2019 - 2020 LEGISLATURE
SENATE AMENDMENT 13,
TO ASSEMBLY BILL 56
June 26, 2019 - Offered by Senator
At the locations indicated, amend the bill
, as shown by assembly substitute 2
amendment 1, as follows:
At the appropriate places, insert all of the following:
49.471 (4m) of the statutes is created to read:
49.471 (4m) Purchase options for BadgerCare Plus and the assistance for
6childless adults demonstration project.
(a) 1. The department shall, if required, 7
request a waiver from or submit amendments to the state Medical Assistance plan 8
to the secretary of the federal department of health and human services to establish 9
a program that allows individuals with income above the maximum income 10
eligibility limit applicable under this section or the assistance for childless adults 11
demonstration project under s. 49.45 (23), and who otherwise meet the eligibility 12
requirements under this section or under s. 49.45 (23), the option of purchasing 13
coverage through this section or through the demonstration project under s. 49.45
(23) instead of purchasing an individual health plan through private insurance. The 2
department shall also include a request for any federal waiver or state Medical 3
Assistance plan amendments necessary to allow an option for small businesses to 4
purchase coverage for their employees under this section as part of the small 5
business health options program through an exchange under 42 USC 18031
2. The department shall seek any federal waiver and state Medical Assistance 7
plan amendments necessary to allow individuals who qualify under subd. 1. to use 8
advanced tax credits and cost-sharing credits, if eligible, to purchase one of the 9
options described under subd. 1.
(b) 1. The department shall coordinate the administration of the purchase 11
options under this subsection with the programs under this section and s. 49.45 (23) 12
to maximize efficiency and improve the continuity of care, consistent with the 13
requirements of this section and s. 49.45 (23). The department shall seek to 14
implement mechanisms to ensure the long-term financial sustainability of the 15
programs under this section and s. 49.45 (23). These mechanisms must address 16
issues related to minimizing adverse selection, the state financial risk and 17
contribution, and negative impacts to premiums in the individual and group 18
2. The purchase option program shall include, at a minimum, all of the 20
a. Establishment of an annual per enrollee premium rate similar to the average 22
rate paid by the state to managed care plan contractors.
b. Establishment of a benefit set equal to the benefits covered under this section 24
and s. 49.45 (23).
c. Annual enrollment that is limited to the same annual open enrollment 2
periods established for the programs under this section and s. 49.45 (23).
d. The ability for the department to adjust the purchase option's actuarial value 4
to a value no lower than 87 percent.
e. Reimbursement mechanisms for addressing potential increased costs to the 6
programs under this section and s. 49.45 (23).
(c) By March 1, 2018, the department of health services shall submit a report 8
to the appropriate standing committee in each house of the legislature under s. 9
13.172 (3) that provides information on the status of the request for a federal waiver 10
and the results from actuarial and economic analyses that are necessary for a waiver 11
(d) If any necessary waiver or amendments to the state plan described under 13
par. (a) 1. are approved, the department shall implement the program. If the 14
department is authorized to implement the program, and if any waiver or state plan 15
amendment described under par. (a) 2. is necessary and is approved, or if the 16
department determines neither a waiver nor state plan amendment is necessary, the 17
department shall allow the purchase options described under par. (a) 2.”.