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.
One component of W-2 is a health plan to be operated as part of MA. Under
current law, beginning on the first day of the 6th month beginning after the statewide
implementation of W-2, MA will not be available to those individuals who are
eligible for the W-2 health plan. However, MA will continue to be available to eligible
persons over the age of 65 and to eligible disabled persons. Federal law does not
currently permit the implementation of the W-2 health plan as part of MA.
This bill directs DHFS to request a waiver from the secretary of the federal
department of health and human services or to seek the enactment of federal
legislation to permit the implementation of the W-2 health plan as part of MA. If
a waiver is in effect or permissive federal legislation is enacted, DHFS must
implement the W-2 health plan beginning no later than the first day of the 3rd
month beginning after the waiver is granted or the federal legislation is enacted and
must publish a notice in the Wisconsin Administrative Register indicating the date
that it will implement the W-2 health plan. Under the bill, if a waiver is in effect
or federal legislation is enacted, DHFS may terminate the MA eligibility of those
persons who are eligible for the W-2 health plan beginning on the date published in
the notice.
Wisconsin works
Under current law, no person may participate in W-2 for more than 60 months,
unless a W-2 agency determines that unusual circumstances exist that warrant an
extension of the participation period. In calculating the months of participation for
an individual, a W-2 agency must include any months of participation in the job
opportunities and basic skills (JOBS) program that occurred since July 1, 1996.
Under the JOBS program, AFDC recipients who are not exempt are required to
participate in certain job-related activities. Currently, under TANF, no state may
use any part of a TANF grant to provide assistance to a family that includes an adult
member who has received for 60 months any TANF-funded assistance in any state,
although federal law permits a state to grant extensions for hardship or in cases in
which an individual in the family has been battered or subjected to extreme cruelty.
Federal law requires states to disregard any month during which an individual
received TANF-funded assistance while living either on an American Indian
reservation or in an Alaskan Native village if, during that month, at least 1,000
individuals were living on that reservation or in that village and at least 50% of the
adults living on the reservation or in the village were unemployed.
Currently, under federal law, a state to which a TANF grant is made must
achieve certain monthly work participation rates for single-parent and 2-parent
families that receive TANF-funded assistance. In a 2-parent family, one parent
must work at least 35 hours per week, not fewer than 30 of which must be
attributable to certain federally prescribed work activities. If the family receives
federally funded child care assistance, the other parent must work at least 20 hours
per week in certain federally prescribed work activities, unless an adult in the family
is disabled or caring for a severely disabled child.
This bill modifies the eligibility criteria for W-2 to preclude from eligibility a
person who has received any TANF-funded assistance for a total of 60 months. In
calculating the months of participation for an individual, a W-2 agency must include
months of participation in JOBS that occurred since October 1, 1996, any month that
the individual received emergency assistance if the assistance was funded from
TANF grant money and any month during which any other adult member of the W-2
group participated in a W-2 employment position while the individual was a member
of that W-2 group. If the individual joins a new W-2 group in which another adult
member of the group has received TANF-funded assistance, the W-2 agency must
attribute to that individual the greater of the following:
1. The number of months that the individual received any TANF-funded
assistance.
2. The number of months that the other adult member of the new W-2 group
received TANF-funded assistance.
The bill requires a W-2 agency to disregard any months that a person received
TANF-funded assistance while living either on an American Indian reservation or
in an Alaskan Native village if, during that month, at least 1,000 individuals were
living on that reservation or in that village and at least 50% of the adults living on
the reservation or in the village were unemployed.
The bill also requires that, if a participant in a W-2 employment position
resides with the other parent of the participant's dependent child, and if the W-2
group receives federally funded child care assistance on behalf of the dependent
child, the other parent must work at least 20 hours per week in certain federally
prescribed work activities unless that parent is disabled or caring for a severely
disabled child.
Under the bill, no additional grant or wage subsidy is paid for the other parent's
work activities. The monthly grant of a participant in a community service job or
transitional placement is reduced by $5.15 for every hour that an individual who is
in the participant's W-2 group and who is subject to the work requirement fails to
meet the work requirement in a month without good cause. Additionally, if the
individual who is subject to the work requirement demonstrates 3 times a refusal to
participate, the individual who is a participant in a W-2 employment position loses
eligibility to continue to participate in the particular employment position
component in which the participant had been participating. The participant may,
however, be eligible for at least one of the other 2 employment position components.
The bill also provides that the custodial parent of an infant may receive a grant
without being required to work only if no other adult member of the custodial
parent's W-2 group is participating or eligible to participate in a W-2 employment
position or working in an unsubsidized job.
Also, under the bill, a W-2 agency may require, as a condition of continued
eligibility for a community service job or transitional job, that a person submit to a
test for drug use if that person has been convicted, after August 22, 1996, of a felony
that has as an element possession, use or distribution of a controlled substance. If
the test results are positive, the W-2 agency must reduce the participant's grant
amount by not more than 15%. The reduction lasts for at least 12 months, or for the
remainder of the participant's participation period in a community service job or
transitional placement, if less than 12 months. The full benefit amount must be
restored for a person who continues to be a participant in a community service job
or transitional placement after 12 months if the participant submits to a drug test
at that time and the test results are negative.
Under current law, an individual is eligible for a child care subsidy under W-2
if the individual meets certain nonfinancial and resource eligibility requirements
and if the gross income of the individual's family is at or below 165% of the federal
poverty line for a family the size of the individual's family.
This bill permits an individual who is already receiving a child care subsidy
under W-2 to remain eligible for the subsidy if the gross income of the individual's
family is at or below 200% of the federal poverty line for a family the size of the
individual's family and the individual continues to meet the other eligibility
requirements.
Under current law, recipients of AFDC are required to assign to the state any
rights they have to support or maintenance while receiving AFDC. Under W-2,
participants are not generally required to assign rights to support or maintenance.
Currently, under TANF, states must require applicants and participants in
TANF-funded assistance programs to assign to the state any rights to support and
maintenance while participating in the TANF-funded program. This bill modifies
the W-2 eligibility requirements to provide that an individual is eligible for W-2
benefits only if he or she assigns his or her rights to any support or maintenance to
the state for the period of time that he or she receives W-2 benefits.
Under current law, an individual whose application for a W-2 employment
position is not acted upon with reasonable promptness after filing the application,
or is denied in whole or in part, whose benefit is modified or canceled, or who believes
that the benefit was calculated incorrectly, may petition the W-2 agency for a review
of that action. The W-2 agency must give the individual reasonable notice and an
opportunity for a review. The individual may petition DILJD for a review of the W-2
agency's decision within 15 days after the decision or the W-2 agency may request
DILJD to review the W-2 agency's decision. Currently, state law does not specify a
remedy for a successful petitioner.
This bill permits an individual whose application for any component of W-2 has
been denied in whole or in part, whose benefit is modified or canceled, or who believes
that the benefit was calculated incorrectly, to petition the W-2 agency for a review
of that action. The individual may seek a review by DILJD of the W-2 agency's
decision.
The bill provides that, following a review, if a W-2 agency or DILJD determines
that an individual's application for a W-2 employment position was denied because
of an erroneous determination of ineligibility or that an individual was placed in an
inappropriate W-2 employment position, the W-2 agency must place that individual
in the first appropriate W-2 employment position available. Benefits under that
position are available to the individual beginning on the date on which the individual
begins participation in that position. The bill further provides that, following a
review, if the W-2 agency or DILJD determines that the individual's benefit was
improperly modified or canceled or was calculated incorrectly, the W-2 agency must
retroactively restore the benefit to the proper level.
The bill also provides a review process under the emergency assistance for
families with needy children program. Under that process, an individual whose
application for emergency assistance is not acted upon by DILJD or the W-2 agency
with reasonable promptness after the filing of the application or is denied in whole
or in part, or who believes that the assistance amount was calculated incorrectly, may
petition DILJD or the W-2 agency for a review of that action.
Currently, a W-2 participant in a community service job receives a monthly
grant of $555, reduced by $4.25 for each hour of work or education or training activity
missed without good cause. A participant in a transitional placement (a placement
for an individual unable to participate in a trial or community service job) receives
a monthly grant of $518, reduced by $4.25 for each hour of work or education or
training activity missed without good cause. The grant is paid by the W-2 agency.
The grant to a custodial parent of an infant that is 12 weeks old or younger is not
subject to reduction.
Under this bill, the grant amount for community service jobs and for an eligible
custodial parent of a 12-week old or younger infant is increased to $673 per month
and the grant amount for a transitional placement is increased to $628 per month.
These amounts are reduced by $5.15 for every hour that the participant fails to
participate in any activity required for the participant's placement.
The bill also provides that DILJD may make the benefit payments for a
community service job and transitional placement and payments to a custodial
parent of an infant by an electronic funds transfer system.
Under current law, a person may be licensed by DHFS or certified by a county
department as a family day care provider. Certification by a county department
must be done in accordance with rules promulgated by DHFS. Under
1995
Wisconsin Act 404, the duties of DHFS primarily related to the administration of
child care programs were transferred to DILJD. This bill requires that DILJD,
rather than DHFS, promulgate the rules related to certification of family day care
providers.
