In order to continue complying with section 6008 of the FFCRA and to receive up to $150 million in federal funding per quarter, the Department has determined that permanent rules that supplant the emergency rule currently in effect and temporarily suspend certain Medicaid eligibility provisions are necessary so that the Department maintains continuous enrollment of Medicaid recipients during the declared emergency period. The permanent rule will create sunset provisions that seek to amend or create provisions in chs. DHS 102, 103 and 109 specific to maintaining continuous Medicaid enrollment, and then repeal those provisions after end of the federal public health emergency. Summary of, and comparison with, existing or proposed federal regulations
In order to qualify for increased federal funding under s. 6008 of the FFCRA, states are required to maintain continuous Medicaid eligibility for persons enrolled in Medicaid, unless the person leaves the state or requests disenrollment, and not increase Medicaid premiums during the designated time periods.
Comparison with rules in adjacent states
Illinois:
Not applicable – The rule order is based on authority explicitly granted in 2019 Act 185 s. 105 (1) (a)-(d) and is necessary to gain increased federal funding made available under s. 6008 of the Families First Coronavirus Response Act, P.L. 116-127. Iowa:
Not applicable – The rule order is based on authority explicitly granted in 2019 Act 185 s. 105 (1) (a)-(d) and is necessary to gain increased federal funding made available under s. 6008 of the Families First Coronavirus Response Act, P.L. 116-127. Michigan:
Not applicable – The rule order is based on authority explicitly granted in 2019 Act 185 s. 105 (1) (a)-(d) and is necessary to gain increased federal funding made available under s. 6008 of the Families First Coronavirus Response Act, P.L. 116-127. Minnesota:
Not applicable – The rule order is based on authority explicitly granted in 2019 Act 185 s. 105 (1) (a)-(d) and is necessary to gain increased federal funding made available under s. 6008 of the Families First Coronavirus Response Act, P.L. 116-127. Summary of factual data and analytical methodologies
The Department relied upon requirements under ch. 227, Stats., and information provided to the Department by the Legislative Reference Bureau. Analysis and supporting documents used to determine effect on small business
The rule is not anticipated to have an effect on small business. See the associated Fiscal Estimate & Economic Impact Analysis.
Effect on small business
The rule is not anticipated to have an effect on small business.
Agency contact person
Statement on quality of agency data
See “summary of factual data and analytical methodologies” section above.
Place where comments are to be submitted and deadline for submission
RULE TEXT
SECTION 1. DHS 102.03 (4) is created to read:
DHS 102.03 (4) Subsections (1) to (3) shall not be enforced until the first day of the month following the end of the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic. SECTION 2. DHS 102.03 (4), as affected by this rule, is repealed.
SECTION 3. DHS 102.04 (4) is created to read:
DHS 102.04 (4) Review of eligibility suspended during the COVID-19 pandemic. All provisions regarding the review of eligibility in accordance with sub. (3) shall be suspended until the first day of the month following the end of the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic. SECTION 4. DHS 102.04 (4), as affected by this rule, is repealed.
SECTION 5. DHS 103.03 (intro.) is amended to read:
DHS 103.03 Non−financial conditions for eligibility. In order to be eligible for MA, a person shall meet both non−financial conditions for eligibility in this section and financial conditions for eligibility under s. DHS 103.04. Once determined eligible, a person shall continue to receive benefits until the person either requests the benefits to be ended, the person loses Wisconsin residency as defined in sub. (3), or the person becomes deceased. The non−financial conditions for eligibility are: SECTION 6. DHS 103.03 (intro.), as affected by this rule, is amended to read:
DHS 103.03 (intro.) Non−financial conditions for eligibility. In order to be eligible for MA, a person shall meet both non−financial conditions for eligibility in this section and financial conditions for eligibility under s. DHS 103.04. Once determined eligible, a person shall continue to receive benefits until the person either requests the benefits to be ended, the person loses Wisconsin residency as defined in sub. (3), or the person becomes deceased. The non−financial conditions for eligibility are: SECTION 7. DHS 103.03 (1) (g) 4. and (1) (h) 5. are created to read:
DHS 103.03 (1) (g) 4. The non-financial eligibility requirements in s. subs. 1. of this paragraph shall not be enforced until the first day of the month following the end of the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic. DHS 103.03 (1) (h) 5. ‘Suspension during the COVID-19 pandemic.’ The Medicaid purchase plan health and employment counseling eligibility provisions in this subds. 1. to 4. of this paragraph shall not be enforced until the first day of the month following the end of the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic. SECTION 8. DHS 103.03 (1) (g) 4. and (1) (h) 5., as affected by this rule, are repealed.
SECTION 9. DHS 103.08 (2) (c) 1. is amended to read:
DHS 103.08 (2) (c) 1. Once the expenditure or obligation of excess income has been achieved, the AFDC−related or SSI−related MA group shall be eligible for the balance of the 6–month spend–down period, unless it is determined that assets have increased enough to make the MA group ineligible, or that a change in circumstances has caused someone in the MA group to become ineligible for non−financial reasons remain eligible for MA.
SECTION 10. DHS 103.08 (2) (c) 1., as affected by this rule, is amended to read:
DHS 103.08 (2) (c) 1. Once the expenditure or obligation of excess income has been achieved, the AFDC−related or SSI−related MA group shall remain eligible for MA be eligible for the balance of the 6–month spend–down period, unless it is determined that assets have increased enough to make the MA group ineligible, or that a change in circumstances has caused someone in the MA group to become ineligible for non−financial reasons.
SECTION 11. DHS 103.08 (2) (c) 2. is amended to read:
DHS 103.08 (2) (c) 2. If the entire group is determined ineligible, the MA benefits shall be discontinued with proper notice. If only one person in the MA group is determined ineligible for non-financial reasons, only that person's AFDC-related or SSI-related MA benefits shall, with proper notice, be discontinued. The other person or persons in the MA group continue their eligibility until the end of the 6–month period. This provision shall not be enforced until the first day of the month following the end of the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic. SECTION 12. DHS 103.08 (2) (c) 2., as affected by this rule, is amended to read:
DHS 103.08 (2) (c) 2. If the entire group is determined ineligible, the MA benefits shall be discontinued with proper notice. If only one person in the MA group is determined ineligible for non-financial reasons, only that person's AFDC-related or SSI-related MA benefits shall, with proper notice, be discontinued. The other person or persons in the MA group continue their eligibility until the end of the 6–month period. This provision shall not be enforced during the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic. SECTION 13. DHS 103.087 (1) (h) 5. is created to read:
DHS 103.087 (1) (h) 5. The requirements of this paragraph shall not be enforced until the first day of the quarter or the first day of the calendar month following the month in which the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic, whichever occurs later. SECTION 14. DHS 103.087 (1) (h) 5., as affected by this rule, is repealed.
SECTION 15. DHS 103.09 (2) and (3) (a) to (c) are amended to read:
DHS 103.09 (2) Four-month continuation of eligibility Continuation of eligibility when excess income from spousal support. When an MA group becomes ineligible for AFDC due solely to excess income, is receiving child support payments and all of the excess income consists of child support collections, and has received an AFDC payment in at least 3 of the 6 months immediately preceding the month in which ineligibility begins, eligibility for MA shall continue for 4 months from the date that AFDC eligibility was terminated. The 6 months preceding the month in which ineligibility begins includes the month in which the MA group became ineligible for AFDC if the MA group was eligible for and received AFDC for that month.
DHS 103.09 (3)Twelve-month continuation of eligibility Continuation of eligibility when earned income changes.
(a) When an MA group becomes ineligible for AFDC due to loss of the earned income disregards under s. 49.19 (5) (a) 4. and 4m., or (am), Stats., or to a change in the amount of earned income disregards under s. 49.19 (5) (a) 4. and 4m., or (am), Stats., eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated. DHS 103.09 (3) (b) When an MA group becomes ineligible for AFDC due to an increase in earned income or an increase in hours of employment or a combination of increased earned income and increased hours of employment, eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated provided that at least one member of the MA group received AFDC for at least 3 of the 6 months immediately preceding the month in which AFDC was discontinued and at least one member of the MA group is continuously employed during that period.
DHS 103.09 (3) (c) When an MA group becomes ineligible for AFDC due to an increase in earned income, or to a combination of an increase in earned income and in increase in child support payments, and has received an AFDC payment in at least 3 of the 6 months immediately preceding the month in which ineligibility begins, eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated. The 6 months preceding the month in which ineligibility begins includes the month in which the MA group became ineligible for AFDC if the MA group was eligible for and received AFDC for that month.
SECTION 16. DHS 103.09 (2) and (3) (a) to (c), as affected by this rule, are amended to read:
DHS 103.09 (2) Continuation of eligibility when excess income from spousal support Four-month continuation of eligibility When an MA group becomes ineligible for AFDC due solely to excess income, is receiving child support payments and all of the excess income consists of child support collections, and has received an AFDC payment in at least 3 of the 6 months immediately preceding the month in which ineligibility begins, eligibility for MA shall continue for 4 months from the date that AFDC eligibility was terminated. The 6 months preceding the month in which ineligibility begins includes the month in which the MA group became ineligible for AFDC if the MA group was eligible for and received AFDC for that month.
DHS 103.09 (3) Continuation of eligibility when earned income changes. Twelve-month continuation of eligibility
(a) When an MA group becomes ineligible for AFDC due to loss of the earned income disregards under s. 49.19 (5) (a) 4. and 4m., or (am), Stats., or to a change in the amount of earned income disregards under s. 49.19 (5) (a) 4. and 4m., or (am), Stats., eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated. DHS 103.09 (3) (b) When an MA group becomes ineligible for AFDC due to an increase in earned income or an increase in hours of employment or a combination of increased earned income and increased hours of employment, eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated provided that at least one member of the MA group received AFDC for at least 3 of the 6 months immediately preceding the month in which AFDC was discontinued and at least one member of the MA group is continuously employed during that period.
DHS 103.09 (3) (c) When an MA group becomes ineligible for AFDC due to an increase in earned income, or to a combination of an increase in earned income and in increase in child support payments, and has received an AFDC payment in at least 3 of the 6 months immediately preceding the month in which ineligibility begins, eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated. The 6 months preceding the month in which ineligibility begins includes the month in which the MA group became ineligible for AFDC if the MA group was eligible for and received AFDC for that month.
SECTION 17. DHS 109.11 (6) (e) is created to read:
DHS 109.11 (6) (e) Paragraphs (6) (a) to (d) shall not be enforced until the first day of the month following the end of the emergency period defined in par. (1)(B) of s. 1135(g) of the Social Security Act, 42 USC 1320b-5(g)), and declared by the United States Secretary of Health And Human Services in relation to the COVID-19 pandemic. SECTION 18. DHS 109.11 (6) (e), as affected by this rule, is repealed.
SECTION 19. Effective dates. In accordance with s. 227.22 (2) (intro.), Stats., these rules shall take effect on the first day of the month following publication in the administrative register, except as follows: Sections 2, 4, 6, 8, 10, 12, 16, and 18 of this rule order shall take effect on the first day of the month after the emergency period, as defined in s. 1135 (g) (1) (b) of the Social Security Act, 42 U.S.C. § 1320b-5 (g) (1) (B) and declared in response to the COVID-19 pandemic, ends.
Section 14 of this rule order shall take effect on the first day of the month after the last day of the quarter or on the first day of the calendar month following the month in which the emergency period, as defined in s. 1135 (g) (1) (b) of the Social Security Act, 42 U.S.C. § 1320b-5 (g) (1) (B) and declared in response to the COVID-19 pandemic, ends, whichever occurs later.
