Under current law, the department of industry, labor and job development
(DILJD) administers the food stamp employment and training program under which
certain food stamp recipients aged 18 to 60 may be required to work or participate
in job training. Currently, DILJD is authorized, to the extent permitted by federal
law or waiver, to distribute food stamp benefits based on the number of hours that
an individual participates in the work or training requirement, a method commonly
referred to as "pay-for-performance".
This bill expands the food stamp benefit distribution methods to include use of
not more than $300 of a household's food stamp benefit amount as a wage subsidy
to be paid to an employer of a member of the household who is employed by that
employer as a participant in a Wisconsin works (W-2) employment position. W-2
is this state's replacement program for the aid to families with dependent children
(AFDC) program. Participants in W-2 employment positions receive a cash benefit
based on work participation rather than family size, as under AFDC. The bill also
permits DILJD to distribute food stamp benefits as cash to households in which: 1)
a member has been employed in unsubsidized employment for at least 90 days, has
earned at least $350 per month for the last 90 days and continues to earn at least
$350 per month; or 2) a member is a participant in a W-2 employment position or
was a participant in a W-2 employment position but became ineligible solely because
of earnings. DILJD may not implement either of these methods of distribution,
however, until the secretary of administration reviews and approves a plan
submitted to DOA by DILJD detailing how DILJD will implement the distribution
methods and what the fiscal impact of those methods will be.
The bill also modifies the eligibility requirements under the food stamp
program. Under the bill, an individual is disqualified from the food stamp program
for noncompliance with the work requirements of the program. For the first
occurrence of noncompliance, the ineligibility period is one month; for the 2nd
occurrence, 3 months; and for the 3rd and subsequent occurrences, 6 months.
In addition, under the bill, in order to be eligible for food stamp benefits, a
person who is a custodial parent of a child who is under the age of 18 and who has
an absent parent, a person who is a noncustodial or putative parent of a child who
is under the age of 18 or a person who lives with and exercises parental control over
a child who is under the age of 18 and who has an absent parent must cooperate with
efforts to establish the paternity of the child and with efforts to secure any support
to which the person or child may have rights.
Finally, under the bill, DILJD must require an applicant for the food stamp
program to state in writing whether the applicant or any member of the applicant's
household has been convicted in any state or federal court of a felony that has as an
element possession, use or distribution of a controlled substance (dangerous drug).
A person who, after August 22, 1996, has been convicted of such a felony is ineligible
for food stamps and, in determining a household's eligibility for food stamps, the
needs of that person are not considered. However, the person's income and resources
are considered to be available to the household. The period of ineligibility or
disregard of the person's needs continues for at least 12 months, but must end after
12 months if the person submits to a test for drug use and the results of the test are
negative.
Under current law, a county department of social or human services is required
to certify eligibility for and issue food coupons to needy households, except that a W-2
agency (the agency with which DILJD contracts to administer W-2) is required to
certify eligibility for and issue food coupons to eligible participants in the W-2
program.
This bill requires a W-2 agency also to certify eligibility for and issue food
coupons to: 1) persons who may be required to participate in the food stamp
employment and training program; and 2) other persons who are under the age of
61 and who are not disabled.
Currently, certain offenses under the food stamp program are punishable by
fines or imprisonment or both. The maximum punishment for an offense involving
food coupons having a value of more than $100 is a fine of not more than $10,000 or
imprisonment for not more than 5 years or both. In addition, a court may suspend
a person who violates the food stamp provisions from participation in the food stamp
program for up to 18 months.
Under federal law, an offense involving food coupons having a value of $5,000
or more is punishable by a fine of not more than $250,000 or imprisonment for not
more than 20 years or both. Also, under federal law, a person who violates certain
provisions of the food stamp program must be suspended from the program for one
year for the first offense, 2 years for the 2nd offense and permanently for the 3rd
offense. Upon conviction of an offense under the federal law involving food coupons,
authorization cards or access devices having a value of $500 of more, the person must
be suspended from the program permanently. Additionally, under federal law, a
person who a court determines has traded a controlled substance for food coupons
must be suspended from the food stamp program for 2 years upon the first
determination and permanently upon a 2nd determination. A person who a court
determines has traded firearms, ammunition or explosives for food coupons must be
permanently suspended from the program.
In addition, under federal law, a person who is a fugitive felon is ineligible for
the food stamp program or for any program for which block grant moneys under the
federal temporary assistance for needy families (TANF) program are used. TANF is
the federal block grant program designed to replace AFDC. (W-2 is expected to be
funded in part by a TANF grant.) Federal law also requires a 10-year suspension
from the food stamp program for a person who is convicted of fraudulently misstating
or misrepresenting his or her identity or place of residence for the purpose of
obtaining simultaneous multiple food stamp benefits. Finally, federal law requires
a 10-year suspension from any TANF-funded program for a person who is convicted
of fraudulently misstating or misrepresenting his or her identity or place of residence
for the purpose of obtaining benefits in 2 or more states under the food stamp
program, the federal supplemental security income (SSI) program (a cash benefit
program for the aged, blind and disabled), the medical assistance program or any
program for which TANF moneys are used. The person's eligibility may be
reinstated, however, if the president of the United States pardons that person for the
conduct for which the person was suspended.
This bill modifies the W-2 and food stamp provisions to reflect the federal
requirements.
Under current law, a person who receives assistance under SSI or state
supplemental payments is ineligible for AFDC. The person may, however, apply for
AFDC on behalf of his or her dependent child. Currently, AFDC is due to expire 6
months after the date that DILJD specifies in the Wisconsin Administrative Register
as the statewide implementation date of W-2. A person who receives assistance
under SSI or state supplemental payments is ineligible to participate in the
employment component of W-2.
This bill requires DHFS to make a monthly payment of $77 to a recipient of SSI
or of state supplemental payments for each dependent child of that recipient if the
recipient is the custodial parent of that child. DHFS may not make the payment
unless: 1) the child meets the eligibility criteria for AFDC; and 2) the custodial
parent is ineligible for AFDC or W-2 solely because he or she receives SSI or state
supplemental payments. If a dependent child has 2 custodial parents, both custodial
parents must receive either SSI or state supplemental payments to be eligible for the
payment and only one payment per month may be made for any child. The $77
payment is unavailable for a child who receives SSI benefits, and a child on whose
behalf the $77 payment is made may not receive AFDC. Under the bill, a child for
whom the $77 payment is made is eligible for medical assistance (MA), under which
medical services are provided to low-income persons.
Under current law, DHFS administers the state supplemental food program for
women, infants and children, commonly referred to as WIC. Under WIC, DHFS
provides supplemental food, nutrition education and other services to eligible
low-income women, infants and children.
This bill authorizes DHFS to authorize grocery stores and pharmacies to accept
WIC drafts in exchange for certain food. Under the bill, DHFS may also contract for
alternative food distribution with entities other than grocery stores or pharmacies.
The bill provides that a person who violates rules promulgated by DHFS relating to
the WIC program may be subject to one of the following:
1. Denial of an application to be authorized as a WIC vendor or participant.
2. Suspension or termination of authorization as a WIC vendor.
3. Disqualification from WIC.
4. A forfeiture (civil monetary penalty) of not less than $10 nor more than
$1,000.
5. Repayment of cash or benefits.
In addition, the bill provides that a person who is found guilty of certain
violations of the WIC provisions may be subject to a fine of not more than $10,000
or imprisonment for not more than 2 years, or both, for the first offense, and a fine
of not more than $10,000 or imprisonment for not more than 5 years, or both, for a
2nd or subsequent offense.
Under current law, reimbursement for home health, personal care and
private-duty nursing services that are provided to a medical assistance recipient in
a month may not exceed 120% of the average monthly cost of nursing home care, as
determined by DHFS. The monthly limit does not apply to an MA recipient under
the age of 22 or a ventilator-dependent individual, or if DHFS determines that the
cost of providing an individual with nursing home care would exceed the cost of
providing the person with the home health, personal care or private-duty nursing
services.
This bill eliminates the monthly limit on reimbursement under MA for home
health, personal care and private-duty nursing services that are provided to an MA
recipient.
Under the current formula for state and federal payment for care received in
nursing homes and certain C-BRF's by MA recipients, DHFS may establish
minimum patient day occupancy standards for determining costs per patient day for
each of these facilities. DHFS determines payment by dividing the total allowable
facility costs by the actual adjusted patient days or patient days based on 91% of
occupancy, whichever is higher. Also under current law, the maximum number of
licensed nursing home beds statewide is 51,795, as adjusted under various criteria
by DHFS.
This bill permits nursing homes for which the bed occupancy rate is less than
91% to request DHFS to delicense a licensed bed. If DHFS approves the request,
DHFS may not include the bed in determining costs per patient day for the nursing
home. The nursing home may not sell or use a bed that is delicensed. Every 12
months after a bed is delicensed, DHFS must reduce the licensed bed capacity of the
nursing home by 10% of all the nursing home's delicensed beds or by 25% of one bed,
whichever is greater, and must also reduce the statewide maximum number of
licensed nursing home beds by this number. However, the nursing home retains the
right to resume use and licensure of a delicensed bed for 18 months after the facility
notifies DHFS that the facility intends to resume licensure of the bed, except that the
nursing home may not resume licensure of a bed or fraction of a bed for which the
licensed bed capacity of the nursing home has been reduced.
Under current law, DHFS may use state revenues under MA and federal
matching funds to reimburse the 3 state centers for the developmentally disabled for
the cost of services provided by the centers. Under a community integration
program, for each placement into a community of a person who is relocated from one
of the state centers, DHFS reduces this reimbursement by a specified amount and
community care for the person is paid for under MA. Currently, the reimbursement
reduction amount for the Central Wisconsin Center for the Developmentally
Disabled is $205 per day, the amount for the Northern Wisconsin Center for the
Developmentally Disabled is $199 per day and the amount for the Southern
Wisconsin Center for the Developmentally Disabled is $149 per day. This bill
changes the reimbursement reduction amounts for the Northern Wisconsin Center
for the Developmentally Disabled and the Southern Wisconsin Center for the
Developmentally Disabled to $174 per day.
Under current law, a county department of developmental disabilities services
authorizes all care of a developmentally disabled patient in a state facility, including
a state center for the developmentally disabled. Although the cost of care for the
majority of patients in a state center for the developmentally disabled is paid for
under MA, DHFS bills county departments of developmental disabilities services for
persons who are ineligible for MA and who lack other means of full payment, for
certain mentally ill persons who exhibit extremely aggressive and challenging
behaviors, and, at 10% of the MA rate, for a person placed in a state center who is
found under an independent professional review to be appropriate for community,
rather than institutional, care.
Under this bill, beginning January 1, 1998, county departments of
developmental disabilities services may be billed $184 per day for the care of a
patient of a state center who is found under an independent professional review to
be appropriate for community care. Also under the bill, beginning January 1, 1998,
if a county department of developmental disabilities services authorizes admission
to a state center for the developmentally disabled of a nonemergency new patient
whose care in the community would cost less than $184 per day, the county
department must reimburse the state center for the cost of that patient at the rate
of $184 per day.
Under current law, DHFS is required to file a claim against the estate of a
recipient of MA for the amount of MA paid on behalf of the recipient while the
recipient resided in a nursing home or while the recipient was an inpatient in a
medical institution and was required to contribute to the cost of care. DHFS must
also file a claim against the estate of a recipient of MA for certain MA services paid
on behalf of the recipient after the recipient attained the age of 55. Currently, DHFS
may collect the amount from, among other property of the decedent, funds of the
decedent that were held by the decedent immediately before death in a joint account
or a payable-on-death (P.O.D.) account. DHFS may collect from certain solely
owned property of the decedent by a transfer by affidavit process, rather than the
formal probate process, if the value of the solely owned property does not exceed
$10,000 and certain other conditions are met.
This bill authorizes DHFS to collect by affidavit signed by a DHFS
representative funds of a decedent that were held by the decedent immediately
before death in a joint account or a P.O.D. account, if all of the other conditions
allowing DHFS to collect by affidavit are met. The bill also authorizes DHFS to
establish a payment schedule, subject to reasonable interest, for heirs of an estate
who wish to satisfy a recovery claim without selling a nonliquid asset.
Under current law, DHFS, DILJD, a county or an elected tribal governing body
that provides certain public assistance benefits as a result of an injury, sickness or
death that creates a claim or cause of action on the part of the public assistance
recipient or beneficiary or the estate of the recipient or beneficiary against a 3rd
party must be joined by the plaintiff as a party to the claim or action. This is known
as subrogation and as a subrogated party, DHFS, DILJD, a county or an elected tribal
governing body may maintain an action or intervene in an action by the recipient,
beneficiary or estate against the 3rd party. Currently, a party that is joined based
on subrogation may do one of the following:
1. Participate in the prosecution of the action.
2. Agree to have his or her interests represented by the party who caused the
joinder.
3. Move for dismissal.
Current law also provides that a prevailing defendant is entitled to costs from
the plaintiffs, including subrogated plaintiffs who neither participated in the
prosecution of the action nor moved for dismissal.
This bill excludes DHFS and counties from liability for costs to prevailing
defendants in actions in which DHFS or a county is subrogated because of the
implication of MA payments if DHFS or the county does not participate in the
prosecution of the action.
Under the bill, DHFS need not take any affirmative action in order to have its
interests represented by the party causing the joinder. Regardless of whether DHFS
participates in prosecuting the claim, if the plaintiff prevails, the portion of the
proceeds of the claim that represents benefits paid under MA as a result of the
occurrence of injury, sickness or death for which the claim arose must be paid to
DHFS.
Under current law, an 18-year-old high school student who is ineligible for
AFDC solely because of his or her age is eligible for aid to 18-year-old students if he
or she meets certain conditions. The amount of aid paid to the person is equal to the
amount of aid to which that person would have been entitled under AFDC if he or
she were 17 years of age, except that if the person's family became ineligible for
AFDC on the person's 18th birthday the amount paid equals the amount of aid
granted to a single person under AFDC. This bill repeals the aid to 18-year-old
students program.
Under current law, DILJD may contract with a county to administer a work
experience and job training program for noncustodial parents who fail to pay child
support or to meet their children's needs for support because of unemployment or
underemployment. Currently, the program may include certain kinds of work
experience and job training, job orientation and job search activities. This bill limits
the permitted activities of the program to work experience and job search activities.
Under current law, DHFS determines, by use of a prospective payment formula
that is updated each fiscal year, the rates of payment for nursing homes and certain
C-BRFs that provide care to MA recipients. The current payment formula requires
DHFS to consider, in determining payments for individual facilities, costs for
allowable direct care, allowable support services, allowable fuel and utilities, net
property tax or allowable municipal services, allowable administrative and general
costs, allowable facility interest expenses and capital payment necessary for the
provision of service over time. For allowable direct care costs, DHFS must establish
standards for payment that are at least 110% of the median for direct care costs for
facilities that do not primarily serve the developmentally disabled and, for facilities
that primarily serve the developmentally disabled, standards for payment that are
at least 110% of the median for direct care costs for those facilities.
This bill revises the payment formula to limit an increase in payment, including
an increase resulting from adjustment of facility base rates and percentage increases
over facility base rates, in fiscal year 1997-98 to no more than 6.1% over that paid
in fiscal year 1996-97, or $50,975,000, whichever is less. The bill limits an increase
in this payment in fiscal year 1998-99 to no more than 3.5% over that paid in fiscal
year 1997-98, or $30,322,500, whichever is less, including an increase resulting from
adjustment of a percentage increase over facility base rates. The bill also clarifies
that this limited increase in payment is an aggregate increase for all nursing homes
and C-BRFs that are payable under the formula. Lastly, the bill changes the
standards for payment of allowable direct care costs; for facilities primarily serving
the developmentally disabled, the standards for payment are not less than the
median of direct care costs for a sample of all facilities in the state primarily serving
the developmentally disabled. For facilities that do not primarily serve the
developmentally disabled, the standards for payment are not less than the median
of direct care costs for a sample of all of those facilities in the state.
Under current law, certain nursing homes receive MA payments that are
supplemental to the payments established under the payment formula for all
facilities. Under one supplemental payment program, DHFS must distribute not
more than $20,000,000 in federal MA funds in each of fiscal years 1995-96 and
1996-97, plus any additional unanticipated federal MA funds that equal funds that
a county certifies were expended to operate a county facility and that are matched
by county funds. Under a 2nd supplemental payment program, DHFS must
distribute not more than $18,600,000 in federal MA funds in each fiscal year to
county, city, village or town nursing homes if the funds are matched by county, city,
village or town funds, if the county certifies to DHFS the amount of all county funds
expended in each calendar year to operate the facility and if certain other
requirements are met.
This bill consolidates the 2 programs of supplemental payments to nursing
homes and permits payment of county-matched funds of not more than $38,600,000
in each fiscal year.
Under current law, DILJD is directed to request a waiver from the secretary of
the federal department of health and human services to enable the state, by July 1,
1997, to cease making payments under AFDC to a nonlegally responsible relative on
behalf of a dependent child. Previously, AFDC payments to eligible nonlegally
responsible relatives could not cease unless a waiver was in effect.
Currently, under the federal Personal Responsibility and Work Opportunity
Reconciliation Act, a waiver is not necessary in order to cease making such
payments. This bill eliminates the requirement that DILJD request a waiver and
that a waiver be granted and in effect in order to end such payments. Under the bill,
a nonlegally responsible relative who is receiving AFDC payments on behalf of a
dependent child on the day on which this bill becomes law may not receive AFDC
payments after December 31, 1997, or the date of the first reinvestigation of the
person occurring after the day on which this bill becomes law, whichever occurs first.
A nonlegally responsible relative who is not receiving AFDC payments on the day on
which this bill becomes law may not receive any AFDC payments on or after that
date.
Current law requires a county department of human services or social services
(county department) to pay $215 per month to a relative of a child who is providing
care and maintenance for the child (kinship care) if certain conditions are met. This
bill makes a relative ineligible for kinship care payments if the child for whom the
relative is providing care and maintenance is already receiving federal SSI payments
or state supplemental payments to the child's SSI payments.
Under current law, DHFS or an entity to which DHFS has delegated authority
must annually review every resident of a nursing home or institution for mental
diseases who has a developmental disability or mental illness to determine if the
resident needs facility care or needs active treatment for the developmental
disability or mental illness. If the review determines that the resident does not need
facility care, no MA payment may be made for that resident's care and the resident
must be relocated unless he or she is determined to need active treatment for a
developmental disability or mental illness and he or she has continuously resided in
a nursing home or institution for mental diseases for at least 30 months before the
determination date. However, if the resident requires active treatment and has met
the continuous residency requirement, he or she may receive MA-paid active
treatment in the facility or in an alternative setting.
This bill eliminates the requirement for annual review of residents of a nursing
home and institution for mental diseases who have a developmental disability or
mental illness and, instead, requires review of those residents who have experienced
a significant change in physical or mental condition.
Currently, certain MA recipients may receive case management services that
are reimbursable under the MA program if the services are provided by a certified
case management provider in a county, city, village or town that elects to make the
services available and that reimburses the service provider for the amount of
allowable charges that are not paid from federal MA moneys.
This bill expands the eligibility for case management services under the MA
program, if provided by a certified provider in a county, city, village or town that
elects to provide the services, to include women who are aged 45 to 64 and who are
not residents of nursing homes or otherwise receiving case management services.
Currently, under a waiver of federal medicaid laws, state revenues and federal
medicaid moneys provide home or community-based care for persons who are
eligible for MA and who are diagnosed as developmentally disabled. These persons
are either relocated into the community from certain institutions other than a state
center for the developmentally disabled, or they receive care in intermediate care
facilities for the mentally retarded. The program providing this care is one of several
"community integration" programs and is commonly known as "CIP 1B".
This bill requires a county that owns a facility from which an individual is
relocated to the community under the "CIP 1B" program to submit to DHFS a plan
for delicensing a bed of the facility that is approved by DHFS in order to receive
funding for the individual's relocation under the "CIP 1B" program.
Under current law, a person whose application for MA is denied or is not acted
upon promptly or who believes that the payments made in the person's behalf were
not properly determined may file an appeal with DHFS pursuant to the appeal
process set forth under the AFDC program. Currently, the AFDC appeal process is
due to expire on the first day of the 6th month beginning after the date indicated by
DILJD in the Wisconsin Administrative Register as the statewide implementation
date for W-2. Federal law requires a similar appeal process under the MA program.
This bill creates an appeal process under the MA program.
Currently, DHFS is required to make eligibility determinations for MA, but
may delegate this responsibility to a county department of social services. Under this
bill, DHFS may also delegate responsibility of eligibility determinations to a county
department of human services or to a W-2 agency.
Currently, a county or governing body of a federally recognized American
Indian tribe may retain a portion of the amount that the state is authorized to retain
for an overpayment made under the food stamp program that is recovered because
of the efforts of an employe or officer of the county or tribe, unless the overpayment
was made because of an error on the part of the county or tribe. DILJD is required
to promulgate a rule establishing the portion of the amount of the recovered
overpayment that the county or tribal governing body may retain.
This bill deletes the requirement that DILJD establish the portion by rule and
instead authorizes a county or tribal governing body to retain 15% of the amount that
the state is authorized to retain. The bill also authorizes a W-2 agency to retain 15%
of the amount the state is authorized to retain for an overpayment made under the
food stamp program that is recovered because of the efforts of an employe or officer
of the W-2 agency.
Currently, a county or governing body of a federally recognized American
Indian tribe may retain 15% of benefits distributed under the AFDC program (unless
the benefits were provided as a result of state, county or tribal error) and under the
MA program that are recovered because of the efforts of an employe or officer of the
county or tribe.
This bill authorizes a W-2 agency to retain 15% of distributed AFDC benefits
(unless the benefits were provided as a result of state, county or tribal error) and MA
benefits that are recovered because of the efforts of an employe or officer of the W-2
agency.
The bill also authorizes a W-2 agency to retain 15% of an overpayment made
under the W-2 program that is recovered because of the efforts of an employe or
officer of the W-2 agency, unless the overpayment was made because of an error on
the part of the W-2 agency.
Under current law, DILJD is required to implement a program of emergency
assistance for families with needy children in cases of fire, flood, natural disaster,
homelessness or energy crisis. Currently, emergency assistance in cases of
homelessness, except homelessness created by a domestic abuse situation, may be
provided to a needy person only once in a 36-month period. Current law does not
specify how frequently emergency assistance may be provided in cases of fire, flood,
natural disaster or energy crisis.
This bill specifies that emergency assistance in cases of fire, flood, natural
disaster or energy crisis may be provided to a needy person only once in a 12-month
period.
Under current law, each county department administering AFDC is required
to maintain a monthly report, open for public inspection, showing the names of all
persons receiving benefits under AFDC and the amounts received by those recipients
during the preceding month. Each W-2 agency administering W-2 is required to
maintain a monthly report, open for public inspection, showing the names and
addresses of all persons receiving benefits under W-2 and the amounts received by
those recipients during the preceding month. This bill eliminates the requirement
that the report contain the addresses of W-2 recipients.
Currently, the address of an AFDC or W-2 recipient may be released to a law
enforcement officer if the officer provides, in writing, the recipient's name and social
security number and satisfactorily demonstrates, in writing: 1) that the recipient is
a fugitive felon; 2) that the location or apprehension of the recipient is within the
official duties of the officer; and 3) that the officer is making the request in the proper
exercise of his or her duties.
Currently, federal law prohibits a state agency from preventing the release of
the current address of a recipient of aid that is funded under a TANF grant or of a
recipient of food stamps to a law enforcement officer if the officer furnishes the
agency with the name of the recipient and notifies the agency that the recipient is
a fugitive felon, is violating a condition of probation or parole or has information that
is necessary for the officer to conduct his or her official duties.
This bill removes the requirement that the law enforcement officer provide the
social security number of the recipient in order to receive information regarding the
recipient's current address. The bill also permits the county department or W-2
agency to release the current address of a recipient to a law enforcement officer if the
officer satisfactorily demonstrates, in writing, that the recipient has information
that is necessary for the officer to conduct the official duties of the officer.
Under current law, DILJD is required to implement W-2 statewide no later
than September 1997, if a waiver is in effect or legislation is enacted permitting the
use of federal funds for the program and if DILJD determines that sufficient funds
are available. Currently, under TANF, federal law permits the implementation of
most of the components of W-2 without a waiver.
