LRB-3687/1
PJK/TJD/JK:jld/kjf/eev/cjs:rs
December 2013 Special Session
2013 - 2014 LEGISLATURE
December 2, 2013 - Introduced by Joint Committee on Finance. Referred to Joint
Committee on Finance.
SB1,2,2 1An Act to repeal 49.471 (4m) and 49.67 (9m); to amend 20.145 (5) (k), 71.07 (5g)
2(b), 71.07 (5g) (c) 1., 71.07 (5g) (d) 2., 71.28 (5g) (b), 71.28 (5g) (c) 1., 71.28 (5g)
3(d) 2., 71.47 (5g) (b), 71.47 (5g) (c) 1., 71.47 (5g) (d) 2., 76.655 (2), 76.655 (3) (a),
476.655 (5), 177.075 (3), 895.514 (2), 895.514 (3) (a) and 895.514 (3) (b); to repeal
5and recreate
49.45 (23) (a), 49.45 (23) (a) and 49.471 (4) (a) 4. b. of the statutes;
6and to affect 2013 Wisconsin Act 20, section 9122 (1L) (b) 1. b., 2013 Wisconsin
7Act 20
, section 9122 (1L) (b) 1. c., 2013 Wisconsin Act 20, section 9122 (1L) (b)
82. and 3. a. and c., 2013 Wisconsin Act 20, section 9122 (1L) (b) 4., 2013
9Wisconsin Act 20
, section 9122 (1L) (b) 8. (intro.), 2013 Wisconsin Act 20, section
109122 (1L) (b) 8. a., 9. a., 10. a. and b. and 11. b., 2013 Wisconsin Act 20, section
119418 (7), 2013 Wisconsin Act 20, section 9418 (7m) and 2013 Wisconsin Act 20,
12section 9418 (9); relating to: delaying eligibility changes to BadgerCare Plus
13and BadgerCare Plus Core and delaying other changes to the Medical

1Assistance program; and extending coverage under, and the deadline for the
2dissolution of, the Health Insurance Risk-Sharing Plan.
Analysis by the Legislative Reference Bureau
Medical Assistance
Currently, the Department of Health Services (DHS) administers the Medical
Assistance (MA) program, which is a joint federal and state program that provides
health services to individuals who have limited resources. Some services are
provided through programs that operate under a waiver of federal Medicaid laws,
including services provided through the BadgerCare Plus (BC+) and BadgerCare
Plus Core (BC+ Core) programs. Under current law, BC+ provides health and
medical services to eligible recipients and has a standard plan with a larger set of
benefits and a Benchmark plan with fewer benefits. The 2013-2015 biennial budget
act, 2013 Wisconsin Act 20 (Act 20), makes changes to BC+, BC+ Core, and MA, and
some of those changes are not in effect until January 1, 2014.
Under current law, unless DHS has a policy that conflicts with current state law
eligibility requirements, certain individuals are eligible for benefits under the BC+
standard plan. Beginning on January 1, 2014, Act 20 reduces the income eligibility
level for the BC+ standard plan for parents and caretaker relatives from not more
than 200 percent of the federal poverty line (FPL) to not more than 100 percent of
the FPL before a 5 percent income disregard is applied. Act 20 also defines,
beginning on January 1, 2014, for purposes of eligibility of a parent or caretaker
relative, a "dependent child." In addition, Act 20 eliminates the distinction between
self-employment income and other income. This bill delays the effective date of
these changes enacted in Act 20 from January 1, 2014, to April 1, 2014.
Under current law, certain individuals are eligible for benefits under the BC+
Benchmark plan including pregnant women whose family income exceeds 200
percent but does not exceed 300 percent of the FPL and children under one year of
age of those women; certain other pregnant women; children whose family income
exceeds 200 percent but does not exceed 300 percent of the FPL; and parents or
caretaker relatives whose family income includes self-employment income and does
not exceed 200 percent of the FPL under a certain calculation. Act 20, beginning on
January 1, 2014, provides benefits under the standard plan to the pregnant women
and children who are currently eligible for the BC+ Benchmark plan. Under Act 20,
parents and caretaker relatives are covered only under the standard plan. Certain
individuals, under current law, may pay the full member per month cost of coverage
to receive benefits under the Benchmark plan. On January 1, 2014, Act 20
eliminates the ability of children whose family incomes exceed 300 percent of the
FPL to receive Benchmark plan benefits. This bill delays the effective date of these
changes enacted in Act 20 from January 1, 2014, to April 1, 2014.
Under current law, BC+ Core provides basic primary and preventive care to
eligible individuals. Adults who are under age 65, who have family incomes that do
not exceed 200 percent of the FPL, and who are not otherwise eligible for MA,

including BC+, are eligible for benefits under BC+ Core. Beginning January 1, 2014,
Act 20 allows only those individuals whose family incomes do not exceed 100 percent
of the FPL, before a 5 percent income disregard is applied, to be eligible for BC+ Core.
Act 20 removes limitations on the benefits provided to individuals in BC+ Core and,
thus, allows DHS to provide standard plan benefits to these individuals. This bill
delays the effective date of these changes enacted in Act 20 from January 1, 2014,
to April 1, 2014.
Under current law, family income is the total gross earned and unearned
income received by all members of a family. Beginning on January 1, 2014, under
Act 20, for purposes of determining eligibility for BC+ and BC+ Core, family income
has the meaning given for household income under a federal regulation, which uses
an income calculation based on modified adjusted gross income. Act 20 also requires
DHS, beginning on January 1, 2014, to apply the definition of household in federal
regulations to determinations of income. Act 20 also makes other changes to the
calculation of income and family size for BC+ and BC+ Core on January 1, 2014. This
bill delays the effective date of these changes enacted in Act 20 from January 1, 2014,
to April 1, 2014.
DHS also currently administers the BadgerCare Plus Basic (BC+ Basic) plan,
which is not an MA program but is funded by premiums paid by plan participants.
To be eligible for the BC+ Basic plan, an individual must be on the waiting list for
BC+ Core. BC+ Basic provides health care benefits that do not exceed those benefits
provided by BC+ Core. Under current law, BC+ Basic terminates on January 1, 2014,
and Act 20 repeals the BC+ Basic statutory language on that same date. The bill
eliminates the statutory termination date and delays the repeal of BC+ Basic
enacted in Act 20 until April 1, 2014.
Under current law, DHS is required to develop a purchasing pool, known as
Badger Rx Gold, for pharmacy benefits and set eligibility requirements to obtain
prescription drug coverage through the purchasing pool. Current law allows DHS
to contract with an entity to operate the purchasing pool, which is not an MA
program. Act 20 eliminates the purchasing pool, Badger Rx Gold, on January 1,
2014. The bill delays the elimination of Badger Rx Gold until April 1, 2014.
Dissolution of the Health Insurance Risk-Sharing Plan
The Health Insurance Risk-Sharing Plan (HIRSP), which is administered by
the Health Insurance Risk-Sharing Plan Authority (authority), provides health
insurance coverage in individual policies for persons who are covered under
Medicare because they are disabled, persons who have tested positive for human
immunodeficiency virus (HIV), persons who have been refused coverage, or coverage
at an affordable price, in the private health insurance market because of their mental
or physical health condition, and persons (called "eligible individuals" in the
statutes) who do not currently have health insurance coverage, but who were covered
under certain types of health insurance coverage (creditable coverage) for at least 18
months in the past. HIRSP is funded by premiums paid by covered persons, insurer
assessments, and provider payment discounts.
Current law provides for the dissolution of HIRSP and the authority. Generally,
coverage under HIRSP may not be issued to any person after December 1, 2013,

existing coverage under HIRSP will end on January 1, 2014, or on the date that any
health insurance coverage that is accessed through an American health benefit
exchange in this state is effective, if that is later than January 1, 2014, and the
authority must pay the costs of HIRSP that are incurred before administrative
responsibility for HIRSP and HIRSP's remaining cash assets, tangible personal
property, contracts and agreements, and all other matters, including grievances and
independent reviews, are transferred to the Office of the Commissioner of Insurance
(OCI). Thereafter, OCI must take any action necessary or advisable to wind up the
affairs of HIRSP.
Extension of coverage under the Health Insurance Risk-Sharing Plan
The bill makes various modifications to the timetable for the dissolution of
HIRSP, including the following:
1. Under the bill, all coverage under HIRSP terminates at 11:59 p.m. on
December 31, 2013, but an individual who has coverage on December 1, 2013, and
who has paid the December premium may elect to obtain a policy under HIRSP by
making a timely payment of the January 2014 premium. Any such new policy must
have the same benefits, including the deductible amount, that were in effect on
December 1, 2013, and may not extend beyond March 31, 2014. An individual who
is eligible for Medicare has the same option to extend coverage under a HIRSP policy
until March 31, 2014, if the individual was covered under HIRSP on December 1,
2013, has paid the December premium, did not enroll in Medicare Advantage during
the federal open enrollment period in 2013, and, for individuals whose coverage is
funded under a contract with the federal Department of Health and Human Services,
the federal Department of Health and Human Services takes certain actions.
2. Under current law, provider claims for payment for medical services
provided to individuals with coverage under HIRSP must be filed no later than 90
days after coverage terminates or they will not be paid. Under the bill, all provider
claims for services provided to HIRSP enrollees must be filed no later than June 1,
2014, or they will not be paid. All provider claims must be adjudicated by September
30, 2014.
3. Under current law, a grievance must be submitted no later than 180 days
after coverage terminates or be barred, and an independent review must be
requested no later than 60 days after the individual receives notice of the disposition
of his or her grievance. The bill provides that a grievance must be received no later
than July 1, 2014, or be barred, and that an individual who submits a grievance after
March 31, 2014, must request an independent review with respect to the grievance
no later than August 1, 2014, or be barred from requesting an independent review.
4. Under current law, the transfer from the authority to OCI of administrative
responsibility for HIRSP and HIRSP's remaining cash assets, tangible personal
property, contracts and agreements, and all other matters takes place 60 days after
coverage under HIRSP terminates. Under the bill, the transfer takes place on
February 28, 2014.
5. Under current law, the authority must pay HIRSP's costs incurred in 2013
and those that are incurred before the transfer to OCI. The authority must make
every effort to pay costs in accordance with the manner provided in the statutes,

which is that costs are to be paid 60 percent from premiums, 20 percent from insurer
assessments, and 20 percent from adjustments to provider payments. Under the bill,
the authority before March 1, 2014, and OCI on and after March 1, 2014, must pay
all of HIRSP's costs in accordance with the manner provided in the statutes, except
that any available surplus may be used before an assessment is imposed against
insurers. OCI must determine no later than July 1, 2014, whether an insurer
assessment is necessary.
Time-limited guaranteed issue under Medicare supplement and
replacement policies
Under current law, an insurer that offers a Medicare supplement or
replacement policy must provide coverage to any individual who is eligible for
Medicare, who had coverage under HIRSP, whose coverage terminates on January
1, 2014, or on the date that any health insurance coverage that is accessed through
an American health benefit exchange in this state is effective, if that is later than
January 1, 2014, who applies for coverage before 63 days after their coverage
terminated, and who pays the premium. Coverage may not be denied on the basis
of health status, receipt of health care, claims experience, or medical condition.
Under the bill, the requirement to provide coverage applies if the individual's
coverage under HIRSP terminated on December 31, 2014, which is the new date for
coverage termination under the bill. In addition, the bill imposes the same
requirement on an insurer that offers a Medicare supplement or replacement policy
to provide coverage under such a policy to an individual who is eligible for Medicare,
whose coverage under HIRSP terminates on March 31, 2014, who applies for
coverage under the Medicare supplement or replacement policy before 63 days after
their coverage terminated, and who pays the premium.
For further information see the state 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:
SB1,1 1Section 1. 20.145 (5) (k) of the statutes, as created by 2013 Wisconsin Act 20,
2is amended to read:
SB1,5,63 20.145 (5) (k) Operational expenses. All moneys transferred from the
4appropriation account under par. (g) for operational expenses related to winding up
5the affairs of the Health Insurance Risk-Sharing Plan, including hiring consultants,
6limited-term employees, and experts.
SB1,2
1Section 2 . 49.45 (23) (a) of the statutes, as affected by 2013 Wisconsin Act 20,
2section 1046, is repealed and recreated to read:
SB1,6,113 49.45 (23) (a) The department shall request a waiver from the secretary of the
4federal department of health and human services to permit the department to
5conduct a demonstration project to provide health care coverage to adults who are
6under the age of 65, who have family incomes not to exceed 100 percent of the poverty
7line before application of the 5 percent income disregard under 42 CFR 435.603 (d),
8and who are not otherwise eligible for medical assistance under this subchapter, the
9Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395
10et seq. If the department creates a policy under sub. (2m) (c) 10., this paragraph does
11not apply to the extent that it conflicts with the policy.
SB1,3 12Section 3 . 49.45 (23) (a) of the statutes, as affected by 2013 Wisconsin Act 20,
13section 1047, and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
SB1,6,2114 49.45 (23) (a) The department shall request a waiver from the secretary of the
15federal department of health and human services to permit the department to
16conduct a demonstration project to provide health care coverage to adults who are
17under the age of 65, who have family incomes not to exceed 100 percent of the poverty
18line before application of the 5 percent income disregard under 42 CFR 435.603 (d),
19and who are not otherwise eligible for medical assistance under this subchapter, the
20Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395
21et seq.
SB1,4 22Section 4. 49.471 (4) (a) 4. b. of the statutes, as affected by 2013 Wisconsin Act
2320
, is repealed and recreated to read:
SB1,7,3
149.471 (4) (a) 4. b. The individual's family income does not exceed 100 percent
2of the poverty line before application of the 5 percent income disregard under 42 CFR
3435.603
(d).
SB1,5 4Section 5. 49.471 (4m) of the statutes, as created by 2013 Wisconsin Act 20,
5is repealed.
SB1,6 6Section 6. 49.67 (9m) of the statutes is repealed.
SB1,7 7Section 7. 71.07 (5g) (b) of the statutes, as affected by 2013 Wisconsin Act 20,
8is amended to read:
SB1,7,149 71.07 (5g) (b) Filing claims. Subject to the limitations provided under this
10subsection, for taxable years beginning after December 31, 2005, and before January
111, 2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1271.02 an amount that is equal to the amount of the assessment under s. 149.13, 2011
13stats., that the claimant paid in the claimant's taxable year, multiplied by the
14percentage determined under par. (c) 1.
SB1,8 15Section 8. 71.07 (5g) (c) 1. of the statutes, as affected by 2013 Wisconsin Act
1620
, is amended to read:
SB1,8,417 71.07 (5g) (c) 1. The department of revenue, in consultation with the office of
18the commissioner of insurance, shall determine the percentage under par. (b) for
19each claimant for each taxable year. The percentage shall be equal to $5,000,000
20divided by the aggregate assessment under s. 149.13, 2011 stats., except that for
21taxable years beginning after December 31, 2013, and before January 1, 2015, the
22percentage shall be equal to $1,250,000 divided by the aggregate assessment under
23s. 149.13, 2011 stats., and shall not exceed 100 percent.
The office of the
24commissioner of insurance shall provide to each claimant that participates in the
25cost of administering the plan the aggregate assessment at the time that it notifies

1the claimant of the claimant's assessment. The aggregate amount of the credit under
2this subsection and ss. 71.28 (5g), 71.47 (5g), and 76.655 for all claimants
3participating in the cost of administering the plan under ch. 149, 2011 stats., shall
4not exceed $5,000,000 in each fiscal year.
SB1,9 5Section 9. 71.07 (5g) (d) 2. of the statutes, as created by 2013 Wisconsin Act
620
, is amended to read:
SB1,8,107 71.07 (5g) (d) 2. No credit may be claimed under this subsection for taxable
8years beginning after December 31, 2013 2014. Credits under this subsection for
9taxable years that begin before January 1, 2014 2015, may be carried forward to
10taxable years that begin after December 31, 2013 2014.
SB1,10 11Section 10. 71.28 (5g) (b) of the statutes, as affected by 2013 Wisconsin Act 20,
12is amended to read:
SB1,8,1813 71.28 (5g) (b) Filing claims. Subject to the limitations provided under this
14subsection, for taxable years beginning after December 31, 2005, and before January
151, 2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1671.23 an amount that is equal to the amount of assessment under s. 149.13, 2011
17stats., that the claimant paid in the claimant's taxable year, multiplied by the
18percentage determined under par. (c) 1.
SB1,11 19Section 11. 71.28 (5g) (c) 1. of the statutes, as affected by 2013 Wisconsin Act
2020
, is amended to read:
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