Under this bill, if a person wishes to receive a subsidy for child care that is
needed in order to pursue basic education (such as English as a second language
courses, high school graduation equivalency courses or literacy tutoring), that
person must demonstrate that he or she is employed in unsubsidized employment
(without regard to length of employment) or that he or she is a participant in a W-2
employment position. A person who wishes to receive a subsidy for child care that
is needed in order for the person to participate in a course of study at a technical
college, or to pursue education that provides an employment skill, must demonstrate
that he or she has been working in unsubsidized employment for three months (and
continues to be so employed) or that he or she is in a W-2 employment position. As
under current law, the W-2 agency must determine that the basic, technical or other
education would facilitate the person's efforts to obtain employment.
Under current law, a contract to operate as a W-2 agency must require that the
W-2 agency provide, or contract with another person to provide, credit
establishment and credit repair assistance to W-2 participants. Currently, DWD
may allocate not more than $3,000,000 annually for credit assistance to W-2
recipients in the city of Milwaukee.
Under this bill, rather than requiring credit establishment and credit repair
services, a W-2 agency contract must require that the W-2 agency provide, or
contract with another to provide, budgeting and financial planning services. The bill
eliminates the allocation for credit establishment and credit repair services offered
to W-2 participants in the city of Milwaukee.
Current contracts between DWD and W-2 agencies require the agencies to offer
follow-up services for 60 days after a W-2 participant moves from a W-2
employment position to unsubsidized employment. This bill permits a W-2 agency,
subsequent to that follow-up period, to offer case management services, including
the provision of employment skills training, English as a second language classes
and basic education, to an individual who has moved from a W-2 employment
position to unsubsidized employment, regardless of the individual's income or asset
level.
Currently, in calculating a person's income for the purpose of determining
financial eligibility for W-2 or for a W-2 child care subsidy, a W-2 agency must
include child support payments received by the person on behalf of any child who is
a member of that person's household. This bill removes child support payments from
the income consideration. The bill also directs the W-2 agency to include in the
calculation of income for W-2 child care eligibility net earnings and certain
business-related expenses reported to the Internal Revenue Service for farm and
self-employment income.
Medical assistance
Under current law, certain people are eligible for MA because of substantial
medical needs that consume so much of their income as to qualify them as
low-income. This category of MA recipients is commonly referred to as medically
needy. Other people are eligible for MA by virtue of their receipt of other federal
assistance, such as SSI. This category of MA recipients is commonly referred to as
categorically needy.
This bill directs DHFS to seek federal approval and to request any necessary
waivers to expand MA eligibility to disabled persons who would qualify for SSI but
for excess income and assets. Under the bill, a disabled person whose family's income
is less than 250% of the federal poverty line and whose assets do not exceed $20,000
is eligible to receive MA if the person pays a monthly premium and a one-time initial
premium established by DHFS. The bill directs DHFS, however, to pay the monthly
premium for a person who is eligible for this MA purchase plan and who is receiving
services under COP. The bill also authorizes DHFS to pay for that person's one-time
entry premium.
The bill also requires DHFS to evaluate how to coordinate the MA purchase
plan with HIRSP, which provides major medical health insurance coverage for,
among others, persons who are covered under medicare because they are disabled
but for which persons who are eligible for MA are not eligible. DHFS is required, if
necessary, to develop proposed legislation that coordinates the two programs and
that addresses the provision of health care coverage for individuals who are eligible
for both HIRSP and the MA purchase plan.
Under the current MA program, DHFS certifies persons or facilities that meet
certain criteria as providers and pays for services and items that MA recipients
receive from the certified providers. DHFS is authorized or required to enforce
numerous sanctions, including decertification or suspension from the MA program,
against providers who fail to comply with requirements under the program or to
whom improper or erroneous payments or overpayments have been made. To
implement these sanctions, DHFS must provide written notice, a fair hearing and
a written decision.
This bill prohibits MA providers from submitting false claims for payment of
services or items. The bill permits DHFS to assess forfeitures for violations of the
prohibitions and to impose a surcharge on a forfeiture that is assessed.
The bill authorizes DHFS to require certain MA providers, as a condition of
certification, to file with DHFS a surety bond, payable to DHFS, under terms and in
an amount specified by DHFS, that would reasonably pay the amount of a recovery
and DHFS's costs to pursue recovery of overpayments or to investigate and pursue
allegations of false claims or statements.
The bill authorizes DHFS, if DHFS first makes specified findings, to prescribe
MA provider certification criteria that limit the number of providers of particular
services or that limit the amount of resources, including employes and equipment,
that a certified provider may use to provide MA services and items.
The bill makes various changes relating to the procedures for the recovery by
DHFS of improper or erroneous MA payments or overpayments.
The bill eliminates DHFS's general authority to suspend a provider, but
authorizes DHFS, if certain criteria are met, to suspend certification for a provider
pending a hearing on whether the provider must be decertified for violation of federal
or state laws. The bill eliminates the right of notice, a fair hearing and a written
decision for most sanctions against providers that DHFS may enforce, except for
decertification from or restriction of a provider's participation in the MA program.
The bill authorizes DHFS to prescribe conditions of MA participation and
reimbursement terms and to impose additional sanctions for noncompliance. The
bill requires immediate access, upon request by DHFS, to provider records and
specifies that a provider's failure to provide access constitutes grounds for
decertification.
The bill changes provisions concerning liability for repayment of improper or
erroneous payments or overpayments of a provider who sells or otherwise transfers
ownership of his or her business. Under the bill, before such a sale or transfer may
take place, the provider must notify DHFS of the impending sale and DHFS must
inform the provider of the extent of liability, if any. If liability exists, the provider
must so inform the prospective transferee of the extent of the liability and the
liability attaches to both the provider and the transferee, with the sale or other
transfer conditioned upon repayment. If the provider fails to inform the transferee,
liability does not attach to the transferee. Repayment must be made prior to the sale
or transfer and, if not done, the sale or transfer is void.
Currently, a person who disposes of assets for less than the fair market value
in order to qualify for MA is ineligible for MA for a certain period. Current law
specifies that a transfer of assets to an irrevocable annuity is a transfer that is below
the fair market value if the amount of the transfer exceeds the expected benefit.
This bill provides that a transfer of an asset to an irrevocable annuity, or a
transfer of an asset by promissory note or similar instrument, is a transfer for the
fair market value of the asset if certain conditions are met.
Under current law, DHFS must recover from the estate of a deceased MA
recipient the amount of MA paid on behalf of the recipient while the recipient was
a resident in a nursing home or an inpatient in a medical institution and the amount
of MA paid on behalf of the recipient for certain services received by the recipient
after the recipient was over the age of 55. One mechanism for recovery is a claim filed
against the estate, which may include a lien placed on the home of a recipient who
is a nursing home resident and not expected to return home. Currently, a lien may
only be for the amount of MA paid on behalf of the recipient while the recipient
resides in a nursing home.
This bill expands the estate recovery program as follows:
1. In addition to obtaining a lien on the home of a nursing home resident who
is not expected to return home, the bill directs DHFS to obtain a lien on the home of
an inpatient in a hospital who is not expected to return home. The lien, in both cases,
is for the amount of MA paid on behalf of that recipient that is generally recoverable,
rather than only the amount paid while the recipient was in the nursing home (or
hospital).
2. DHFS must recover expenditures for personal care services, which include
assistance with meals, dressing, movement, bathing or other personal needs or
maintenance.
Under current law, a court may reduce DHFS's claim in an estate by up to
$3,000 to allow heirs and beneficiaries to retain certain personal property, including
up to $1,000 in tangible personal property that is not used in trade, agriculture or
other business. This bill allows a court to reduce DHFS's claim in an estate by up
to $5,000, including $3,000 in tangible personal property that is not used in trade,
agriculture or other business.
Under current law, payments to nursing homes for care provided to recipients
of MA are determined under a payment system that considers specific allowable
costs, under standards prescribed by DHFS. The standards for payment of allowable
direct care costs, support service costs, heating fuel and utility costs and
administrative and general costs of a nursing home may not be less than the median
for such costs of a sample of all nursing homes. Payment for net property taxes or
municipal services are required to be made on a range from actual costs to a
maximum limit determined by DHFS. Payment for capital costs of a nursing home
must be based on the home's replacement value, subject to DHFS limitations, except
that DHFS may not reduce final capital payment by more than $3.50 per patient day
and except that DHFS limitations do not apply to certain nursing homes that have
high capital costs. DHFS must calculate a payment for a nursing home by applying
specified standards and considering specified cost centers and allowable costs.
Payments are based on cost reports from the nursing home's previous fiscal year.
This bill eliminates the requirement that DHFS base payment on information
from cost reports from the nursing home's previous fiscal year. The bill also
eliminates the requirement that the standards for payment by DHFS of allowable
costs for direct care, support services, heating fuel and utilities, administration and
general services be not less than the median for such costs for a sample of all nursing
homes, although the bill still requires DHFS to consider a sampling of nursing homes
in determining payment. The bill eliminates the limitation on the amount by which
DHFS may reduce final capital costs payment of a nursing home. The bill revises the
standard for payment for net property taxes or municipal services to limit the
payment to actual previous costs, subject to a maximum determined by DHFS.
Under current federal law, with certain exceptions, states are permitted to
require an individual who is eligible for MA to enroll in a managed care plan
(generally a health maintenance organization, or HMO) rather than receiving
services under the traditional fee-for-service system. Federal law prohibits states
from requiring a child who is in foster care to enroll in a managed care plan as a
condition of receiving MA.
This bill authorizes DHFS to request a waiver from the secretary of the federal
department of health and human services to permit DHFS to require children in
foster care to enroll in a managed care plan as a condition of receiving MA. If the
waiver is granted and in effect, the bill permits DHFS to implement the waiver.
This bill requires DHFS to request a waiver from the secretary of the federal
department of health and human services to permit DHFS to cover under MA clinical
evaluation services for certain persons with HIV. The bill limits coverage to $500 per
year per person.
Currently, DHFS must annually submit to JCF a report on nursing home bed
utilization by MA recipients for the previous year. If the report indicates that the
utilization has decreased, DHFS must include a proposal to transfer funds from the
MA appropriation account to the COP appropriation account for expenditure for
noninstitutional long-term support services.
This bill provides that the transfer of funds from MA to COP may not reduce
the MA appropriation account balance below the amount necessary to ensure that
the appropriation account will end the current fiscal year or the current fiscal
biennium with a positive balance. The bill requires that DHFS's report to JCF
include a discussion and detailed projection of the likely balances, expenditures,
encumbrances and carry-over of currently appropriated amounts in the MA
appropriation accounts.
Currently, MA recipients may obtain coverage for inpatient hospital services
and outpatient services for treatment of alcohol or other drug abuse. This bill
provides that MA recipients may receive, until July 1, 2003, residential treatment
services for alcohol and other drug abuse, limited to 45 days of treatment services per
treatment episode. The benefit may be provided only in a facility of fewer than 16
beds in a county, city, town or village that elects both to become certified as a provider
of the services, or to contract with a certified provider to provide the services, and to
pay the amount of the allowable charges for the services under the MA program that
is not provided by the federal government.
Under current law, dental services are provided to MA recipients on a
fee-for-service basis or under some form of managed care, such as through
enrollment by a recipient in a health maintenance organization that provides dental
services. This bill increases the amount paid under the MA program for dental
services providers who provide services on a fee-for-services basis.
Currently, DHFS annually may distribute no more than $2,256,000 of MA
moneys as supplements to rural hospitals that, compared to other rural hospitals,
have a high utilization of inpatient services by persons whose care is provided from
governmental sources. This bill authorizes DHFS to distribute the supplements of
MA moneys also to critical access hospitals. A critical access hospital is a hospital
that DHFS determines meets specific federal medicaid requirements and has
specific federal certification.
Under current law, at the request of DHFS, health insurers must provide
information to enable DHFS to identify MA recipients who are eligible, or who would
be eligible as dependents, for health insurance coverage. This bill authorizes DHFS
to provide any information that it receives from a health insurer to DWD. The two
departments must agree on procedures to safeguard the confidentiality of the
information.
Currently, DHFS is authorized to provide enhanced reimbursement under CIP
for a person who was relocated to the community from an intermediate care facility
for the mentally retarded that closes. This bill additionally authorizes DHFS to
provide enhanced reimbursement under CIP for a person who is relocated to the
community from an intermediate care facility for the mentally retarded, or a distinct
part of the facility, that has a DHFS-approved plan of closure and that intends to
close within 12 months.
Children
Under current law, DHFS awards grants for various programs relating to youth
alcohol and other drug abuse, adolescent pregnancy and other adolescent services.
These programs include a neighborhood drug use and violence prevention program,
a community alcohol and other drug abuse prevention program, a drug prevention
program for Milwaukee public high school athletes, an adolescent self-sufficiency
program, an adolescent pregnancy prevention program, an adolescent resource
center in Milwaukee, a minority adolescent parenting skills program in Milwaukee
and an adolescent choices project.
This bill eliminates all of these programs. The bill directs DHFS to award
grants to public and private organizations operating in Milwaukee County; county
departments of human services, social services, community programs or
developmental disabilities services operating in counties other than Milwaukee
County; and federally recognized American Indian tribes or bands in this state to
provide programs to prevent and reduce the incidence of youth violence and other
delinquent behavior, youth alcohol and other drug use and abuse, nonmarital
pregnancy and child abuse and neglect; to increase the use of abstinence as a method
of preventing nonmarital pregnancy; and to increase adolescent self-sufficiency by
encouraging high school graduation, vocational preparedness, improved social and
other interpersonal skills and responsible decision making. The bill requires DHFS
to provide a set of benchmark indicators to measure the outcomes that are expected
of a program receiving a grant and permits DHFS to renew a grant only if the
recipient shows improvement on those indicators.
Under current law, an agency that is responsible for investigating reports of
suspected or threatened child abuse or neglect must determine, within 60 days after
receipt of such a report, whether abuse or neglect has occurred or is likely to occur.
Currently, there is no procedure for appealing that determination. This bill provides
that if such a determination contains a finding that a specific person has abused or
neglected a child, that person may appeal that finding in accordance with procedures
established by DHFS.
Under current law, an agency that is responsible for investigating reports of
suspected or threatened child abuse or neglect must keep its records confidential and
may disclose those records only under certain conditions. This bill permits such an
agency, subject to standards established by DHFS, to disclose to the news media and
the general public information from the agency's records in cases in which a child
died or was placed in serious or critical condition as a result of abuse or neglect.
Under current federal law, each state that receives a grant under the federal
Child Abuse Prevention and Treatment Act must establish not less than three child
abuse and neglect citizen review panels to evaluate the extent to which local agencies
responsible for providing child protective services are effectively discharging their
responsibilities and must ensure that otherwise confidential child abuse and neglect
records are made available to those panels. This bill permits a child abuse and
neglect citizen review panel established by DHFS or a county department to have
access to the otherwise confidential child abuse and neglect records of an agency
responsible for child protection as necessary for the panel to carry out its functions.
Under current law, a person is eligible for a subsidy for child care for a child who
is under the age of 13 if the person meets certain requirements. The person must be
a parent or other primary caretaker of the child; the person must initially have a
gross income at or below 165% of the federal poverty line; and the person's assets may
not exceed $2,500 in combined equity value.
This bill expands eligibility for a child care subsidy beginning on January 1,
2000. Under the bill, the initial income limit is increased to 185% of the poverty line
and the asset limit is eliminated. The bill also expands the subsidy to cover child care
for disabled children who are under the age of 19.
Under current law, DWD must award grants for the start-up or expansion of
child care services and must attempt to award these grants to head start agencies,
employers that provide or wish to provide child care services for their employes,
family day care centers, group day care centers and day care programs for the
children of student parents. A person who is awarded a child care start-up or
expansion grant must contribute matching funds equal to 25% of the amount
awarded and may not use any grant moneys to purchase or improve land or to
purchase, construct or permanently improve, other than minor remodeling, any
building or facility.
This bill requires DWD to award low-interest loans for the start-up or
expansion of child care services. Under the bill, the same requirements that apply
to the awarding of child care start-up or expansion grants, other than the matching
funds requirement, apply to the awarding of child care start-up or expansion
low-interest loans. The bill also requires DWD to attempt to award child care
start-up and expansion grants and low-interest loans to organizations that provide
child care for sick children and to child care providers that employ participants or
former participants in a W-2 employment position.
Under current law, if a W-2 agency determines that a person is eligible for a
child care subsidy, the W-2 agency must refer that person to the county department.
The county department determines, in accordance with a schedule developed by
DWD, the amount of the person's copayment for child care; provides a child care
subsidy, either in the form of a voucher or a direct payment to the child care provider;
and helps the person identify available and appropriate child care. The county
department also sets maximum reimbursement rates for child care providers and
certifies certain child care providers. Finally, under current law, a county
department is responsible for conducting a background investigation of child care
providers prior to certifying them.
This bill permits DWD to require a county department, a tribal governing body
or a W-2 agency to administer the child care subsidy program, except that in
Milwaukee County, DWD must require a W-2 agency to administer the child care
subsidy program in that county. Under the bill, whichever entity administers the
program is responsible for determining the copayment amount, providing the
subsidy, conducting background investigations on and certifying child care providers
and identifying available and appropriate child care for subsidy recipients. County
departments, however, retain the responsibility for setting maximum
reimbursement rates for child care providers.
Under current law, DHFS may not license a person to operate a foster home,
treatment foster home, group home, shelter care facility, child welfare agency or day
care center; a county department or a child welfare agency may not license a person
to operate a foster home or treatment foster home; a county department may not
certify a person as a day care provider; and a school board may not contract with a
person to operate a day care program if the person has been convicted of or has
pending a charge for a serious crime, as defined by DHFS by rule; has abused or
neglected a client or a child; has misappropriated client property; or is not
sufficiently credentialed to provide adequate client care. In addition, such a licensed,
certified or contracting entity may not hire or contract with such a person if the
person is expected to have access to the entity's clients and may not permit such a
person to reside at the entity as a nonclient. Such a person may, however, subject to
certain exceptions, demonstrate that he or she has been rehabilitated. At the time
of initial licensure, certification, hiring, contracting or residence and every four years
after that, DHFS, a county department, a child welfare agency or a school board must
obtain, with respect to an operator or nonclient resident of an entity, and an entity
must obtain, with respect to an employe or contractor who has or is expected to have
access to the entity's clients, certain personal background information, including
information obtained from a criminal history search. DHFS, a county department,
a child welfare agency or a school board may charge a fee for obtaining this
background information about an operator or nonclient resident of an entity.
This bill changes the type of interaction with clients that an employe or
contractor must have to require a background investigation of the employe or
contractor and to prohibit the employe or contractor from being hired by or from
contracting with an entity. The bill, rather than requiring an investigation of an
employe or contractor who has or is expected to have access to a client, instead
requires an investigation of an employe or contractor who provides or is expected to
provide to clients direct care that is more intensive than negligible in quantity or
quality or in the amount of time required to provide the care. The bill also permits
DHFS, a county department, a child welfare agency, a W-2 agency or a school board
to charge a fee for the cost of providing background information to an entity about
an employe or contractor and to charge a fee to a person for the cost of determining
whether the person has been rehabilitated.
Under current law, a foster home may provide care and maintenance for no
more than four children unless all of the children are siblings. This bill permits a
foster home to provide care and maintenance for no more than four children or, if
necessary to enable a sibling group to remain together, for no more than six children
or, if DHFS promulgates rules permitting a different number of children, for the
number of children permitted under those rules.
Under current law, subject to certain exceptions, DHFS, a county department
or a licensed child welfare agency (collectively "agency") may not make available for
inspection or disclose the contents of any record kept or information received about
an individual in the care or legal custody of the agency except by order of the court
assigned to exercise jurisdiction under the children's code (juvenile court). Current
law, however, is silent as to the confidentiality of records kept and information
received relating to a foster parent, treatment foster parent or family-operated
group home parent (substitute care parent).
This bill prohibits an agency from making available for inspection or disclosing
the contents of any record kept or information received relating to a substitute care
parent or a family member of a substitute care parent without first receiving the
written permission of the substitute care parent, except by order of the juvenile
court. The bill does not prohibit an agency from disclosing information in confidence
to another social welfare agency, from disclosing the contents of a record as permitted
under the child abuse and neglect reporting law, from disclosing to the child's parent,
guardian or legal custodian the name and address of the substitute care parent or
from including the location of the child's placement in the child's permanency plan.
Current law appropriates to DHFS certain general purpose revenues (GPR)
and federal revenues for foster care and for adoption assistance payments to parents
who adopt children with special needs. This bill expands the purposes for which GPR
and federal foster care and adoption services moneys are appropriated to DHFS to
include the cost of contracting with private adoption agencies to provide adoption
services for children with special needs who are under the guardianship of DHFS.
Under current law, in Milwaukee County, DHFS is required to provide the
juvenile court with services necessary for investigating and supervising child
welfare cases under the children's code and the county board of supervisors is
required to provide the juvenile court with services necessary for investigating and
supervising cases under the juvenile justice code. Child welfare cases under the
children's code include cases in which a child is alleged to have been abused or
neglected or otherwise to be in need of protection or services under the children's
code. Cases under the juvenile justice code include cases in which a juvenile is
alleged to be delinquent, in violation of a civil law or ordinance or in need of protection
or services under the juvenile justice code, that is, habitually truant from home or
school, uncontrollable or a school dropout. The chief judge of the judicial
administrative district covering Milwaukee County must formulate written judicial
policy governing intake and juvenile court services for matters under the children's
code and the juvenile justice code.
This bill prohibits the chief judge from directing DHFS to provide intake and
juvenile court services in cases in which the referral information indicates that the
juvenile should be referred to the juvenile court under the juvenile justice code,
unless that information indicates that the juvenile should also be referred to the
juvenile court under the children's code. The bill also requires the chief judge to
direct DHFS and Milwaukee County to coordinate the provision of services in cases
in which a DHFS intake worker determines that jurisdiction exists under the
juvenile justice code instead of or in addition to the children's code and in cases in
which a Milwaukee County intake worker determines that jurisdiction exists under
the children's code instead of or in addition to the juvenile justice code.
Health
Under current law, DHFS must administer a health care program (known as
badger care) to provide health care coverage to low-income (generally defined as
having an income at or below 185% of the federal poverty line) children and their
parents if the children reside with their parents.
This bill expands the badger care program to cover any child under the age of
19 who meets financial and other eligibility requirements, regardless of whether the
child resides with his or her parents. The bill also requires DHFS to lower the
maximum income level for initial eligibility for badger care if funding for badger care
is insufficient to accommodate the projected enrollment in badger care and requires
DHFS to raise the income limit to up to 185% of the federal poverty line if, after
having lowered the income level, funding for badger care becomes sufficient to cover
projected enrollment of persons at the higher income level.
