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AB1225: Bill Text
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2025 - 2026 LEGISLATURE
LRB-5536/1
KMS:skw
2025 ASSEMBLY BILL 1225
March 19, 2026 - Introduced by Representatives
Phelps
,
Clancy
,
Cruz
,
Hong
,
Madison
,
Tenorio
and
Moore Omokunde
. Referred to Committee on Health, Aging and Long-Term Care.
AB1225,1,10
1
An Act
to repeal
20.435 (4) (bb), 49.45 (3) (c), 49.45 (22), 49.45 (56) (c), 49.45
2
(59), 49.665 (4g) (c) and 50.38 (7) (b), (c), (f) and (g);
to renumber and amend
3
49.45 (26g) (a);
to amend
20.435 (4) (xc), 49.45 (2) (b) 2., 49.45 (3) (e) 11., 49.45
4
(3) (em), 49.45 (9) and 49.45 (24k) (a) 2.;
to create
20.435 (1) (dw), 20.435 (4)
5
(bb), 46.93, 49.45 (2) (a) 2m., 49.45 (2) (a) 2s., 49.45 (2) (a) 3m., 49.45 (2) (a) 25.,
6
49.45 (3) (cm), 49.45 (24d), 49.45 (26g) (ab), 49.459 and 49.46 (2) (b) 18m. of the
7
statutes;
relating to:
direct payments for Medical Assistance, Medical
8
Assistance reimbursement rates, care coordination services under the Medical
9
Assistance program, grants for community primary care and outreach, and
10
making an appropriation.
Analysis by the Legislative Reference Bureau
This bill prohibits the Department of Health Services from entering into or renewing a contract with managed care organizations for the provision of Medical Assistance, prohibits DHS from entering into or renewing a contract to shift the risk for Medical Assistance costs to health care providers or other entities, requires DHS to maintain a statewide network of Medical Assistance providers, and directs DHS to pay providers directly, on a fee-for-service basis, for services provided to Medical Assistance recipients. The prohibitions on managed care and risk-shifting contracts do not apply to contracts between DHS and counties that operate managed care organizations for the Family Care, Family Care Partnership, and Program for All-Inclusive Care for the Elderly (PACE) programs, and the requirement for direct payments does not apply to services provided under those programs.
The bill authorizes DHS to contract with administrative services organizations for the administration of the Medical Assistance program. Under the bill, administrative service organizations are noninsurance entities that do not assume financial risk for the cost of Medical Assistance.
In addition, the bill requires DHS to maintain a call center and website to assist Medical Assistance recipients in locating health care providers; provide a nurse consultation helpline for Medical Assistance recipients; assist Medical Assistance recipients who have not had preventive visits in selecting a primary care provider; ensure provider reimbursement rates are reasonable and fair and conform to the requirements of the federal Centers for Medicare and Medicaid services; increase the reimbursement rate for services for which there is a a severe shortage of health care providers due to inadequate reimbursement rates; reimburse Medical Assistance providers on a timely basis; collaborate with Medical Assistance providers to improve health care quality and reduce costs; track data related to the Medical Assistance program; and maintain a publicly accessible dashboard containing the data.
The bill also requires DHS to provide a flat fee payment to primary care providers for care coordination services provided to Medical Assistance recipients. The bill requires DHS to request any necessary waiver of federal law or amendment to the state Medical Assistance plan for federal financial participation in the payments, but requires DHS to provide the payments even if no waiver or amendment is granted. The bill also allows DHS to contract with counties, federally qualified health centers, and community-based programs to provide care coordination services to Medical Assistance recipients.
In addition, the bill requires DHS to award grants as follows:
1. To community health centers and managed care organizations operated by counties for the Family Care, Family Care Partnership, and PACE programs to hire community health workers, nurses, or social workers to perform community outreach and deliver medical care and coordination services to patients who are unlikely to obtain needed care and treatment and assist patients in enrolling in the Medical Assistance program.
2. To community health workers to visit patients in their homes to chart their health status and coordinate the delivery of health care.
The bill provides funding to DHS for the grants, for increasing Medical Assistance provider reimbursement rates, for the cost of administering the Medical Assistance program through direct, fee-for-service payments, and for improving Medical Assistance technology systems and outreach and enrollment efforts.
For further information see the state and local 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:
AB1225,1
1
Section
1
.
20.005 (3) (schedule) of the statutes: at the appropriate place,
2
insert the following amounts for the purposes indicated:
-
See PDF for table
-
See PDF for table
AB1225,2
11
Section
2
.
20.435 (1) (dw) of the statutes is created to read:
AB1225,2,14
12
20.435
(1)
(dw)
Community primary care and outreach grants.
The amounts
13
in the schedule for grants for community primary care and hiring community
14
health workers, nurses, or social workers under s. 46.93 (2).
AB1225,3
15
Section
3
.
20.435 (4) (bb) of the statutes is created to read:
AB1225,2,19
16
20.435
(4)
(bb)
BadgerCare Direct stabilization.
As a continuing
17
appropriation, the amounts in the schedule for the costs of administering the
18
Medical Assistance program through direct, fee-for-service payments to providers
19
as provided in s. 49.459 (2) and (5).
AB1225,4
1
Section
4
.
20.435 (4) (bb) of the statutes, as created by 2025 Wisconsin Act
2
.... (this act), is repealed.
AB1225,5
3
Section
5
.
20.435 (4) (xc) of the statutes, as affected by
2025 Wisconsin Act
4
15
, is amended to read:
AB1225,3,14
5
20.435
(4)
(xc)
Hospital assessment fund; hospital payments.
From the
6
hospital assessment fund, all moneys received from the assessment under s. 50.38
7
(2) (a) and (b), except moneys appropriated under s. 20.285 (1) (qe) and (qj) and
8
except amounts transferred to the Medical Assistance trust fund under s. 50.38 (8),
9
to reimburse eligible hospitals for services provided under the Medical Assistance
10
Program under subch. IV of ch. 49,
make payments to health maintenance
11
organizations under s. 49.45 (59),
provide supplemental funds to rural hospitals
12
under s. 49.45 (5m) (am), make supplemental payments to Level I adult trauma
13
centers under s. 49.45 (6y) (ap), make supplemental payments to hospitals based on
14
performance under s. 49.45 (6y) (ar), and make refunds under s. 50.38 (6).
AB1225,6
15
Section
6
.
46.93 of the statutes is created to read:
AB1225,3,17
16
46.93
Community primary care and outreach grants.
(1)
In this
17
section:
AB1225,3,18
18
(a) “Community health center” has the meaning given in s. 250.15 (1) (a).
AB1225,3,20
19
(b) “Community health worker” means an individual to whom all of the
20
following apply:
AB1225,3,22
21
1. Is a trusted member of the community served by the individual or has an
22
intimate understanding of that community.
AB1225,3,24
23
2. Serves as a liaison between health and social services and the community
24
served by the individual.
AB1225,4,2
1
3. Facilitates access to services and improves the quality and cultural
2
competence of service delivery.
AB1225,4,5
3
4. Assists in increasing health knowledge and self sufficiency through
4
activities such as outreach, community education, informal counseling, social
5
support, and advocacy.
AB1225,4,10
6
(c) “Community primary care” means a system of care under which
7
community health workers, in collaboration with federally qualified health centers,
8
visit patients in their homes at least once annually to chart health status and
9
health care needs over time and coordinate with health care providers for the
10
delivery of needed health care.
AB1225,4,12
11
(d) “County department” means a county department under s. 46.215 or
12
46.22.
AB1225,4,14
13
(e) “Federally qualified health center” has the meaning given in s. 253.075 (1)
14
(e).
AB1225,4,16
15
(2)
From the appropriation under s. 20.435 (1) (dw), the department shall
16
award grants as follows:
AB1225,4,18
17
(a) For the provision of community primary care in areas of this state with
18
poor health outcomes and large health disparities.
AB1225,4,21
19
(b) To community health centers or federally qualified health centers for
20
hiring community health workers, nurses, or social workers to do all of the
21
following:
AB1225,5,2
22
1. In coordination with a county department, perform community outreach
23
and deliver medical care and care coordination services in the community to
1
patients who, because of mental illness, homelessness, or other circumstances, are
2
unlikely to obtain needed care and treatment.
AB1225,5,4
3
2. Assist patients in enrolling in the Medical Assistance program under
4
subch. IV of ch. 49.
AB1225,7
5
Section
7
.
49.45 (2) (a) 2m. of the statutes is created to read:
AB1225,5,7
6
49.45
(2)
(a) 2m. Ensure that medically necessary services are provided to
7
Medical Assistance recipients in a timely and equitable manner.
AB1225,8
8
Section
8
.
49.45 (2) (a) 2s. of the statutes is created to read:
AB1225,5,12
9
49.45
(2)
(a) 2s. Recruit health care providers to participate in the Medical
10
Assistance program in order to ensure there are sufficient culturally competent and
11
geographically distributed health care providers available to meet Medical
12
Assistance recipients’ needs.
AB1225,9
13
Section
9
.
49.45 (2) (a) 3m. of the statutes is created to read:
AB1225,5,18
14
49.45
(2)
(a) 3m. Maintain a call center and website to assist Medical
15
Assistance recipients in locating providers; maintain a nurse consultation helpline
16
24 hours per day, 7 days per week for Medical Assistance recipients; and contact
17
Medical Assistance recipients who, based on claims data, have not had preventive
18
visits to help them select a primary care provider.
AB1225,10
19
Section
10
.
49.45 (2) (a) 25. of the statutes is created to read:
AB1225,5,21
20
49.45
(2)
(a) 25. Collaborate with individual health care providers to explore
21
means of improving health care quality and reducing costs.
AB1225,11
22
Section
11
.
49.45 (2) (b) 2. of the statutes is amended to read:
AB1225,6,11
23
49.45
(2)
(b) 2.
Contract
Subject to s. 49.459 (2), contract
with any
24
organization whether or not organized for profit to administer, in full or in part, the
1
benefits under the medical assistance program
including prepaid health care
. The
2
department shall accept bids on contracts for administrative services and services
3
evaluating the medical assistance program as provided in ch. 16, but may accept the
4
contract deemed most advantageous for claims processing services; or
, subject to s.
5
49.459 (2),
contract with any insurer authorized under the insurance code of this
6
state to insure the program in full or in part and on behalf of the department. The
7
department shall submit a report each December 31 to the governor, the joint
8
committee on finance and the chief clerk of each house of the legislature, for
9
distribution to the appropriate standing committees under s. 13.172 (3), regarding
10
the effectiveness of the management information system for monitoring and
11
analyzing medical assistance expenditures.
AB1225,12
12
Section
12
.
49.45 (3) (c) of the statutes is repealed.
AB1225,13
13
Section
13
.
49.45 (3) (cm) of the statutes is created to read:
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