LRB-3785/1
SWB:wlj
2017 - 2018 LEGISLATURE
July 25, 2017 - Introduced by Representatives Genrich, Crowley, Goyke, Mason,
Hebl, Anderson, Brostoff, Billings, C. Taylor, Pope, Kolste, Subeck,
Sargent, Considine, Berceau, Wachs, Ohnstad, Riemer, Shankland,
Vruwink and Zepnick, cosponsored by Senators Johnson, Hansen, Risser,
Ringhand, Larson, Carpenter, Miller and Vinehout. Referred to Committee
on Insurance.
AB449,1,2 1An Act to create 49.471 (4m) of the statutes; relating to: BadgerCare Plus and
2assistance for childless adults demonstration project purchase options.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health Services to request a waiver or
submit amendments to the state Medical Assistance plan to permit certain
individuals whose income is greater than the income eligibility limit for the
BadgerCare Plus program or the assistance for childless adults demonstration
project to purchase coverage through these programs through a separate purchase
option. The bill also requires DHS to include a request to allow an option for small
businesses to purchase coverage under these programs for their employees.
Currently, DHS administers the Medical Assistance program, which is a joint
federal and state program that provides health services to individuals who have
limited financial resources. Some services are provided through programs that
operate under a waiver of federal Medicaid laws, including services provided through
the BadgerCare Plus program and the childless adults demonstration project.
Under current law, certain parents and caretaker relatives with incomes of not more
than 100 percent of the federal poverty line, before a 5 percent income disregard is
applied, are eligible for BadgerCare Plus benefits. Under current law, childless
adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent
of the FPL, before a 5 percent income disregard is applied; and 3) are not otherwise
eligible for Medical Assistance, including BadgerCare Plus, are eligible for benefits
under the assistance for childless adults demonstration project.
This bill requires DHS to request a waiver from or submit amendments to the
state Medical Assistance plan to the secretary of the federal Department of Health

and Human Services that would allow individuals whose income is greater than the
eligibility limit for the BadgerCare Plus or the childless adults demonstration
project, but who otherwise meet the eligibility requirements, to purchase coverage
through a separate purchase option program that meets criteria specified in the bill.
The bill also requires DHS to include a request for any federal waiver or state plan
amendments necessary to allow an option for small businesses to purchase coverage
for their employees as part of the Small Business Health Options Program through
an exchange established under federal law. Under the bill, DHS must submit a
report providing information on the status on the progress of receiving a federal
waiver and the results from actuarial and economic analyses that are necessary for
a waiver proposal. If any necessary waiver or state plan amendments are approved,
DHS must implement the program.
Under the bill, DHS must also seek any federal waiver and state Medical
Assistance plan amendments necessary to allow qualified individuals who choose to
purchase the BadgerCare Plus option or the childless adults demonstration project
option to use advanced tax credits and cost-sharing credits, if eligible, to purchase
one of these options. If DHS is authorized to implement the program, and if 1) any
waiver or state plan amendment is necessary and is approved or 2) DHS determines
neither a waiver nor state plan amendment is necessary, DHS shall allow the use of
advanced tax credits and cost-sharing credits to purchase the BadgerCare Plus
option or the childless adults demonstration project option.
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:
AB449,1 1Section 1. 49.471 (4m) of the statutes is created to read:
AB449,3,52 49.471 (4m) Purchase options for BadgerCare Plus and the assistance for
3childless adults demonstration project.
(a) 1. The department shall, if required,
4request a waiver from or submit amendments to the state Medical Assistance plan
5to the secretary of the federal department of health and human services to establish
6a program that allows individuals with income above the maximum income
7eligibility limit applicable under this section or the assistance for childless adults
8demonstration project under s. 49.45 (23), and who otherwise meet the eligibility
9requirements under this section or under s. 49.45 (23), the option of purchasing
10coverage through this section or through the demonstration project under s. 49.45

1(23) instead of purchasing an individual health plan through private insurance. The
2department shall also include a request for any federal waiver or state Medical
3Assistance plan amendments necessary to allow an option for small businesses to
4purchase coverage for their employees under this section as part of the small
5business health options program through an exchange under 42 USC 18031.
AB449,3,96 2. The department shall seek any federal waiver and state Medical Assistance
7plan amendments necessary to allow individuals who qualify under subd. 1. to use
8advanced tax credits and cost-sharing credits, if eligible, to purchase one of the
9options described under subd. 1.
AB449,3,1810 (b) 1. The department shall coordinate the administration of the purchase
11options under this subsection with the programs under this section and s. 49.45 (23)
12to maximize efficiency and improve the continuity of care, consistent with the
13requirements of this section and s. 49.45 (23). The department shall seek to
14implement mechanisms to ensure the long-term financial sustainability of the
15programs under this section and s. 49.45 (23). These mechanisms must address
16issues related to minimizing adverse selection, the state financial risk and
17contribution, and negative impacts to premiums in the individual and group
18insurance markets.
AB449,3,2019 2. The purchase option program shall include, at a minimum, all of the
20following attributes:
AB449,3,2221 a. Establishment of an annual per enrollee premium rate similar to the average
22rate paid by the state to managed care plan contractors.
AB449,3,2423 b. Establishment of a benefit set equal to the benefits covered under this section
24and s. 49.45 (23).
AB449,4,2
1c. Annual enrollment that is limited to the same annual open enrollment
2periods established for the programs under this section and s. 49.45 (23).
AB449,4,43 d. The ability for the department to adjust the purchase option's actuarial value
4to a value no lower than 87 percent.
AB449,4,65 e. Reimbursement mechanisms for addressing potential increased costs to the
6programs under this section and s. 49.45 (23).
AB449,4,117 (c) By March 1, 2018, the department of health services shall submit a report
8to the appropriate standing committee in each house of the legislature under s.
913.172 (3) that provides information on the status of the request for a federal waiver
10and the results from actuarial and economic analyses that are necessary for a waiver
11proposal.
AB449,4,1712 (d) If any necessary waiver or amendments to the state plan described under
13par. (a) 1. are approved, the department shall implement the program. If the
14department is authorized to implement the program, and if any waiver or state plan
15amendment described under par. (a) 2. is necessary and is approved, or if the
16department determines neither a waiver nor state plan amendment is necessary, the
17department shall allow the purchase options described under par. (a) 2.
AB449,4,1818 (End)
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