LRB-0981/1
TJD:cdc
2019 - 2020 LEGISLATURE
June 3, 2019 - Introduced by Representatives Subeck, Brostoff, Anderson,
Billings, Bowen, Emerson, Gruszynski, Goyke, Hesselbein, Kolste, Milroy,
L. Myers, Neubauer, Ohnstad, Pope, Sargent, Shankland, Sinicki, Spreitzer
and Vruwink, cosponsored by Senators Johnson, Smith, Bewley, Carpenter,
Larson, Miller, Ringhand, Risser and Schachtner. Referred to Committee
on Medicaid Reform and Oversight.
AB255,1,5 1An Act to amend 49.45 (23) (a) and 49.471 (4) (a) 4. b.; and to create 49.471 (1)
2(cr) and 49.471 (4g) of the statutes; relating to: increasing reimbursement for
3personal care services under the Medical Assistance program, Medicaid
4expansion and eligibility for BadgerCare Plus and BadgerCare Plus Core, and
5making an appropriation.
Analysis by the Legislative Reference Bureau
Generally, this bill implements the federal Medicaid expansion under the
federal Patient Protection and Affordable Care Act and increases reimbursement
rates under the Medical Assistance program for personal care services.
The bill changes the family income eligibility level to up to 133 percent of the
federal poverty line for parents and caretaker relatives under BadgerCare Plus and
for childless adults under BadgerCare Plus Core. BadgerCare Plus and BadgerCare
Plus Core are programs under the state's Medical Assistance program, which
provides health services to individuals who have limited financial resources. The
federal Patient Protection and Affordable Care Act allows a state to receive an
enhanced federal medical assistance percentage payment for providing benefits to
certain individuals through a state's Medical Assistance program. The bill requires
the Department of Health Services to comply with all federal requirements and to
request any amendment to the state Medical Assistance plan, waiver of Medicaid
law, or other federal approval necessary to qualify for the highest available enhanced
federal medical assistance percentage for parents and caretaker relatives and

childless adults under the BadgerCare Plus and BadgerCare Plus Core programs.
If DHS does not qualify for the enhanced federal medical assistance percentage or
if the percentage is reduced, DHS is required to submit to the Joint Committee on
Finance a fiscal analysis comparing the cost of covering parents and caretaker
relatives and childless adults under the Medical Assistance program at up to 133
percent of the federal poverty line to the cost of limiting income eligibility to those
adults to up to 100 percent of the federal poverty line. DHS may reduce income
eligibility levels for those adults to up to 100 percent of the federal poverty line only
if the Joint Committee on Finance approves.
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 federal poverty line, 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 BadgerCare Plus Core.
The bill also requires DHS to increase the reimbursement rates by 2.5 percent
for personal care services provided under the Medical Assistance program in each
fiscal year of the current fiscal biennium. To receive an increased reimbursement
rate, a person who provides personal care services shall pay the reimbursement rate
increase to employees or contractors who provide personal care services directly to
a Medical Assistance recipient.
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:
AB255,1 1Section 1. 49.45 (23) (a) of the statutes is amended to read:
AB255,2,92 49.45 (23) (a) The department shall request a waiver from the secretary of the
3federal department of health and human services to permit the department to
4conduct a demonstration project to provide health care coverage to adults who are
5under the age of 65, who have family incomes not to exceed 100 133 percent of the
6poverty line before application of the 5 percent income disregard under 42 CFR
7435.603 (d)
, except as provided in s. 49.471 (4g), and who are not otherwise eligible
8for medical assistance under this subchapter, the Badger Care health care program
9under s. 49.665, or Medicare under 42 USC 1395 et seq.
AB255,2
1Section 2. 49.471 (1) (cr) of the statutes is created to read:
AB255,3,32 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
3federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB255,3 4Section 3. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB255,3,75 49.471 (4) (a) 4. b. The Except as provided in sub. (4g), the individual's family
6income does not exceed 100 133 percent of the poverty line before application of the
75 percent income disregard under 42 CFR 435.603 (d)
.
AB255,4 8Section 4. 49.471 (4g) of the statutes is created to read:
AB255,3,179 49.471 (4g) Medicaid expansion; federal medical assistance percentage. (a)
10For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23),
11the department shall comply with all federal requirements to qualify for the highest
12available enhanced federal medical assistance percentage. The department shall
13submit any amendment to the state medical assistance plan, request for a waiver of
14federal Medicaid law, or other approval request required by the federal government
15to provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23)
16and qualify for the highest available enhanced federal medical assistance
17percentage.
AB255,4,418 (b) If the department does not qualify for an enhanced federal medical
19assistance percentage, or if the enhanced federal medical assistance percentage
20obtained by the department is lower than printed in federal law as of July 1, 2013,
21for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall
22submit to the joint committee on finance a fiscal analysis comparing the cost to
23maintain coverage for adults who are not pregnant and not elderly with family
24incomes of up to 133 percent of the poverty line to the cost of limiting eligibility to
25those adults with family incomes of up to 100 percent of the poverty line. The

1department may reduce income eligibility for adults who are not pregnant and not
2elderly from family incomes of up to 133 percent of the poverty line to family incomes
3of up to 100 percent of the poverty line only if this reduction in income eligibility
4levels is approved by the joint committee on finance.
AB255,5 5Section 5 . Nonstatutory provisions.
AB255,4,126 (1) Personal care rate increase. The department of health services shall
7increase the reimbursement rates by 2.5 percent for personal care services provided
8under the Medical Assistance program in each fiscal year of the 2019-21 fiscal
9biennium. To receive an increased reimbursement rate under this subsection, a
10person who provides personal care services shall pay the reimbursement rate
11increase to employees or contractors who provide personal care services directly to
12a Medical Assistance recipient.
AB255,6 13Section 6 . Fiscal changes.
AB255,4,2214 (1) Personal care rate increase. In the schedule under s. 20.005 (3) for the
15appropriation to the department of health services under s. 20.435 (4) (b), the dollar
16amount for fiscal year 2019-20 is increased by $13,262,515 to increase
17reimbursement rates for personal care services under the Medical Assistance
18program under Section 5 (1) of this act. In the schedule under s. 20.005 (3) for the
19appropriation to the department of health services under s. 20.435 (4) (b), the dollar
20amount for fiscal year 2020-21 is increased by $28,318,166 to increase
21reimbursement rates for personal care services under the Medical Assistance
22program under Section 5 (1) of this act.
AB255,5,523 (2) Medicaid expansion. In the schedule under s. 20.005 (3) for the
24appropriation to the department of health services under s. 20.435 (4) (b), the dollar
25amount for fiscal year 2019-20 is decreased by $98,900,000 to provide Medical

1Assistance to certain adults with family incomes of up to 133 percent of the federal
2poverty line. In the schedule under s. 20.005 (3) for the appropriation to the
3department of health services under s. 20.435 (4) (b), the dollar amount for fiscal year
42020-21 is decreased by $187,400,000 to provide Medical Assistance to certain
5adults with family incomes of up to 133 percent of the federal poverty line.
AB255,7 6Section 7. Effective dates. This act takes effect on the day after publication,
7except as follows:
AB255,5,10 8(1) Medicaid expansion. The treatment of ss. 49.45 (23) (a) and 49.471 (1) (cr),
9(4) (a) 4. b., and (4g) and Section 6 (2) of this act take effect on July 1, 2019, or on the
10day after publication, whichever is later.
AB255,5,1111 (End)
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