA trust fund,
and federal Medicaid matching moneys.
Currently, under the Community Aids Program, DHFS distributes to county
departments of social services, human services, community programs, and
developmental disabilities services moneys for community social, mental health,

developmental disabilities, and alcohol and other drug abuse services, and other
services, including child abuse and neglect and unborn child abuse services and
Alzheimer's family and caregiver support services. Moneys for the Community Aids
Program are provided from, among other sources, state general purpose revenues,
county revenues, and federal moneys under the federal social services block grant,
converted Temporary Assistance for Needy Families block grant moneys, and
moneys under Title IV-B of the federal Social Security Act.
Under current law under 2003 Wisconsin Act 33 (the biennial budget act), an
appropriation account of program revenue was created to provide supplemental MA
program benefits for numerous services and to receive moneys that, upon demand
by DHFS, were required, under the biennial budget act, to be paid by counties
through intergovernmental transfers to obtain federal Medicaid matching moneys.
Also under current law under the biennial budget act, the community services
deficit reduction benefit (CSDRB), under which counties and local health
departments can claim federal Medicaid matching funds to cover costs for MA
services provided that are not fully reimbursed, was made inapplicable if increased
federal Medicaid matching funds through the use of intergovernmental transfers
were approved before July 1, 2005. Any county or local health department that
received a CSDRB distribution after 2002 would be required to return the
distribution to DHFS. However, moneys from the MA trust fund were required to
provide payments to county departments and local health departments to hold them
harmless from the elimination of the CSDRB.
This bill authorizes DHFS, beginning on January 1, 2003, to make, from the
general purpose revenue appropriation account for the Community Aids Program,
MA payment adjustments to county departments of social services, human services,
community programs, or developmental disabilities services or to local health
departments for MA services. The MA services for which this funding is provided
include early and periodic screening and diagnosis; home health services; services
and supplies for family planning; physical and occupational therapy; speech,
hearing, and language disorder services; medical day treatment services; certain
mental health and alcohol and other drug abuse services; certain nursing services;
personal care services; respiratory care services; care coordination for high-risk
pregnancies; prenatal, postpartum, and young child care coordination; lead
poisoning and lead exposure services; mental health crisis intervention services; and
certain case management services. The bill also authorizes payment under the
Community Aids appropriation account, until January 1, 2006, of MA payments to
providers of personal care, home health, and respiratory care services. The bill
decreases the Community Aids Program general purpose revenues appropriation for
fiscal year 2004-05, and increases the MA general purpose revenues appropriation
by a like amount for the same fiscal year. The bill also requires DHFS to submit
program and financial information to the Department of Administration and the
Legislative Fiscal Bureau for the 2005-07 biennial budget bill as if the increase and
decrease had not been made.
The bill eliminates the appropriation account of program revenue created
under the biennial budget act to supplement MA program benefits, eliminates the

requirements for counties, upon demand by DHFS, to make payments to DHFS for
inclusion in that appropriation account, and eliminates the designation of moneys
transferred from that appropriation account to the MA trust fund.
The bill eliminates the allocation of moneys from the MA trust fund to hold
county departments and local health departments harmless for the loss of moneys
under the elimination of the CSDRB and reduces the MA trust fund by $17,000,000
for fiscal year 2004-05. However, the bill permits DHFS to make payments from the
Community Aids general purpose revenue appropriation account in fiscal year
2004-05 to city health departments that had been receiving CSDRB payments. As
of January 1, 2006, the bill also eliminates provisions that would have made the
CSDRB inapplicable if increased federal Medicaid matching funds through the use
of intergovernmental transfers had been approved, and restores the CSDRB. To
ensure that county departments and local health departments are held harmless
from any payment gap that would exist in 2006, the bill recreates, for that year only,
authority to expend moneys from the MA trust fund to provide payment for that
purpose.
Lastly, the act is void on the earlier of July 1, 2005, if an amendment to the state
MA plan that provides for MA payment adjustments to be made from the Community
Aids Program to county departments of social services, human services, community
programs, or developmental disabilities services or to local health departments is not
approved in writing by the federal Centers for Medicare and Medicaid Services by
that date, or any date on which the amendment is disapproved, and the secretary of
administration must notify the revisor of statutes of the lack of approval or
disapproval.
For further information see the state and local 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:
AB996, s. 1 1Section 1. 20.435 (4) (hm) of the statutes, as created by 2003 Wisconsin Act
233
, is repealed.
AB996, s. 2 3Section 2. 20.435 (4) (w) of the statutes, as affected by 2003 Wisconsin Act 33,
4is amended to read:
AB996,4,25 20.435 (4) (w) Medical Assistance trust fund. From the Medical Assistance
6trust fund, biennially, the amounts in the schedule for meeting costs of medical
7assistance administered under ss. 46.27, 46.275 (5), 46.278 (6), 46.283 (5), 46.284 (5),
849.45, and 49.472 (6), for providing distributions under s. 49.45 (6tt), and for

1administrative costs associated with augmenting the amount of federal moneys
2received under 42 CFR 433.51.
AB996, s. 3 3Section 3 . 20.435 (4) (w) of the statutes, as affected by 2003 Wisconsin Act ....
4(this act), section 2, is amended to read:
AB996,4,105 20.435 (4) (w) Medical Assistance trust fund. From the Medical Assistance
6trust fund, biennially, the amounts in the schedule for meeting costs of medical
7assistance administered under ss. 46.27, 46.275 (5), 46.278 (6), 46.283 (5), 46.284 (5),
849.45, and 49.472 (6), for providing distributions under s. 49.45 (6tu), and for
9administrative costs associated with augmenting the amount of federal moneys
10received under 42 CFR 433.51.
AB996, s. 4 11Section 4 . 20.435 (4) (w) of the statutes, as affected by 2003 Wisconsin Act ...
12(this act), section 3, is amended to read:
AB996,4,1813 20.435 (4) (w) Medical Assistance trust fund. From the Medical Assistance
14trust fund, biennially, the amounts in the schedule for meeting costs of medical
15assistance administered under ss. 46.27, 46.275 (5), 46.278 (6), 46.283 (5), 46.284 (5),
1649.45, and 49.472 (6), for providing distributions under s. 49.45 (6tu), and for
17administrative costs associated with augmenting the amount of federal moneys
18received under 42 CFR 433.51.
AB996, s. 5 19Section 5. 20.435 (7) (b) of the statutes is amended to read:
AB996,5,1520 20.435 (7) (b) Community aids and Medical Assistance payments. The
21amounts in the schedule for human services under s. 46.40, to fund services provided
22by resource centers under s. 46.283 (5), for services under the family care benefit
23under s. 46.284 (5), for reimbursement to counties having a population of less than
24500,000 for the cost of court attached intake services under s. 48.06 (4), for shelter
25care under ss. 48.58 and 938.22 and, for foster care and treatment foster care under

1s. 49.19 (10), for Medical Assistance payment adjustments under s. 49.45 (52), for
2Medical Assistance payments under s. 49.45 (53), and for payments under
Section
325 (3 )
. Social services disbursements under s. 46.03 (20) (b) may be made from this
4appropriation. Refunds received relating to payments made under s. 46.03 (20) (b)
5for the provision of services for which moneys are appropriated under this paragraph
6shall be returned to this appropriation. Notwithstanding ss. 20.001 (3) (a) and
720.002 (1), the department of health and family services may transfer funds between
8fiscal years under this paragraph. The department shall deposit into this
9appropriation funds it recovers under ss. 46.495 (2) (b) and 51.423 (15) from prior
10year audit adjustments including those resulting from audits of services under s.
1146.26, 1993 stats., or s. 46.27. Except for amounts authorized to be carried forward
12under s. 46.45, all funds recovered under ss. 46.495 (2) (b) and 51.423 (15) and all
13funds allocated under s. 46.40 and not spent or encumbered by December 31 of each
14year shall lapse to the general fund on the succeeding January 1 unless carried
15forward to the next calendar year by the joint committee on finance.
AB996, s. 6 16Section 6 . 20.435 (7) (b) of the statutes, as affected by 2003 Wisconsin Act ....
17(this act), is amended to read:
AB996,6,1318 20.435 (7) (b) Community aids and Medical Assistance payments. The
19amounts in the schedule for human services under s. 46.40, to fund services provided
20by resource centers under s. 46.283 (5), for services under the family care benefit
21under s. 46.284 (5), for reimbursement to counties having a population of less than
22500,000 for the cost of court attached intake services under s. 48.06 (4), for shelter
23care under ss. 48.58 and 938.22, and for foster care and treatment foster care under
24s. 49.19 (10), for Medical Assistance payment adjustments under s. 49.45 (52), for
25Medical Assistance payments under s. 49.45 (53), and for payments under Section

125 (3)
. Social services disbursements under s. 46.03 (20) (b) may be made from this
2appropriation. Refunds received relating to payments made under s. 46.03 (20) (b)
3for the provision of services for which moneys are appropriated under this paragraph
4shall be returned to this appropriation. Notwithstanding ss. 20.001 (3) (a) and
520.002 (1), the department of health and family services may transfer funds between
6fiscal years under this paragraph. The department shall deposit into this
7appropriation funds it recovers under ss. 46.495 (2) (b) and 51.423 (15) from prior
8year audit adjustments including those resulting from audits of services under s.
946.26, 1993 stats., or s. 46.27. Except for amounts authorized to be carried forward
10under s. 46.45, all funds recovered under ss. 46.495 (2) (b) and 51.423 (15) and all
11funds allocated under s. 46.40 and not spent or encumbered by December 31 of each
12year shall lapse to the general fund on the succeeding January 1 unless carried
13forward to the next calendar year by the joint committee on finance.
AB996, s. 7 14Section 7. 25.77 (5) of the statutes, as created by 2003 Wisconsin Act 33, is
15repealed.
AB996, s. 8 16Section 8. 46.275 (5) (a) of the statutes, as affected by 2003 Wisconsin Act 33,
17is amended to read:
AB996,6,2318 46.275 (5) (a) Medical Assistance reimbursement for services a county, or the
19department under sub. (3r), provides under this program is available from the
20appropriation accounts under s. 20.435 (4) (b), (gp), (hm), (o), and (w). If 2 or more
21counties jointly contract to provide services under this program and the department
22approves the contract, Medical Assistance reimbursement is also available for
23services provided jointly by these counties.
AB996, s. 9 24Section 9. 46.275 (5) (c) of the statutes, as affected by 2003 Wisconsin Act 33,
25is amended to read:
AB996,7,7
146.275 (5) (c) The total allocation under s. 20.435 (4) (b), (gp), (hm), (o), and (w)
2to counties and to the department under sub. (3r) for services provided under this
3section may not exceed the amount approved by the federal department of health and
4human services. A county may use funds received under this section only to provide
5services to persons who meet the requirements under sub. (4) and may not use
6unexpended funds received under this section to serve other developmentally
7disabled persons residing in the county.
AB996, s. 10 8Section 10. 46.40 (9) (d) of the statutes is created to read:
AB996,7,159 46.40 (9) (d) Payment adjustments for certain Medical Assistance services. The
10department may decrease a county's allocation under sub. (2) by the amount of any
11payment adjustments under s. 49.45 (52) made for that county from the
12appropriation account under s. 20.435 (7) (b). The total amount of the decrease for
13a county under this paragraph during any fiscal year may not exceed that part of the
14county's allocation under sub. (2) that derives from the appropriation account under
15s. 20.435 (7) (b) for that fiscal year.
AB996, s. 11 16Section 11. 46.40 (9) (d) of the statutes, as created by 2003 Wisconsin Act ....
17(this act), is repealed.
AB996, s. 12 18Section 12. 46.495 (1) (d) of the statutes is amended to read:
AB996,8,1419 46.495 (1) (d) From the appropriations under s. 20.435 (3) (o) and (7) (b) and
20(o), the department shall distribute the funding for social services, including funding
21for foster care or treatment foster care of a child on whose behalf aid is received under
22s. 46.261, to county departments under ss. 46.215, 46.22, and 46.23 as provided
23under s. 46.40. County matching funds are required for the distributions under s.
2446.40 (2), (8), and (9) (b). Each county's required match for the distributions
25distribution under s. 46.40 (2) and shall be specified in a schedule established

1annually by the department of health and family services. Each county's required
2match for the distribution under s. 46.40
(8) for a year equals 9.89% of the total of
3the county's distributions under s. 46.40 (2) and (8) for that year for which matching
4funds are required plus the amount the county was required by s. 46.26 (2) (c), 1985
5stats., to spend for juvenile delinquency-related services from its distribution for
61987. Each county's required match for the distribution under s. 46.40 (9) (b) for a
7year equals 9.89% of that county's amounts described in s. 46.40 (9) (a) (intro.) for
8that year. Matching funds may be from county tax levies, federal and state revenue
9sharing funds, or private donations to the county that meet the requirements
10specified in s. 51.423 (5). Private donations may not exceed 25% of the total county
11match. If the county match is less than the amount required to generate the full
12amount of state and federal funds distributed for this period, the decrease in the
13amount of state and federal funds equals the difference between the required and the
14actual amount of county matching funds.
AB996, s. 13 15Section 13 . 46.495 (1) (d) of the statutes, as affected by 2003 Wisconsin Act ....
16(this act), is amended to read:
AB996,9,1217 46.495 (1) (d) From the appropriations under s. 20.435 (3) (o) and (7) (b) and
18(o), the department shall distribute the funding for social services, including funding
19for foster care or treatment foster care of a child on whose behalf aid is received under
20s. 46.261, to county departments under ss. 46.215, 46.22, and 46.23 as provided
21under s. 46.40. County matching funds are required for the distributions under s.
2246.40 (2), (8), and (9) (b). Each county's required match for the distribution
23distributions under s. 46.40 (2) shall be specified in a schedule established annually
24by the department of health and family services. Each county's required match for
25the distribution under s. 46.40
and (8) for a year equals 9.89% of the total of the

1county's distributions under s. 46.40 (2) and (8) for that year for which matching
2funds are required plus the amount the county was required by s. 46.26 (2) (c), 1985
3stats., to spend for juvenile delinquency-related services from its distribution for
41987. Each county's required match for the distribution under s. 46.40 (9) (b) for a
5year equals 9.89% of that county's amounts described in s. 46.40 (9) (a) (intro.) for
6that year. Matching funds may be from county tax levies, federal and state revenue
7sharing funds, or private donations to the county that meet the requirements
8specified in s. 51.423 (5). Private donations may not exceed 25% of the total county
9match. If the county match is less than the amount required to generate the full
10amount of state and federal funds distributed for this period, the decrease in the
11amount of state and federal funds equals the difference between the required and the
12actual amount of county matching funds.
AB996, s. 14 13Section 14. 49.45 (6t) (a) of the statutes, as affected by 2001 Wisconsin Act 16
14and 2003 Wisconsin Act 33, is renumbered 49.45 (6t).
AB996, s. 15 15Section 15. 49.45 (6t) (b) of the statutes, as created by 2003 Wisconsin Act 33,
16is repealed.
AB996, s. 16 17Section 16. 49.45 (6tt) of the statutes, as created by 2003 Wisconsin Act 33,
18is repealed.
AB996, s. 17 19Section 17. 49.45 (6tu) of the statutes is created to read:
AB996,9,2420 49.45 (6tu) Distributions to county departments and local health
21departments.
From the appropriation under s. 20.435 (4) (w), the department may
22in each fiscal year distribute moneys to county departments under s. 46.215, 46.22,
2346.23, or 51.42 or to local health departments, as defined in s. 250.01 (4), under a plan
24developed by the department.
AB996, s. 18
1Section 18. 49.45 (6tu) of the statutes, as created by 2003 Wisconsin Act ....
2(this act), is repealed.
AB996, s. 19 3Section 19. 49.45 (52) of the statutes is created to read:
AB996,10,134 49.45 (52) Payment adjustments. Beginning on January 1, 2003, the
5department may, from the appropriation account under s. 20.435 (7) (b), make
6Medical Assistance payment adjustments to county departments under s. 46.215,
746.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
8(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
9(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment
10adjustments under this subsection shall include the state share of the payments.
11The total of any payment adjustments under this subsection and Medical Assistance
12payments made from appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w)
13may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).
AB996, s. 20 14Section 20. 49.45 (52) of the statutes, as created by 2003 Wisconsin Act .... (this
15act), is repealed.
AB996, s. 21 16Section 21. 49.45 (53) of the statutes is created to read:
AB996,10,2017 49.45 (53) Payments for certain services. Beginning on January 1, 2003, the
18department may, from the appropriation account under s. 20.435 (7) (b), make
19Medical Assistance payments to providers for covered services under s. 49.46 (2) (a)
204. d. and (b) 6. j. and m.
AB996, s. 22 21Section 22. 49.45 (53) of the statutes, as created by 2003 Wisconsin Act .... (this
22act), is repealed.
AB996, s. 23 23Section 23. 59.53 (24) of the statutes, as created by 2003 Wisconsin Act 33, is
24repealed.
AB996, s. 24 25Section 24. 2003 Wisconsin Act 33, section 9124 (8) is repealed.
AB996, s. 25
1Section 25 . Nonstatutory provisions.
AB996,11,72 (1) Community Aids funding decrease. Notwithstanding section 16.42 (1) (e)
3of the statutes, in submitting information under section 16.42 of the statutes for
4purposes of the 2005-07 biennial budget bill, the department of health and family
5services shall submit information concerning the appropriation under section 20.435
6(7) (b) of the statutes as though the decrease in the dollar amount of that
7appropriation by Section 26 (1) of this act had not been made.
AB996,11,138 (2) Medical Assistance funding increase. Notwithstanding section 16.42 (1)
9(e) of the statutes, in submitting information under section 16.42 of the statutes for
10purposes of the 2005-07 biennial budget bill, the department of health and family
11services shall submit information concerning the appropriation under section 20.435
12(4) (b) of the statutes as though the increase in the dollar amount of that
13appropriation by Section 26 (2) of this act had not been made.
AB996,11,2114 (3) Payments to city health departments. From the appropriation account
15under section 20.435 (7) (b) of the statutes, as affected by this act, in state fiscal year
162004-05 the department of health and family services may make payments to local
17health departments, as defined under s. 250.01 (4) (a) 3. of the statutes. Payment
18under this subsection to such a local health department may not exceed on an
19annualized basis payment made by the department of health and family services to
20the local health department under section 49.45 (6t) of the statutes for services
21provided by the local health department in 2002.
AB996,12,222 (4) If an amendment to the state medical assistance plan that provides for a
23revised payment methodology for Medical Assistance services that are provided by
24a county department or local health department under section 49.45 (52) of the
25statutes, as created by this act, is not approved in writing by the federal centers for

1medicare and medicaid services by July 1, 2005, or if on any date the amendment is
2disapproved, whichever is earlier, all of the following apply:
AB996,12,33 (a) This act, except for this subsection, is void.
AB996,12,54 (b) The secretary of administration shall notify the revisor of statutes
5concerning the lack of approval or disapproval.
AB996, s. 26 6Section 26 . Appropriation changes.
AB996,12,117 (1) Community Aids Program decrease. In the schedule under section 20.005
8(3) of the statutes for the appropriation to the department of health and family
9services under section 20.435 (7) (b) of the statutes, as affected by the acts of 2003,
10the dollar amount is decreased by $53,204,600 for fiscal year 2004-05 for the
11purposes for which the appropriation is made.
AB996,12,1612 (2) Medical Assistance Program increase. In the schedule under section
1320.005 (3) of the statutes for the appropriation to the department of health and family
14services under section 20.435 (4) (b) of the statutes, as affected by the acts of 2003,
15the dollar amount is increased by $53,204,600 for fiscal year 2004-05 for the
16purposes for which the appropriation is made.
AB996,12,2117 (3) Medical Assistance trust fund. In the schedule under section 20.005 (3)
18of the statutes for the appropriation to the department of health and family services
19under section 20.435 (4) (w) of the statutes, as affected by the acts of 2003, the dollar
20amount is decreased by $17,000,000 for fiscal year 2004-05 to for the purposes for
21which the appropriation is made.
AB996, s. 27 22Section 27. Effective dates. This act takes effect on the day after publication,
23except as follows:
AB996,13,424 (1) Medical Assistance payment adjustments. The treatment of section 49.45
25(6t) (a) and (b) of the statutes, the repeal of sections 46.40 (9) (d) and 49.45 (52) and

1(53) of the statutes and section 9124 (8) of 2003 Wisconsin Act 33, the amendment
2of sections 20.435 (4) (w) (by Section 3) and (7) (b) (by Section 6) and 46.495 (1) (d)
3(by Section 13 ) of the statutes, and the creation of section 49.45 (6tu) of the statutes
4take effect on January 1, 2006.
AB996,13,75 (2) Community services deficit reduction benefit. The amendment of section
620.435 (4) (w) (by Section 4 ) of the statutes and the repeal of section 49.45 (6tu) of
7the statutes take effect on January 1, 2007.
AB996,13,88 (End)
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