2025 - 2026 LEGISLATURE
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2025 ASSEMBLY BILL 163
April 8, 2025 - Introduced by Representatives PENTERMAN, BROOKS, DUCHOW,
ALLEN, TUCKER, KREIBICH, KNODL and MURPHY, cosponsored by Senators
STAFSHOLT, NASS and KAPENGA. Referred to Committee on Public Benefit
Reform.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to renumber and amend 49.823; to create 49.45 (2) (a) 3m., 49.471
(4d), (4j) and (4p) and 49.823 (2) of the statutes; relating to: redeterminations
of eligibility for the Medical Assistance program and database confirmation
for public assistance program eligibility.
Analysis by the Legislative Reference Bureau
This bill makes various changes to eligibility determinations for the Medical
Assistance program. Currently, the Department of Health Services administers
the Medical Assistance program, a joint federal and state program that provides
health services to individuals who have limited financial resources.
The bill prohibits DHS from automatically renewing the eligibility of a
recipient under the Medical Assistance program. DHS must determine an
individual[s eligibility every six months under the bill. DHS is also prohibited from
using prepopulated forms or otherwise supplying information, except for name and
address, to a recipient under the Medical Assistance program that has been
supplied to DHS. Additionally, any recipient under the Medical Assistance
program that fails to report to DHS or its designee any change that may affect
eligibility within 10 days following such a change is ineligible for benefits for six
months from the date DHS discovers the failure to report the change. Under
current law, knowingly concealing or failing to disclose any event that an individual
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knows affects the initial or continued right to a Medical Assistance benefit is
subject to a forfeiture of not less than $100 nor more than $15,000 for each
concealment or failure. If DHS determines that it is necessary to obtain permission
from the federal Department of Health and Human Services to implement any
portion of the bill with respect to the Medical Assistance program, the bill requires
DHS to request any state plan amendment, waiver of federal law, or other federal
approval necessary to implement that portion of the bill.
The bill requires DHS to enter into data-sharing agreements with any agency
that maintains a database of financial or personal information about residents of
this state. DHS must confirm the information of an applicant for a public
assistance program against the information contained in those databases. The bill
also requires DHS to share data for the purpose of confirming eligibility for public
assistance programs. Current law requires DHS and the Department of Children
and Families to compare each department[s respective databases against the
databases of death records to identify deceased participants.
The bill directs DHS to complete a redetermination of eligibility for all
recipients of Medical Assistance and immediately remove from Medical Assistance
any recipient who is ineligible before January 1, 2026. For all such individuals
removed from the Medical Assistance program, the bill directs DHS to inform them
of the availability of coverage under a qualified health plan that is offered through
an American health benefit exchange and that they may be eligible for premium
assistance.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SECTION 1. 49.45 (2) (a) 3m. of the statutes is created to read:
49.45 (2) (a) 3m. Remove immediately from eligibility for the Medical
Assistance program under sub. (23) or s. 49.471 any individual who has been
determined to be ineligible.
SECTION 2. 49.471 (4d), (4j) and (4p) of the statutes are created to read:
49.471 (4d) REDETERMINATION OF ELIGIBILITY. The department may not
automatically renew the eligibility of a recipient of Medical Assistance benefits
under this section or s. 49.45 (23). The department shall redetermine eligibility for
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the Medical Assistance program under this section or s. 49.45 (23) for each
individual every 6 months. In collecting information from a recipient of Medical
Assistance benefits or an applicant, the department may not use any form that is
prepopulated with, or otherwise provide to the recipient or applicant, information
that has been supplied to the department except for the recipient[s or applicant[s
name and address.
(4j) FAILURE TO REPORT. Any recipient of Medical Assistance benefits under
this section or s. 49.45 (23) who fails to report to the department or an entity
designated by the department any change that may affect the recipient[s eligibility
for benefits within 10 days following such a change shall be ineligible for benefits
under this section or s. 49.45 (23) for 6 months following the date that the
department discovers the failure to report the change.
(4p) FEDERAL APPROVAL. If the department determines that it is necessary to
obtain permission from the federal department of health and human services to
implement sub. (4d) or (4j), the department shall request any state plan
amendment, waiver of federal law, or other federal approval necessary to implement
subs. (4d) and (4j). If federal approval is necessary under this subsection but not
obtained, the department is not required to implement any portion of sub. (4d) or
(4j) for which federal approval is not obtained.
SECTION 3. 49.823 of the statutes is renumbered 49.823 (1) and amended to
read:
49.823 (1) The department of health services and the department of children
and families shall, at least once every 3 months month, perform a comparison of
each department[s respective public benefit database information against
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nationally recognized databases that contain information on death records,
including the federal social security administration[s Death Master File, to identify
participants in public benefit programs that are deceased. If a department
determines during a review under this section subsection that a participant is
deceased, the department shall designate that individual as ineligible for benefits
in any applicable database. The requirements under this section subsection do not
apply to the department of children and families with regard to child care subsidies
under s. 49.155.
SECTION 4. 49.823 (2) of the statutes is created to read:
49.823 (2) The department of health services shall enter into a data-sharing
agreement with the department of children and families, the department of
workforce development, and any other agency that maintains a database of
financial or personal information about residents of this state. The department of
health services, through the data-sharing agreement, shall confirm the information
submitted by an applicant for a public assistance program with the information
contained in other databases held by other agencies, including all available prison
records, death records, wage and employment records, lottery and gaming
winnings, and out-of-state benefits received under the federal food stamp program
under 7 USC 2011 to 2036. The department of health services shall share data
with other agencies for the purposes of confirming eligibility for public assistance
programs.
SECTION 5. Nonstatutory provisions.
(1) MEDICAL ASSISTANCE ELIGIBILITY REDETERMINATIONS .
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(a) In this subsection, XMedical AssistanceY means the program under subch.
IV of ch. 49.
(b) Beginning on the day after the effective date of this paragraph, the
department of health services shall redetermine the eligibility of all recipients of
Medical Assistance and immediately remove from Medical Assistance any recipient
who is ineligible. The department of health services shall complete
redeterminations of eligibility for all recipients of Medical Assistance before
January 1, 2026.
(c) The department of health services shall inform any individual who is
removed from Medical Assistance under par. (b) of the availability of coverage
under a qualified health plan, as defined in 42 USC 18021 (a), that is offered
through an American health benefit exchange, as described in 42 USC 18031, and
that the individual may be eligible for premium assistance under 26 USC 36B.
(END)
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