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AB 1225

Relating to: direct payments for Medical Assistance, Medical Assistance reimbursement rates, care coordination services under the Medical Assistance program, grants for community primary care and outreach, and making an appropriation. (FE)

2025-2026 Regular Session Introduced by Ryan Clancy and 6 co-sponsors

Establishes direct payments, adjusted Medicaid reimbursements, care coordination, and grants to expand community primary care under Wisconsin’s Medical Assistance.

Senator Larson added as a cosponsor
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WeVote Research Nonpartisan
Bill Summary · AB 1225

Summary of Assembly Bill 1225 (Session 2025, Wisconsin)

Purpose and Intent

AB 1225 relates to the Medical Assistance program (Wisconsin’s Medicaid program) and would establish provisions for direct payments, reimbursement rates, care coordination services, and grants to support community primary care and outreach. The bill also includes an appropriation to fund these changes. The overarching aim appears to be enhancing payment structures, improving care coordination within Medical Assistance, and expanding community-based primary care and outreach efforts.

Key Provisions

  • Direct Payments for Medical Assistance
    The bill creates or expands mechanisms for direct payments under the Medical Assistance program. This could involve payments to providers, facilities, or other eligible entities to support medical services delivered to Medicaid beneficiaries.

  • Medical Assistance Reimbursement Rates
    The measure addresses how Medical Assistance reimbursements are calculated and paid. This could include adjustments to existing payment rates to ensure fair compensation for services and potentially to align incentives with desired care outcomes.

  • Care Coordination Services
    The bill authorizes or expands care coordination services under Medical Assistance. These services aim to improve care management for beneficiaries, likely focusing on care navigation, care plans, and integration of services across providers and settings.

  • Grants for Community Primary Care and Outreach
    The legislation authorizes grants intended to bolster community-based primary care and outreach activities. This may target efforts to expand access in underserved areas, support for community health centers, mobile clinics, or other outreach initiatives that connect residents with primary care.

  • Appropriation
    AB 1225 includes an appropriation to fund the changes described above. The exact funding level and source (general purpose revenues, state funds, federal funds, or a combination) would be specified in the bill’s appropriation section.

Who Would be Affected

  • Medicaid/Medical Assistance Providers
    Hospitals, clinics, physicians, and other entities that participate in Wisconsin’s Medicaid program would be impacted by changes to direct payments and reimbursement rates.

  • Medicare/Medicaid Beneficiaries (Wisconsin Medicaid Enrollees)
    Beneficiaries could experience changes in how services are paid for, and potentially improvements in access and care management through enhanced care coordination.

  • Community Primary Care Providers and Outreach Organizations
    Organizations receiving state grants would benefit from additional funding to expand outreach, increase primary care capacity, and improve access in communities.

  • State Agencies and Agencies Administering Medicaid
    The Department of Health Services (DHS) would administer the new direct payment mechanisms, determine reimbursement rate adjustments, oversee care coordination services, and manage grant programs and the related appropriation.

Procedural and Timeline Aspects

  • Introduced and References

    • Introduced March 19, 2026 by Representatives Phelps, Clancy, Cruz, Hong, Madison, Tenorio, and Moore Omokunde.
    • Referred to the Committee on Health, Aging and Long-Term Care for consideration.

  • Cosponsors
    Notables include: Francesca Hong, Ryan Clancy, Christian Phelps, Supreme Moore Omokunde, Darrin Madison, Angelina Cruz, Angelito Tenorio, with Senator Larson added as a cosponsor (per action history).

  • Status Notes
    The action history indicates movement in the 2026 session and mentions a failed passage pursuant to Senate Joint Resolution 1, reflecting procedural nuances that can affect the bill’s fate (e.g., prioritization, deadlines, or veto considerations). Current status would need to be confirmed from the latest legislative tracking.

  • Effective Dates
    The bill text would specify when the provisions and funding become effective (e.g., upon enactment, by a specified date, or in phases). Absent the text here, exact timelines are not stated.

Additional Considerations

  • The bill’s fiscal impact would depend on the appropriation level and the design of direct payments and grants. Analysis by the Legislative Fiscal Bureau (budget bill subject) would provide the full cost estimates and potential funding sources.

  • Implementation would require coordination between DHS, Medicaid managed care entities (if applicable), and grantee organizations to ensure compliance with program rules and federal Medicaid requirements.

If you’d like, I can tailor this summary to focus on specific stakeholders (providers, beneficiaries, or policymakers) or add a provisional outline of the potential fiscal impact based on typical Medicaid funding structures.

Compiled from official sources — confirm details with the bill’s official record.

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