Under current law, the Governor's Work-Based Learning Board (GWBLB) is
required to plan, coordinate, administer, and implement certain youth
apprenticeship, school-to-work, and work-based learning programs and other
employment and education programs that the governor may, by executive order,
assign to the GWBLB. This bill eliminates the GWBLB and transfers administration
of the employment and education programs currently administered by the GWBLB
to DWD. The bill also creates the Governor's Work-Based Learning Council and
directs the council to oversee the planning, coordination, administration, and
implementation by DWD of those programs.
Under current law, the Wisconsin Service Corps employs young adults to work
on community service activities that address the social, health, and economic needs
of communities within Milwaukee County. This bill eliminates the Wisconsin
Service Corps.
Current law requires DWD to provide a Trade Masters Pilot Program to
recognize advanced training and postapprenticeship achievements in three trades,
crafts, or businesses, one of which must be in the industrial sector, one in the
construction sector, and one in the service sector of the economy. This bill eliminates
the program.
Current law requires DWD to administer an Employment Transit Assistance
Program under which DWD conducts projects, or awards grants to local public bodies
and mass transit systems to conduct projects, to improve access to jobs that are
located in outlying suburban and sparsely populated and developed areas that are
not adequately served by a mass transit system. This bill eliminates certain
requirements that currently apply to the program, including requirements that all
jobs accessed by the program must pay at least $4 per hour, that fares charged under
the program may not exceed $2 per one-way trip, and that employers of employees
participating in the program must pay at least 50% of the cost per one-way trip for
those employees.
Environment
Water quality
Under the Clean Water Fund Program, Wisconsin makes loans at subsidized
interest rates for projects to control water pollution, including sewage treatment
plants. This bill sets the present value of the Clean Water Fund Program subsidies
that may be provided during the 2003-05 biennium at $92,400,000. The bill also
increases the revenue bonding authority for the Clean Water Fund Program by
$259,670,000.
Under the Safe Drinking Water Loan Program, Wisconsin makes loans at
subsidized interest rates to local governmental units for projects to construct or
modify public water systems. This bill sets the present value of the Safe Drinking
Water Loan Program subsidies that may be provided during the 2003-05 biennium
at $12,800,000.
Under current law, DNR provides financial assistance for measures to reduce
water pollution from nonpoint (diffuse) sources. This bill increases the general
obligation bonding authority for nonpoint source financial assistance by $9,546,800.
Under current law, DNR also provides financial assistance for the management
of urban storm water runoff and for flood control projects. This bill increases the
general obligation bonding authority for these programs by $4,700,000.
Hazardous substances and environmental cleanup
Under the Brownfields Grant Program, the Department of Commerce awards
grants for the redevelopment of brownfields and remediation activities associated
with that redevelopment. Brownfields are abandoned, idle, or underused industrial
or commercial facilities or sites the expansion or redevelopment of which is adversely
affected by actual or perceived environmental contamination. Also under current
law, DNR awards grants to local governmental units for investigating environmental
contamination; to municipalities for conducting cleanups of brownfields; and to local
governmental units for brownfields remediation projects that have long-term public
benefits, including the preservation of green space.
This bill eliminates the Brownfields Grant Program administered by the
Department of Commerce and the grant programs related to brownfields
administered by DNR. The bill establishes a new Brownfields Grant Program, under
which DNR awards grants to local governmental units and private entities to
determine the existence and extent of environmental contamination in brownfields
and to remove or contain environmental contamination and restore the environment
at brownfields.
Under current law, the Department of Commerce administers a program
(commonly called PECFA) to reimburse owners of petroleum product storage tanks
for a portion of the costs of cleaning up discharges from those tanks. This bill
increases the revenue bonding authority for PECFA by $115,000,000.
Under the Land Recycling Loan Program, Wisconsin makes loans to political
subdivisions for projects to remedy environmental contamination at sites owned by
the political subdivisions where the environmental contamination has affected, or
threatens to affect, groundwater or surface water. The loans are subsidized, so that
recipients are not required to pay interest. This bill sets the present value of the
Land Recycling Loan Program subsidies that may be provided during the 2003-05
biennium at $12,000,000.
Current law authorizes DNR to conduct or fund activities to remedy
environmental contamination in some situations. This bill increases the authorized
general obligation bonding authority to finance those activities by $6,000,000.
Other environment
Current law authorizes DNR to establish fees for inspecting nonresidential
asbestos demolition and renovation projects that DNR regulates. The fees may not
exceed $210 per project. This bill increases the maximum fees to $450 or $750,
depending on the size of the project. The bill also authorizes DNR to charge
separately for the costs it incurs for laboratory testing for these projects.
Under current law, the Waste Facility Siting Board (WFSB) oversees
negotiations and arbitration between local governments and persons who want to
establish or expand landfills. This bill eliminates the authority of WFSB to appoint
an executive director. The bill requires the Division of Hearings and Appeals,
attached to DOA for administrative purposes, to provide staff to assist WFSB in
performing its duties.
Gambling
Currently, the administrator of the Lottery Division of DOR may determine
whether lottery functions should be performed by DOR or by persons under contract
with DOA. Current law, however, prohibits contracting out the entire management
and operations of the state lottery and specifically prohibits contracting out financial
auditing and security monitoring services. This bill authorizes the administrator to
determine whether any lottery functions, other than procurement and financial
auditing services, should be performed by persons under contract with DOA.
The bill also creates a process whereby the governor, upon the request of DOR,
may create positions funded from lottery revenues in DOR to perform services
relating to the state lottery that are not performed by one or more persons under
contract with DOA.
Current law regulating procurement for the state lottery requires separate bids
to provide instant lottery ticket services and supplies and on-line services and
supplies for the state lottery. This bill eliminates the requirement of separate bids.
Currently, all revenue received by the state under Indian Gaming compacts
funds gaming law enforcement, the Indian gaming operations of the Division of
Gaming in DOA, and a variety of specified programs.
This bill requires that only the first $24,352,500 received in any fiscal year
under these compacts be used for these programs. Receipts that exceed this amount
are available for other purposes under the bill, except that not more than
$112,000,000 may be made available during the 2003-04 fiscal year and not more
than $125,000,000 may be made available during any fiscal year thereafter.
Health and human services
Public assistance
Under administrative rules promulgated by DHFS, persons with family
incomes at or above 300% of the federal poverty line must contribute a certain
percentage of their family incomes for the cost of their medical treatment before
assistance will be provided under the Chronic Disease Aids Program, which provides
financial assistance for the cost of medical care for the treatment of chronic kidney
disease, cystic fibrosis, and hemophilia to persons with those conditions. This bill
increases by 0.25% the percentage of family income that a family must contribute
under the rules. In addition, the bill requires DHFS to promulgate rules requiring
persons with family incomes at or above 200% of the federal poverty line to contribute
a certain percentage of their family incomes for the cost of their medical treatment
before assistance will be provided under the program.
The administrative rules currently require a person receiving benefits under
the program to pay a $5 copayment for a generic prescription drug and a $10
copayment for a brand name prescription drug for which a pharmacy directly bills
the program. The bill changes the copayment amount for a brand name prescription
drug to $15.
The bill makes three additional changes to the Chronic Disease Aids Program.
The bill authorizes DHFS to use managed care methods of cost containment;
eliminates the requirement that the rates paid by DHFS for services provided for the
treatment of chronic kidney disease be equal to the allowable charges under the
federal Medicare program and prohibits a provider from billing a patient for any
difference between the amount that the state pays and the provider's charge for the
service; and provides that a person may not receive benefits under the program
unless, before applying, the person applies for benefits under other health care
coverage programs for which he or she reasonably may be eligible.
Under current law, county departments of social services or human services pay
cemetery, funeral, and burial expenses for decedents whose estates are insufficient
to pay those expenses and who received certain public assistance benefits, such as
Wisconsin Works benefits or Medical Assistance (MA) benefits. The county
departments are reimbursed for those payments by DWD. Under current law, DHFS
contracts with county departments to administer the MA program, the Badger Care
health care program, and the food stamp program and reimburses the county
departments for their administration costs.
Under this bill, DHFS, instead of DWD, reimburses county departments for the
payments that they make for cemetery, funeral, and burial expenses. In addition,
the bill provides that DHFS reimburses county departments for their expenses
incurred in determining eligibility for that program. The bill allows, rather than
requires, DHFS to delegate to county departments the administrative function of
determining eligibility under the MA program.
Wisconsin Works
Wisconsin Works program
The current Wisconsin Works (W-2) program provides work experience and
benefits for low-income custodial parents who are at least 18 years old, as well as job
search assistance to noncustodial parents who are required to pay child support, to
minor custodial parents, and to pregnant women who are not custodial parents.
Also, the parent of a child under the age of 13 or, if the child is disabled, under the
age of 19, is eligible for a child care subsidy under W-2 if the parent needs child care
services to participate in various educational or work activities. W-2 is administered
generally by DWD, which contracts with W-2 agencies to administer the program
locally. W-2 is funded with federal Temporary Assistance for Needy Families
(TANF) block grant money, federal child care block grant moneys, and state general
purpose revenue. In general, an individual may not participate in W-2 more than
five years, which need not be continuous.
Current employment positions
The work components under W-2, called employment positions, consist of three
categories: trial job, community service job, and transitional placement. Employers
for all employment positions must meet criteria established by DWD and all
participants in all employment positions must search for unsubsidized employment
the entire time that they are participating in any W-2 employment position.
Trial jobs. When determining which employment position is the most
appropriate placement for a participant, a W-2 agency must give the highest priority
to trial jobs. A participant in a trial job is paid by his or her employer at least the
minimum wage for every hour actually worked, but not exceeding 40 hours per week,
including required education and training. The W-2 agency pays a wage subsidy of
$300 per month to a trial job employer that agrees to make a good faith effort to retain
the participant as a permanent unsubsidized employee after the trial job terminates.
The employer must provide worker's compensation coverage for a trial job employee.
Unless the W-2 agency grants an extension, a participant may work in any one trial
job for up to three months, and for up to 24 months, which need not be consecutive,
in more than one trial job.
Community service jobs. A W-2 agency must give higher priority to a
community service job than to a transitional placement when placing a W-2
participant. Community service jobs are limited to projects that DWD determines
will serve a useful public purpose or that will generate revenue that wholly or
partially offsets the project's cost. A participant in a community service job may not
work more than 30 hours per week and may be required to participate in education
or training for up to ten hours per week. A participant in a community service job
who works more than 20 hours per week receives from the W-2 agency a monthly
grant of $673, which is reduced if the participant works 20 or fewer hours per week.
In addition, the monthly grant that a participant would receive based on the number
of his or her work hours is reduced by $5.15 for every hour of work that a participant
misses without good cause. Generally, the W-2 agency must provide worker's
compensation coverage for a participant in a community service job. Unless the W-2
agency grants an extension, a participant may work in any one community service
job for up to six months, and for up to 24 months, which need not be consecutive, in
more than one community service job.
Transitional placement. A W-2 participant may be placed in a transitional
placement if he or she has been or will be incapacitated for at least 60 days, is needed
at home because of the illness or incapacity of a member of his or her household, or
is incapable of performing a trial job or community service job. A transitional
placement may consist of work in a community rehabilitation program, a job similar
to a community service job, or volunteer activities. A participant in a transitional
placement may be required to work for up to 28 hours per week and to participate
in education and training for up to 12 hours per week. A participant in a transitional
placement may be required to participate in mental health activities, counseling or
rehabilitation, or alcohol and other drug abuse treatment. A participant in a
transitional placement receives from the W-2 agency a monthly grant of $628, which
is reduced by $5.15 for every hour that a participant fails to participate in any
required activity without good cause. Generally, the W-2 agency must provide
worker's compensation coverage for a participant in a transitional placement.
Unless the W-2 agency grants an extension, a participant may participate in a
transitional placement for up to 24 months, which need not be consecutive.
New employment position
Transitional subsidized private sector jobs. This bill creates a new employment
position in W-2, called a transitional subsidized private sector job. A W-2 agency
must give placement in a transitional subsidized private sector job the same priority
as placement in a community service job. If a W-2 agency determines that placement
in either a transitional subsidized private sector job or a community service job is
appropriate for a participant, the participant must be allowed to choose between the
two placements. A participant who chooses placement in a transitional subsidized
private sector job will be offered a choice of one or more jobs in locations that are
reasonably accessible to the participant.
Employers for transitional subsidized private sector jobs must be selected by
DWD in a request-for-proposals process. To be selected, an employer must show the
ability to create useful transitional subsidized private sector jobs. A selected
employer that employs a participant in a transitional subsidized private sector job
is reimbursed by DWD for up to 100% of the employer's costs that are attributable
to employing the participant, such as wages, federal social security taxes, and
worker's compensation and liability insurance premiums.
Each transitional subsidized private sector job must be designed by the
employer, in consultation with DWD and the W-2 agency, for the participant who is
offered the job. DWD may design a transitional subsidized private sector job that
allows a participant to work in supported employment or to care for a severely
disabled child or other relative. Each transitional subsidized private sector job must
provide 25 to 30 hours of work per week. A participant in a transitional subsidized
private sector job is an employee of his or her employer for all purposes and must be
paid at least the federal minimum wage by the employer. DWD may require that a
participant in a transitional subsidized private sector job be given a sick leave
benefit.
After a participant has been working satisfactorily in a transitional subsidized
private sector job for at least two weeks, the participant and W-2 agency, in
consultation with the employer, may enter into an agreement allowing the
participant to enroll in education or training to acquire skills leading to unsubsidized
employment, reducing the participant's hours in the transitional subsidized private
sector job to 15 to 20 hours, and requiring the W-2 agency to pay the participant a
stipend equal to 90% of what the participant would have earned in the transitional
subsidized private sector job if his or her hours had not been reduced.
Unless the W-2 agency grants an extension, a participant may work in any one
transitional subsidized private sector job for up to six months, and for up to 24
months, which need not be consecutive, in more than one transitional subsidized
private sector job. A participant in a transitional subsidized private sector job may
be terminated by his or her employer for misconduct, failure to perform work
satisfactorily, or repeated unexcused absences. A participant may also be
terminated from a transitional subsidized private sector job by the W-2 agency for
not making a good faith effort to seek unsubsidized employment. In either case, a
participant who believes that he or she was wrongfully terminated may appeal the
termination to DWD.
Caretaker of newborn infant program change and studies
Under current law, a person who meets the eligibility requirements for W-2 and
who is the custodial parent of a child who is 12 weeks old or younger may receive a
monthly grant of $673 and may not be required to participate in a W-2 employment
position. This bill increases the maximum age of the child so that the custodial
parent of a child who is six months old or younger may receive the monthly grant and
may not be required to participate in an employment position.
The bill directs DWD to conduct a study to determine the best ways to assist
low-income custodial parents and other at-risk low-income adults in getting and
keeping a job. DWD must submit a report with its findings and recommendations
to the governor and legislature. The bill also directs DWD to investigate ways in
which federal funding other than TANF block grants can be used to create a seamless
system of employment and education training services for low-income adults in
Wisconsin and to submit a report on its findings to DOA.
Under current law, DWD certifies to DOR any overpayment of food stamp
benefits or various benefits under W-2 for recovery as a setoff against any income
tax refund owed to the person who received the overpayment. Also under current
law, DWD makes job access loans to persons who are eligible for W-2 to enable them
to obtain or continue employment.
This bill authorizes DWD to certify delinquent job access loan repayments to
DOR for setoff against any income tax refund owed to the person who received the
loan. Delinquent repayment amounts collected by DOR and paid to DWD must be
used to make more job access loans.
Medical Assistance
Under current law, the MA trust fund (MATF) consists of all public funds for
MA nursing home payments that are transferred to the MATF as the nonfederal
share for the purpose of claiming federal moneys, and of all the matching moneys
received in return under the federal MA program (commonly known as Medicaid).
Counties that make these transfers to the MATF are reimbursed by DHFS from the
general fund.
This bill appropriates money from the MATF to reimburse counties for the
moneys the counties transferred to the state in support of MA payment for nursing
home services and that were used as the nonfederal share of MA payments.
Currently, under a waiver of federal Medicaid laws, DHFS administers a
community integration program (commonly known as CIP IA) under which MA
recipients who reside in state centers for the developmentally disabled are relocated
into their communities and provided home and community-based services. DHFS
administers another similar community integration program (commonly known as
"CIP IB"), under which persons with developmental disabilities who are relocated
from institutions other than state centers for the developmentally disabled or who
meet requirements for the care provided in intermediate care facilities for the
mentally retarded or brain injury rehabilitation facilities are relocated into their
communities.
This bill appropriates the moneys received from counties to provide
supplemental MA program benefits for CIP IA and CIP IB, emergency medical
transportation services, alcohol and other drug abuse and mental health treatment
and services, and school medical services, as part of a claim for federal Medicaid
matching moneys. The moneys counties must pay are related to the federal share
of rate increases for CIP IA and CIP IB beginning in 2001, the federal share of rate
increases for alcohol and other drug abuse and mental health treatment and services
beginning in 2003, and the moneys paid in support of the claim for federal Medicaid
matching moneys. If the amount received by DHFS exceeds payments for services,
the excess must be transferred to the MATF. The bill annually decreases the total
amount paid to school districts for special education by the amount of the
supplementary payment for MA school-based services received. In addition, the bill
expands the MATF to include moneys that are related to any MA service. Lastly, the
bill authorizes DHFS to award grants to counties from the MATF for mental health
community support programs and to distribute to counties and local health
departments from the MATF an amount equal to the amount that was distributed
in 2002 to reduce operating deficits.
Under current law, persons who apply for admission to nursing homes, state
centers for the developmentally disabled, or institutions for mental diseases,
including persons who are found by a court to be in need of protective services and
are protectively placed, must be screened to determine if they have a developmental
disability or mental illness and need facility care and active treatment. Residents
of these facilities who have a developmental disability or mental illness and
significant changes in their physical or mental conditions must also be screened to
determine if they need facility care or active treatment. Persons who are not in need
of facility care must be relocated. Currently, counties must provide the portion of the
MA program payment that is not provided by the federal government for services to
individuals in state centers for the developmentally disabled who are also mentally
ill and exhibit extremely aggressive and challenging behaviors. Under CIP IB, a
county that owns the institution from which a person is relocated into the community
must receive approval from DHFS of a plan for delicensing a bed of the institution
for the county to obtain reimbursement for the person's community care.
This bill restricts protective placements and admissions, after March 31, 2004,
of persons with developmental disabilities to intermediate facilities and nursing
facilities. Within 90 days after receiving written notice of the prospective placement
or admission of a person with developmental disabilities in an intermediate facility,
a county department of social services, human services, developmental disabilities
services, or community programs must develop a plan for providing home or
community-based care to the person in a noninstitutional setting. The person may
not be placed in or admitted to the intermediate facility unless a court finds that
placement in the community under such a plan is not in the person's best interests,
or the person or his or her guardian rejects the plan. Also, a person who has been
screened and found to require active treatment for developmental disability may not
be placed in or admitted to a nursing facility unless his or her need for care cannot
be met in an intermediate facility or under a plan for home or community care.
The bill requires that residents of state centers for the developmentally
disabled who have been determined to need facility care and active treatment for
developmental disability be further screened to determine whether the level of care
that they require could be provided safely in an intermediate facility or under a plan
for home or community care.
The bill prohibits payment of the federal portion of MA for services for a
resident in a state center for the developmentally disabled who is also mentally ill
and exhibits extremely aggressive and challenging behaviors unless the person
receiving the services has been protectively or temporarily placed in the state center
or is placed there for emergency purposes. The bill requires that counties pay the
portion of MA that is not provided by the federal government for services to persons
with developmental disabilities in an intermediate care facility for the mentally
retarded and, if they have been determined to need facility care, for services in a
nursing facility; however, no payment of the federal portion of MA for services to
these persons may be made unless they were placed in or admitted to the facility after
the placing board considered a plan for home or community care and rejected the plan
or found it would not meet their needs. The requirements and limitations first apply
to services provided and payment made on April 1, 2004.
The bill changes laws relating to protective placement of persons who are found
incompetent. Under the bill, the court must notify the appropriate county
department to develop a plan for home or community care for a person about to be
protectively placed and the person must be placed in a noninstitutional community
setting under the plan unless the court finds that placement for home or community
care would not be in the person's best interests.
Under current law, a community integration program (commonly known as CIP
II) provides home or community-based care to persons who are relocated from
institutions other than the state centers for the developmentally disabled and to
persons who meet MA level-of-care requirements in nursing homes.
Beginning on June 1, 2004, this bill requires a county department of human
services, developmental disabilities services, or community programs of a county
that participates in CIP II or CIP IB to perform a needs and costs-based assessment
for nursing home residents who are eligible for but not receiving services under the
program; who have received MA coverage for their nursing home care for at least 30
days; and who prefer services in the community, rather than in the nursing home.
After completing the assessment, the county department must contact DHFS; if
DHFS determines that costs for services for the nursing home resident are below the
limit under a formula specified in the bill, or if DHFS determines that additional
funding is available for above-limit costs, the county department must offer the
home or community-based services to the nursing home resident. The county
department must initiate the assessment before the person has resided in the
nursing home for 90 days or before the cost of the resident's nursing home care has
been paid for under MA for 30 days, whichever is longer, and must complete the
assessment within 90 days. A county department that fails to meet these
requirements and to offer home or community-based care to the resident must pay
the nonfederal share of the resident's MA nursing home care unless the resident
refused to participate or the assessment determined that relocation was not feasible.
Beginning on January 1, 2004, DHFS is authorized to provide funding to counties
from the MA trust fund to conduct these relocation activities and to provide increased
funding for services to the nursing home residents who are relocated to communities.
This bill authorizes DHFS to assess each health maintenance organization
(HMO) 1% of its annual gross revenue, based on a statement that it must file with
OCI annually by March 1. The assessments are deposited into the MA trust fund.
In addition, the bill requires DHFS to distribute moneys in each fiscal year from the
MA trust fund to supplement MA payments to HMOs that provide services to MA
recipients; to supplement payments to HMOs that provide services to recipients of
Badger Care (a program of health care coverage for certain low-income children who
do not reside with a parent and for certain low-income families); to assist in meeting
increasing costs and more intense use of services by recipients; and to meet other
reimbursement needs that DHFS identifies.
Currently, DHFS must distribute in each fiscal year not more than $2,256,000
in supplemental payments to rural hospitals with high use of inpatient services by
patients whose care is paid for by the state or federal government, and to rural
hospitals that meet certain federal MA requirements. This bill eliminates MA
supplemental payments by DHFS to rural hospitals with high MA recipient use and
eliminates the statutory limit on the amount of supplemental payments that DHFS
must make to critical access hospitals.
Under current law, payments to nursing homes for services to recipients under
the MA program are calculated using a formula that considers certain costs of
individual nursing homes, including direct care, support services, fuel and utilities,
net property tax or municipal services, administrative and general costs, interest
expenses, and necessary capital payments. For direct care costs, DHFS must use
standards that sample nursing homes in the state, as adjusted for regional labor cost
variations. For nursing homes in Douglas, Pierce, and St. Croix counties, DHFS uses
a federal Medicare program hospital wage index.
This bill requires DHFS to make a flat-rate payment for MA nursing home
costs, as determined by DHFS, for personal comfort supplies and allowable support
service costs. Beginning July 1, 2004, the bill requires an MA flat-rate payment for
support services (dietary services, environmental services, fuel and utilities,
administrative and general costs) and direct care costs (personal comfort supplies,
medical supplies, over-the-counter drugs and nonbillable services for ancillary
nursing home personnel). Under the bill, cost-based payment will continue to be
made for nonbillable direct care costs for registered nurses, licensed practical nurses,
and nurse's assistants; property tax or municipal services; interest expenses; and
necessary capital payments. The bill eliminates the use of a federal Medicare
Program hospital wage index in calculating MA direct care costs for nursing homes
in Douglas, Pierce, and St. Croix counties and requires, instead, that direct care costs
for nursing homes in those counties be calculated as are direct care costs for nursing
homes in other counties. The bill clarifies that "costs for property taxes and
municipal services" refer to paid, rather than incurred, costs.
Under current law, counties may transfer moneys to the state as the nonfederal
share of public moneys to serve as the basis for claims for federal Medicaid matching
moneys. These federal matching moneys reduce the operating deficits of county, city,
village, or town nursing homes. Currently, if federal matching moneys that are
related to the transfers are not received in a fiscal year, DHFS may distribute up to
$37,100,000 to these facilities or a lesser amount if other federal Medicaid matching
moneys are reduced. If federal matching moneys that are related to the transfers are
received in a fiscal year, DHFS may distribute up to $77,100,000 to these facilities
and to care management organizations that contract with the facilities for services.
This bill eliminates the distinction between receipt and nonreceipt of federal
matching moneys that are related to the transfers with respect to distributing
moneys to reduce the operating deficits of county, city, village, or town nursing homes
and, instead, authorizes DHFS to distribute up to a total of $37,100,000 to these
facilities and to care management organizations.
Under current law, DHFS provides health care services to eligible individuals
under the MA program. Current law requires certain MA recipients to share the cost
of medical services provided under MA by paying up to the maximum amount
allowable under federal law. Current law also limits to $5 per month the total
amount that an MA recipient may be required to pay for prescription drugs if the
recipient designates a pharmacy or pharmacist as his or her sole provider of
prescription drugs.
Under this bill, MA recipients who must pay a portion of their medical services
must pay a copayment of $1 for each prescription for a generic drug and a copayment
of $3 for each prescription for a brand name drug. The bill also raises to $12 per
month the maximum amount an MA recipient may be required to pay for
prescription drugs if the MA recipient designates a pharmacy or pharmacist as his
or her sole provider of prescription drugs.
Under current law, a child or family with health care coverage under
BadgerCare and with an income that is equal to or greater than 150% of the federal
poverty level must contribute a percentage of income to the cost of the health care
according to a schedule established by DHFS. Current law requires DHFS to submit
the schedule to JCF for review and approval if the schedule requires a child or family
to contribute more than 3% of the child's or family's income to the cost of health care,
and JCF may not approve a schedule that requires a child or family to contribute
more than 3.5% of the child's or family's income.
Under this bill, each child or member of a family with health care coverage
under BadgerCare and with an income that is equal to or greater than 150% of the
federal poverty level must pay a copayment of $1 for each prescription for a generic
drug and a copayment of $3 for each prescription for a brand name drug. The bill
eliminates the requirement that DHFS submit the cost-sharing schedule to JCF and
prohibits DHFS from establishing or implementing a cost-sharing schedule that
requires a child or family to contribute more than 5% of income to the cost of health
care.
This bill authorizes DHFS to design and implement a program to reduce the
cost of prescription drugs and to maintain high quality in prescription drug
therapies. The program must include supplemental rebates under agreements with
prescription drug manufacturers for prescription drugs provided to MA and Badger
Care recipients and to persons eligible under a program of prescription drug
assistance to elderly persons (commonly known as Senior Care). The bill also
authorizes DHFS to enter into prescription drug multi-state purchasing agreements
and other agreements with prescription drug purchasers if the other state or
purchaser agrees to participate in any of the activities under the program.
Under current law, if a person who is eligible for BadgerCare or the purchase
plan portion of the MA program is also eligible for health care coverage that is offered
by an employer, DHFS may purchase the employer-offered health care coverage on
behalf of the person if DHFS determines that purchasing the coverage will not cost
more than providing the coverage under BadgerCare or MA.
Also under current law, if an employer offers health care coverage to its
employees, in some cases the insurer that provides the coverage must allow an
employee, or an employee's dependent, to enroll in the health care coverage plan
outside the usual enrollment periods. For example, if an employee refused coverage
under the employer's health care coverage plan during a previous enrollment period
because the employee had other health care coverage, the employee may enroll in the
employer's plan within 30 days after the other health care coverage terminates or is
exhausted. Likewise, if an employee gets married or adopts a child, the employee's
spouse or child may enroll in the employer's health care coverage plan during a
special enrollment period that lasts for 30 days from the date of the marriage or
adoption.
This bill requires an insurer that provides coverage under an employer's health
care coverage plan to permit an employee, or an employee's dependent, who is eligible
for but not enrolled in the employer's health care coverage plan to enroll in the
employer's plan during a special, 30-day enrollment period if: 1) the employee or
dependent is eligible for coverage under BadgerCare or MA; and 2) DHFS will
purchase the coverage on behalf of the employee or dependent because DHFS has
determined that it will not be more costly to pay the portion of the premium for which
the employee is responsible under the employer's plan than to provide coverage for
the employee or dependent under BadgerCare or MA. The 30-day enrollment period
begins on the date on which DHFS makes the determination about the cost of the
coverage.
Also under the bill, if DHFS determines that a waiver is required, DHFS must
request a waiver from the federal Department of Health and Human Services to
allow DHFS to require a family, as a condition of eligibility for BadgerCare, to provide
verification of an employed family member's earnings; whether the employer
provides health care coverage for which the family is eligible; and the amount that
the employer pays, if any, towards the cost of the health care coverage. Under current
law, a family with income below 185% of the poverty line is eligible for BadgerCare
if the family does not have access to employer-provided health care coverage for
which the employer pays at least 80% of the cost.
Under current law, a woman who has been screened for breast or cervical cancer
under a breast and cervical cancer early detection program authorized under a
federal grant, who requires treatment for breast or cervical cancer, who is under 65
years of age, and who is not eligible for health care coverage that qualifies under a
federal law as creditable coverage, (which generally includes any type of health care
coverage) is eligible for MA.
This bill expands the MA eligibility based on breast or cervical cancer in two
ways. First, in conformity with the interpretation of the Centers for Medicare and
Medicaid Services, the requirement that the woman is being treated for breast or
cervical cancer is expanded to include treatment for a precancerous condition of the
breast or cervix. Second, the requirement that a woman must be ineligible for
creditable coverage is changed, in conformity with a change in federal law, to exclude
from consideration eligibility for a medical care program of the federal Indian Health
Service or an American Indian tribal organization.
Under current law, a person who receives MA and who is in a public medical
institution, hospital, skilled nursing facility, or intermediate care facility generally
may retain $45 per month in unearned income for personal needs and must apply
any excess income toward the cost of his or her care in the institution or facility. This
bill changes the amount that may be retained for personal needs to $30 per month.
Under current law, to qualify for MA, an applicant must meet certain income
and asset limits. DHFS must exclude certain assets when determining whether an
applicant meets the asset limit, including up to $3,000 in an irrevocable burial trust.
This bill decreases the limit on an irrevocable burial trust to $1,500.
Under current law, mental health and psychological rehabilitative services
provided by a community support program to individuals with mental illness who
live in the community are a covered benefit under MA. The county pays all costs for
the services that are not paid by the federal government. Also covered, but only if
a county elects to offer the services as a benefit, are psychosocial services provided
by a community-based psychosocial service program to individuals with less severe
mental illness who live in the community. A county that elects to provide the services
as a benefit must pay all costs not paid by the federal government. This bill
eliminates psychosocial services provided by a community-based psychosocial
service program as a benefit under MA.
Under current law, county departments of social services, human services, and
developmental disabilities services, and local health departments that have
incurred costs in excess of reimbursement for providing certain services to MA
recipients may receive from DHFS a 60% federal Medicaid matching amount for
moneys the county departments and local health departments expend to reduce
operating deficits for those costs.
The bill makes these matching payments unavailable if the federal Center for
Medicare and Medicaid Services approves a revised payment methodology for MA
services provided by a local government. If this methodology is approved, a county
department or local health department that received a distribution from DHFS of
federal Medicaid matching moneys under the program for any year after 2002 must
return the moneys to DHFS.
Currently, DHFS must make incentive payments to counties for identifying MA
applicants and recipients who have other health insurance coverage and for
identifying providers of the other coverage. This bill eliminates this requirement.
Under current law, if a married person living in a medical institution or nursing
facility or receiving long-term care through a community-based program
(institutionalized spouse) is eligible for MA and his or her spouse is not also in a
medical institution or nursing facility or receiving long-term care through a
community-based program (community spouse), a certain amount of the couple's
assets need not be used to pay for the institutionalized spouse's care and may be
transferred to or retained by the community spouse. This asset amount is called the
"community spouse resource allowance," which under current law is the greatest of
a range of specified amounts.
To comply with a federal requirement that the community spouse resource
allowance be a single amount instead of a range, this bill changes the community
spouse resource allowance to $50,000 unless the amount established in a fair hearing
or by a court order is greater.
