Governor Walker Signs Extraordinary Session Bills into Law, Including Medicaid Changes

Governor Walker signed the three extraordinary session bills passed by the legislature into law today. While Walker had previously said he was considering possible vetoes, he signed all of the bills into law as passed by the Legislature. The bills limit early voting to two weeks, create new legislative oversight of executive branch functions, place limits on the Attorney General’s ability to withdraw the state from lawsuits, create a process for the Legislature to intervene is certain lawsuits, and put the new work and cost-sharing requirements for childless adults on BadgerCare into law. 


There are several specific changes that may be of interest to WPSA.


  • Requires Joint Finance Committee (JFC) passive review of any Medicaid rate increases, supplemental provider payments or state plan amendments that have a fiscal impact of more than $7.5 million.


  • Creates a new waiver renewal and request process that includes strict legislative oversight. These changes will impact Family Care, IRIS, BadgerCare and other health and long-term care programs which are run using waivers. DHS may not submit a request to a federal agency for a waiver or a renewal, modification, withdrawal, suspension, or termination of a waiver unless legislation has been passed specifically directing the submission of the waiver.  At least 9 months before a waiver expires, DHS must submit a written notice to JFC of the expiration. If DHS intends to request substantive changes to the waiver, they must use the legislative oversight process created by the bill. This includes submitting a waiver implementation plan to the Joint Finance Committee,  submitting the proposed waiver request to JFC for approval before submitting it to the federal government, required bi-weekly contact with the federal agency negotiating the waiver request, progress reports to JFC on the negotiation process and JFC approval of the final negotiated waiver before it can take effect. If JFC determines that DHS has not made sufficient progress with a waiver request, they can reduce DHS’s administrative funding or staffing levels.


  • Creates new standards related to agency guidance documents, which the bill defines as “any formal or official document or communication issued by an agency, including a manual, handbook, directive, or informational bulletin” that explains the agency’s implementation of a statute or rule or offers guidance or advice on how the agency is likely to apply a statute or rule. It requires state agencies to cite the relevant state or federal statutory reference or administrative code in any guidance documents they release. Proposed guidance documents must be posted for public comment before they can be adopted. Once the guidance document is finalized, it must remain on the agency's website as long as it is in effect. It also prohibits agencies from seeking deference in a legal action based on their interpretation of any law.


  • Updates the current law process that allows the Joint Committee for Review of Administrative rules to suspend an administrative rule to clarify that the Committee can initiate the process to suspend a rule multiple times.

WPSA Needs Agencies, Workers and Consumers to Attend Listening Sessions with Gov.-elect Tony Evers  

Governor-elect Tony Evers is holding budget listening sessions over the next 7 days to hear from Wisconsinites about their top priorities. WPSA needs your help to make sure that Gov.-elect Evers addresses the direct care workforce crisis in his state budget.  Sign up to attend one of the listening sessions with Governor-elect Evers below and get your personal care workers and consumers to sign up too!  Big turnout is critical to having our voices heard. You can use the WPSA legislative priorities to help guide your talking points and turn in other written materials.

You must register to attend these listening sessions.

Dec. 17 in Superior: 4:30 p.m. to 6 p.m. at Superior Middle School, 3626 Hammond Ave. Register at

 Dec. 18 in La Crosse: Noon to 1:30 p.m. at American Legion Post 52, 711 6th St. South. Register at .

 Dec. 19 in Milwaukee: 4:30 to 6 p.m. at United Way of Greater Milwaukee, 200 West Pleasant St. Register at

Can’t make a listening session? Fill out this survey:

Here are some things you can say at the listening session:


  • Wisconsin is facing a critical shortage of personal care workers due to chronic underfunding of our long-term care system.


  • 1 out of 2 agencies surveyed by WPSA are considering no longer providing Medicaid personal care services. The Medicaid personal care reimbursement rate of $16.73 per hour is about $2.00 below the actual cost of providing care.  Rates must be increased by at least 11% to make agencies whole.


  • The direct care workforce crisis is threatening the health, safety and independence of people with disabilities and frail elders. Please convene a direct care workforce task force devoted to finding solutions to the worker shortage.


  • Share any stories you can about how the crisis is impacting your clients (for example, people sleeping in wheelchairs overnight, falls, hospitalizations, etc.).

Two Upcoming Opportunities to Provide Input on EVV

There are two upcoming opportunities to provide input into the implementation of Electronic Visit Verification (EVV) for personal care.  Policymakers need to hear from you about how EVV will impact agencies and consumers.  Please considering attending one of these upcoming forums to voice your concerns.


Federal Centers for Medicare and Medicaid Services Forum—November 7

 The Federal Centers for Medicare and Medicaid Services is holding a national conference call to get feedback on EVV on November 7 from 12 p.m.-2 p.m. CST (1 p.m. Eastern Time).

 Participant Dial-In Number: 1-(800)-837-1935

Conference ID: 33979177

State Department of Health Services Forum--November 27

 DHS is holding a forum to provide information and get feedback from stakeholders about Wisconsin’s plans to implement EVV on November 27 from 10 to 11:30 a.m. (CST) at the Stevens Point Holiday Inn Hotel and Conference Center, 1001 Amber Avenue, Stevens Point, WI. The forum will also be live-streamed for those who can’t make it to Stevens Point.

 You must register to attend this forum or to participate in the live-stream: EVV Registration Form

Questions can be submitted to DHS prior to the event at:

Frequently Asked Questions about the November 6th Election

DRW and the Wisconsin Disability Vote Coalition have developed an “FAQ” document with some of the most common questions we receive about the November 6th Election, and brief responses. We encourage you to review this document, which includes some of the basics about voting in Wisconsin, as well as information about disability related accommodations and voting rights.

Check out our November 6th Election FAQ for answers to common questions:
Frequently Asked Questions

Congress Provides Funding for National Family Caregiver Council

Congress has voted to provide $300,000 to help fund implementation of the RAISE Family Caregivers Act. This will help fund the creation of a national Family Caregiving Advisory Council charged with developing a family caregiving strategy.

The Strategy must recommend actions that Federal, State, and local governments, communities, health care providers, long-term services and supports providers, and others are taking, or may take, to recognize and support family caregivers in a manner that reflects their diverse needs. The Advisory Council would consist of the following appointed members:  Family caregivers, older adults with long-term services and supports needs; individuals with disabilities; health care and social service providers; long-term services and supports providers; employers; paraprofessional workers; state and local officials; accreditation bodies; veterans; other experts and advocacy organizations.  

Minneapolis Star Tribune: Congress funds first step for national caregiving strategy

Election Resources to Help You Follow the 2018 Campaign

Many federal and state offices are up for re-election in November 2018. This includes one U.S. Senate seat, all Congressional seats, Governor, Lt. Governor, Attorney General, every member of the State Assembly and State Senators from odd-numbered districts.

While the national and statewide races get the most media coverage, it is just as important to educate yourself on races for State Assembly and State Senate.

To see who is on your ballot this November, visit:

Here are some helpful resources for news and candidate interviews:

Wisconsin Eye:

The Wheeler Report:


DHS Releases State Agency Budget Request

The Department of Health Services has released their agency budget request for 2019-21, which can be viewed here: These requests help the Governor prepare the state budget, which will be introduced in January or February of 2019.


DHS is requesting a cost-to-continue budget for Medicaid, which is an additional $496 million GPR for the biennium. Part of this is to reflect increased long-term care costs due to statewide expansion of Family Care.  DHS also requests an increase for administrative costs, which they say includes EVV for personal care in addition to increased administrative costs from FoodShare and Medicaid work requirements and other federal requirements.


Interestingly, DHS is projecting fee-for-service decreases in intensity/use for personal care, private duty nursing and home health (likely due to Family Care/managed care expansion) but increased fee-for-service costs for hospitalizations and prescription drugs. DHS also projects that nursing facility patient days will decline by 5.0% annually in Fiscal Year (FY)19, FY20 and FY21.


The major funding items they request for the biennium are:


·         Increased Medicaid and FoodShare administrative funding for FSET and implementing Medicaid work requirements/FoodShare work requirements passed by the Legislature in the Spring  as well as new federal administrative requirements, such as EVV for personal care ($22.5 million GPR)

·         Increased costs for the FoodShare Employment and Testing Program, which DHS also plans to use as a way for people to meet the Medicaid work requirement they proposed to CMS for childless adults on BadgerCare ($64.2 million GPR)

·         Cost-to-continue for Medicaid ($496 million GPR). DHS says the significant events that will impact Medicaid in the biennium are:

o   Statewide Family Care, individuals continue to enroll off the waitlist in Adams and Dane

o   Eliminating the waiting list for the Children’s Long Term Support Program, children continue to enroll. In addition, DHS must implement a statewide rate schedule.

o   Expansion of SSI-Managed Care resulted in approximately 20,000 new managed care enrollees, this provides significant opportunities for cost-savings

o   Phase-out of the enhanced federal matching for CHIP will begin in this biennium. However, standard FMAP is projected to increase while CHIP FMAP decreases.  

o   Strong growth of the Regional Comprehensive Community Services (CCS) program

o   Increased costs for FQHCs

o   Medicaid enrollment mix—growth of EBD population—managed care intensity

·         Resources to address childhood lead poisoning ($11 million GPR)

·         Funding for Income Maintenance Consortia to comply with new public assistance requirements, such as work requirements, health savings accounts and drug screenings ($1.8 million GPR)

·         Expansion of the Mendota Juvenile Treatment Center ($11.6 million PR)

·         Funding to sustain the Emergency Dispatcher CPR requirements from legislation passed this session ($233,400 GPR)

·         Additional funding for outpatient competency examinations, conditional and supervised release, and treatment to competency programs ($4.5 million GPR)

·         Increased funding for Mendota and Winnebago Mental Health Institutes to reflect changes in their patient populations ($4.3 million GPR)

·         Increased funding for overtime costs at the Mental Health Institutes, DD Centers and the secure treatment centers ($7.7 million GPR)

Take the DHS Provider Survey on EVV Implementation!

DHS has developed a survey to gather provider feedback about electronic visit verification (EVV) for personal care. Input from providers is essential to the planning process for the EVV requirement. Results from this survey will be used by DHS to help plan for the implementation of the EVV requirement.

Please complete the following survey by August 6, 2018 by clicking on the link below. The survey should take about 5–10 minutes to complete.

EVV Survey

If you have any questions or comments regarding EVV, please contact us at

U.S. House Passes EVV Delay Legislation

The U.S. House acted on a voice vote Tuesday to pass H.R. 6042, which delays EVV financial penalties by 1 year and sets forth some standards about stakeholder input. Specifically, it requires CMS to hold at least one public meeting in 2018 to get feedback  from Medicaid stakeholders on the EVV guidance they issued on May 16, 2018.

This bill was introduced on June 7 by Congressman Brett Guthrie and is slightly different from the bill authored by Senator Lisa Murkowski.

During brief debate on the bill, Congressman Guthrie talked about how EVV is important for program integrity and that OIG has warned of fraud in personal care. He said the delay is needed to make sure that EVV is implemented effectively and that they have received feedback that more time is needed.

The U.S. Senate will now need to vote on this version of the bill before it becomes law. Contract Senators Ron Johnson and Tammy Baldwin and ask them to support this legislation! 

Ask Candidates About Their Plans for Solving the Workforce Crisis!

Election season is upon us again in Wisconsin! The statewide primary will be held August 14 and the general election is on November 6. 

Please attend candidate forums, listening sessions or engage candidates in conversation if you see them at community events this summer. 

Here are some questions would could ask:

1. What steps will you take to address the direct care worker crisis that is being driven by inadequate Medicaid reimbursement rates?

2. How will you ensure that Wisconsin’s long-term care system has an adequate provider network that guarantees access to care in the community?

3. Do you support continued funding of the $25 million of state funds provided to Family Care providers in the last state budget to help support direct care workers? 

Take WPSA's 2018 Rate Survey!

One of the most effective advocacy tools that WPSA used to secure a 2% per year MAPC rate increase in the 2017-19  state budget was the results of our workforce survey.

This data is now several years old and we know the workforce crisis has only gotten worse since our last survey.

Please take a few minutes to fill out the 2018 survey:

New Survey on Employees and Caregiving

The Wisconsin Women’s Council (appointed by the Governor and the State Legislature) in partnership with the Wisconsin Family and Caregiver Support Alliance is looking for employers of all sizes to participate in a first annual survey on caregiving.  The intent of this survey is to improve information and other resources available to Wisconsin employers as they support caregivers on the job.

Survey Link 

The survey will take less than 10 minutes to complete.  Deadline to participate: May 31

For purposes of this survey, caregiving is defined as support provided to a family member (beyond typical care for a minor child) who may be an older adult or person with a disability.  Individual survey responses will remain confidential.  Survey results will be shared with participating employers.

If you have questions about the survey contact Christine Lidbury, Executive Director, Wisconsin Women’s Council  or Lisa Pugh, Co-chair, Wisconsin Family and Caregiver Support Alliance:

Important Information About EVV

The state is currently developing a plan to implement Electronic Visit Verification for Personal Care, as required by the federal 21st Century Cures Act.  DHS has released the following update. For more information, visit:


In response to the federal 21st Century Cures Act, the Wisconsin Department of Health Services (DHS) is required to implement electronic visit verification (EVV) for Medicaid-covered personal care services and home health services. This requirement impacts any personal care and home health services, including services provided through Medicaid and BadgerCare Plus fee-for-service, BadgerCare Plus health maintenance organizations (HMOs), Supplemental Security Income HMOs, Family Care, Family Care Partnership, IRIS (Include, Respect, I Self-Direct), and Children’s Long Term Support Waiver. DHS is in the process of reviewing the Act to determine the specific services that will be subject to EVV.

Effective Dates

DHS plans to implement the new EVV requirement over a span of multiple years based on the federal 21st Century Cures Act requirements.

The federal 21st Century Cures Act requires EVV to be implemented for personal care services by January 1, 2019. DHS acknowledges that implementation of EVV by January 1, 2019, is not practical for personal care providers. As a result, DHS is not planning to implement the EVV requirement by January 1, 2019, and will continue to work with providers, partners, and the federal Centers for Medicare & Medicaid Services (CMS) to develop an appropriate and realistic timeline for EVV implementation. DHS will share updated information regarding the expected timeline with providers when available. Providers do notneed to do anything or purchase anything to be in compliance with the EVV requirement at this time.

The federal 21st Century Cures Act requires EVV to be implemented for home health services by January 1, 2023.


EVV is an electronic system that uses technologies to verify that authorized services were provided. Home care workers will be required to send information at the beginning and end of each visit to an EVV system, including:

  • Date of services.
  • Time of services.
  • Location of services.
  • Service type.
  • Individual providing services.
  • Individual receiving services.

DHS plans to implement EVV by establishing a single EVV vendor. This vendor will provide one EVV system to be used by all DHS programs and impacted providers, HMOs, managed care organizations (MCOs), and program administrators. Providers will not have to purchase an EVV system.

Additional Resources 

DHS has created a dedicated webpage where providers can view all current EVV information. DHS plans to update this webpage to provide current EVV information, including any updates on implementation timelines. Providers are encouraged to visit the webpage frequently to get all updated information on EVV.

CMS has also created an EVV website for the federal 21st Century Cures Act where providers can find more information.

DHS would like to hear from providers and stakeholders regarding the implementation of EVV. The input is essential to the planning process for this new requirement and will be used by DHS to make decisions in implementation planning and assist in determining the best way to be compliant with the federal requirement. Providers and other stakeholders can submit their questions or concerns to DHS by emailing: Submissions to this email address will be used to develop a frequently asked questions document.

DHS is also planning to send a survey to providers to collect input on the EVV requirement. The survey will be sent to providers by email. Providers are highly encouraged to respond to the survey to provide input to DHS on the implementation of the EVV requirement.  

When implementation planning is completed, DHS will provide providers specific information about training, how to record visits, claims, technology, and all key steps of the process for the new EVV requirement. Providers are encouraged to visit the DHS EVV webpagefrequently for forthcoming ForwardHealth Updates and other communications regarding this implementation.