Written comments on the proposed changes are welcome. Comments should be sent to the above address. Comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:40 p.m. daily at:

The State of Wisconsin reimburses health care providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, is called Medical Assistance (MA) or Medicaid. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.

Federal statutes and regulations permit states to require MA recipients to share in the cost of receiving certain MA services through the payment of a flat, nominal fee (copayment) per service. However, federal regulations establish maximum copayments for services and exempt some groups and services from copayments, including:

(a) recipients under the age of 18;

(b) categorically needy persons enrolled in health maintenance organizations;

(c) services relating to pregnancy;

(d) institutional services if individuals are required to spend all their income for medical expenses, except for the amount exempted for personal needs, and

(e) emergency, family planning and hospice services.

The Legislature is considering a proposal to decrease MA benefits funding by an estimated $815,700 ($334,900 state general purpose revenues (GPR) and $480,800 federal financial participation (FFP) funds) effective July 1, 1997, and $1,631,500 ($671,800 GPR and $959,700 FFP) effective July 1, 1998, to reflect the projected cost savings of:

(a) creating a copayment for specialized medical vehicle (SMV) services and free-standing ambulatory surgery services, and

(b) increasing current copayments for other services to the maximum amount permitted under federal law, excluding prescription and over-the-counter (OTC) drugs. The copayment for blood glucose monitoring reagent strips may remain at the current rate of $0.50.

Federal law establishes maximum copayment amounts for services in relation to the state's MA payment for the service, as shown in the following table:

State's MA Payment for Service	Maximum Recipient Copayment
$10.00 or less	$0.50
$10.01 to $25.00	$1.00
$25.01 to $50.00	$2.00
$50.01 or more	$3.00

It is the provider's responsibility to collect copayments. However, no participating provider may deny services to an MA recipient because of the recipient's inability to pay copayments. The MA program does not provide additional compensation to providers when they do not collect payment.

Copies of the proposed changes will be sent to every county social services or human services department main office where they will be available for review. For more information, interested people may write to:

Written comments on the proposed changes are welcome. Comments should be sent to the above address. Comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:40 p.m. daily at:

The State of Wisconsin reimburses providers for dental services provided to Medical Assistance recipients. This is done under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, is called Medical Assistance (MA) or Medicaid. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.

The Legislature is considering a proposal to increase funding to add dental sealants as a covered service for children under MA, effective January 1, 1998. Currently sealants are covered by MA only through the HealthCheck other services benefit, after a child has received a HealthCheck screening. Dental sealants are an important preventive measure that are expected to achieve a significant reduction in future dental expenditures. The fiscal impact of this proposal is to increase expenditures by an estimated $1,047,800 ($430,900 state general purpose revenues (GPR) and $616,900 federal financial participation (FFP) funds) in state fiscal year (SFY) 1997-1998 and $348,300 ($144,000 GPR and $204,300 FFP) in SFY 1998-1999.

Copies of the proposed change will be sent to every county social services or human services department main office where they will be available for review. For more information, interested people may write to:

Written comments on the proposed change are welcome. Comments should be sent to the above address. Comments received on the change will be available for public review between the hours of 7:45 a.m. and 4:40 p.m. daily at:

The State of Wisconsin reimburses providers for ambulance transportation services provided to Medical Assistance recipients under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, is called Medical Assistance (MA) or Medicaid. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.

The MA program covers certain emergency and non-emergency ambulance transportation services in cases where a recipient is suffering from an illness or injury that contraindicates transportation by other means.

Ambulance providers are paid the sum of a basic life support (BLS) rate and a per mile rate under a maximum fee schedule which recognizes cost differences between providers that operate in Milwaukee county, metropolitan areas, and other areas of the state (“statewide” ).

The Legislature is considering a proposal to establish an advanced life support (ALS) rate for ambulance providers effective July 1, 1998, that would be 120% of the current BLS rate in each area: Milwaukee county, designated metropolitan areas, and statewide. ALS services are more costly than BLS services because they require more equipment and training of personnel. Currently MA pays only the BLS rate per trip. The fiscal impact of the new ALS rate is to increase expenditures by an estimated at $1,041,100 ($430,800 state general purpose revenues and $610,300 federal financial participation funds) in state fiscal year 1998-1999.

Copies of the proposed change will be sent to every county social services or human services department main office where they will be available for review. For more information, interested people may write to:

Written comments on the proposed change are welcome. Comments should be sent to the above address. Comments received on the change will be available for public review between the hours of 7:45 a.m. and 4:40 p.m. daily at: