This bill restores the ability for private individuals to file qui tam lawsuits against those who knowingly submit false claims for medical assistance, such as Medicaid fraud. It establishes penalties requiring violators to pay three times the damages caused to the state, while also allowing for reduced penalties if the violator cooperates with the attorney general and reports the fraud promptly. The law outlines procedures for filing complaints, including a 60-day sealing period and the attorney general's option to intervene or take over the case, while also granting the state authority to settle cases with approval from the governor.
This bill requires Wisconsin's Medicaid program (Medical Assistance) to reimburse providers for maternal mental health screenings during pregnancy. It also mandates that all health insurance plans covering maternity must include these screenings as a standard benefit, with no cost to the patient. The law specifies that screenings can be provided by licensed midwives, nurse-midwives, or other qualified healthcare providers. It includes a requirement for the state to develop screening standards in consultation with organizations led by Black, Indigenous, and other people of color. Coverage requirements will take effect for most plans starting September 1, 2026.
This bill would require Wisconsin's Medical Assistance program (similar to Medicaid) to reimburse certified doulas for services provided to program recipients. It mandates that hospitals and birthing centers allow Medical Assistance-certified doulas to accompany patients during labor and birth without counting them toward visitor limits. Facilities must create written policies for this access, post them online, and ensure doulas don't conflict with medical standards. The bill directly affects low-income pregnant people, certified doulas, and healthcare facilities.
AB 1084 expands dental coverage for pregnant individuals enrolled in Wisconsin's Medical Assistance program (Medicaid). The bill requires that pregnant recipients referred for dental care must be seen by a dentist or dental therapist within 30 days of referral. It defines "dental therapist" as a licensed professional under existing law and ensures referrals for basic dental services include this option. This directly affects pregnant Medical Assistance recipients who need dental care, guaranteeing timely access to covered services.
AB 1089 creates a state working group to improve coordination of the Medical Assistance program (state Medicaid) and enhance the experience for program recipients. The Department of Health Services must form this group by June 1, 2026, including representatives from the department, resource centers, multicounty consortia or tribal programs, legislators, healthcare providers, and at least one recipient. The group must submit a report with findings and recommendations to the department and legislature within seven months of its first meeting. This bill directly affects state program administration and recipients by requiring structured collaboration to address changes from recent federal law.
AB 801 establishes a mandatory "all-payer claims database" requiring insurers, healthcare administrators, and managed care organizations (including those serving Medicaid recipients) to submit health claims data in machine-readable format. It mandates data submission within six months of the law's effective date, with standardized electronic reporting and annual submission schedules. The data organization must analyze and publicly report on healthcare costs, quality, and effectiveness in plain language, while restricting data sharing to purposes like public health research or policy decisions. The bill repeals prior requirements and creates new provisions to standardize data collection, reporting, and transparency for the Wisconsin Health Information Organization.
SB 23 extends Medicaid eligibility for postpartum women from 60 days to 365 days (one year) after pregnancy, directly affecting pregnant and postpartum women enrolled in the Medical Assistance program. The bill modifies eligibility rules to ensure coverage continues without regard to income changes during this extended period. It also adds a provision allowing women with family income above 300% of the poverty line to qualify if medical expenses for family members are covered, extending this eligibility to all family members. The bill requires federal approval for the 365-day extension to take effect.
SB 252 amends eligibility rules for state benefit programs by excluding up to $40,000 in inherited assets when calculating an individual's total assets. It directly affects people applying for or receiving state benefits (like Medicaid or food assistance) who inherit assets, allowing them to retain more inheritance without losing eligibility. The bill modifies existing rules to clarify that inherited assets up to $40,000 will not count toward asset limits, while requiring individuals to deposit earned income into designated accounts. This is a procedural adjustment to benefit eligibility criteria, not a new program.
This bill creates "independence accounts" allowing individuals to save up to $15,000 annually from their gross earnings without that money counting toward Medicaid asset limits. It specifically excludes assets acquired through inheritance when determining eligibility for benefits. The department must seek federal approval to implement this change, though the program would take effect if federal authorities approve. The bill directly affects people applying for or receiving Medicaid benefits in the state.
AB 62 establishes a Prescription Drug Affordability Review Board to address prescription drug costs. The board, with members representing pharmaceutical companies, health insurers, healthcare providers, and the public, must meet quarterly and avoid conflicts of interest. Key provisions include creating a $500,000 annual grant program for healthcare providers to develop tools showing patients the cost of prescriptions (Section 601.415), launching a diabetes medication pilot project (Section 601.41), and repealing a section requiring copayments for certain Medicaid services (Section 7). This bill directly affects insurers, pharmacies, drug manufacturers, and healthcare providers who must disclose drug costs to patients.
