2019 - 2020 LEGISLATURE
September 5, 2019 - Introduced by Representatives Riemer, Kolste, Vining,
Billings, Goyke, Hebl, Zamarripa, Pope, Stubbs, Gruszynski, Bowen, Doyle,
Brostoff, Anderson, Hesselbein, Ohnstad, B. Meyers, Neubauer, Spreitzer,
Milroy, Emerson, Sargent, Shankland, Stuck, Hintz, C. Taylor, Sinicki,
Subeck, McGuire, Vruwink, Fields, Crowley, Considine, Haywood, Cabrera
and L. Myers, cosponsored by Senators Erpenbach, Carpenter, Miller,
Ringhand, Wirch, L. Taylor, Risser, Schachtner, Shilling, Smith, Bewley
and Larson. Referred to Committee on Medicaid Reform and Oversight.
1An Act to repeal
49.45 (2p) and 49.45 (23); to amend
20.435 (4) (jw), 49.45 (23b) 2
(title), 49.45 (23b) (b), 49.45 (23b) (c), 49.45 (23b) (e), 49.471 (4) (a) 4. b. and 3
49.686 (3) (d); and to create
49.471 (1) (cr), 49.471 (4) (a) 8. and 49.471 (4g) of 4
the statutes; relating to: eligibility expansion under the Medical Assistance
Analysis by the Legislative Reference Bureau
This 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 currently covered under BadgerCare Plus Core and who are
incorporated into BadgerCare Plus in this bill. 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 childless adults under the BadgerCare
Plus program. DHS must ensure that any increased funding resulting from the bill
is used to improve access to and affordability of health care and to support health care
quality for Wisconsin residents.
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 eliminates the childless
adults demonstration project known as BadgerCare Plus Core.
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:
20.435 (4) (jw) of the statutes is amended to read:
(jw) BadgerCare Plus and hospital assessment.
All moneys received
3from payment of enrollment fees under the program under s. 49.45 (23), all
transferred under s. 50.38 (9), all moneys transferred from the appropriation account 5
under par. (jz), and 10 percent of all moneys received from penalty assessments 6
under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23),
provide a portion of the state share of administrative costs for the BadgerCare Plus 8
Medical Assistance program under s. 49.471,
and for administration of the hospital 9
assessment under s. 50.38.
49.45 (2p) of the statutes is repealed.
49.45 (23) of the statutes is repealed.
49.45 (23b) (title) of the statutes is amended to read:
(title) Childless adults
demonstration project reform waiver
49.45 (23b) (b) of the statutes is amended to read:
(b) Beginning as soon as practicable after October 31, 2018, and 17
ending no sooner than December 31, 2023, the department shall do all of the
following with regard to the
childless adults demonstration project
under sub. (23)
2s. 49.471 (4) (a) 8.
1. Require in each month persons, except exempt individuals, who are eligible 4
to receive Medical Assistance under sub. (23)
s. 49.471 (4) (a) 8.
and who are at least 5
19 years of age but have not attained the age of 50 to participate in, document, and 6
report 80 hours per calendar month of community engagement activities. The 7
department, after finding good cause, may grant a temporary exemption from the 8
requirement under this subdivision upon request of a Medical Assistance recipient.
2. Require persons with incomes of at least 50 percent of the poverty line to pay 10
premiums in accordance with par. (c) as a condition of eligibility for Medical 11
Assistance under sub. (23) s. 49.471 (4) (a) 8
3. Require as a condition of eligibility for Medical Assistance under
sub. (23) 13s. 49.471 (4) (a) 8.
completion of a health risk assessment.
4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
an $8 copayment for nonemergency use of the emergency department in accordance 16
with 42 USC 1396o-1
(e) (1) and 42 CFR 447.54
5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
for 6 18
months any individual who does not pay a required premium under subd. 2. and any 19
individual who is required under subd. 1. to participate in a community engagement 20
activity but who does not participate for 48 aggregate months in the community 21
49.45 (23b) (c) of the statutes is amended to read:
(c) 1. Persons who are eligible
for the demonstration project
under 24sub. (23) s. 49.471 (4) (a) 8.
and who have monthly household income that exceeds 25
50 percent of the poverty line shall pay a monthly premium amount of $8 per
household. A person who is eligible to receive an item or service furnished by an 2
Indian health care provider is exempt from the premium requirement under this 3
2. The department may disenroll under par. (b) 5. a person for nonpayment of 5
a required monthly premium only at annual eligibility redetermination after 6
providing notice and reasonable opportunity for the person to pay. If a person who 7
is disenrolled for nonpayment of premiums pays all owed premiums or becomes 8
exempt from payment of premiums, he or she may reenroll in Medical Assistance 9
under sub. (23) s. 49.471 (4) (a) 8
3. The department shall reduce the amount of the required household premium 11
by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. 12
who does not engage in certain behaviors that increase health risks or who attests 13
to actively managing certain unhealthy behaviors.
49.45 (23b) (e) of the statutes is amended to read:
(e) Before December 31, 2023, the
demonstration project 16
requirements under this subsection may not be withdrawn and the department may 17
not request from the federal government withdrawal, suspension, or termination of 18
the demonstration project
requirements under this subsection unless legislation has 19
been enacted specifically allowing for the withdrawal, suspension, or termination.
49.471 (1) (cr) of the statutes is created to read:
(cr) “Enhanced federal medical assistance percentage" means a 22
federal medical assistance percentage described under 42 USC 1396d
(y) or (z).
49.471 (4) (a) 4. b. of the statutes is amended to read:
(a) 4. b. The individual's family income does not exceed 100 133 2
percent of the poverty line before application of the 5 percent income disregard under
342 CFR 435.603 (d)
49.471 (4) (a) 8. of the statutes is created to read:
(a) 8. An individual who meets all of the following criteria:
a. The individual is an adult under the age of 65.
b. The adult has a family income that does not exceed 133 percent of the poverty 8
line, except as provided in sub. (4g).
c. The adult is not otherwise eligible for the Medical Assistance program under 10
this subchapter or the Medicare program under 42 USC 1395
49.471 (4g) of the statutes is created to read:
49.471 (4g) Medicaid expansion; federal medical assistance percentage.
services provided to individuals described under sub. (4) (a) 8., the department shall 14
comply with all federal requirements to qualify for the highest available enhanced 15
federal medical assistance percentage. The department shall submit any 16
amendment to the state medical assistance plan, request for a waiver of federal 17
Medicaid law, or other approval request required by the federal government to 18
provide services to the individuals described under sub. (4) (a) 8. and qualify for the 19
highest available enhanced federal medical assistance percentage. Sections 20.940 20
and 49.45 (2t) do not apply to a submission to the federal government under this 21
49.686 (3) (d) of the statutes is amended to read:
(d) Has applied for coverage under and has been denied eligibility 24
for medical assistance within 12 months prior to application for reimbursement 25
under sub. (2). This paragraph does not apply to an individual who is eligible for
benefits under the demonstration project for childless adults under s. 49.45 (23) 2BadgerCare Plus under s. 49.471 (4) (a) 8.
or to an individual who is eligible for 3
benefits under BadgerCare Plus under s. 49.471 (11).
Nonstatutory provisions; Health Services.
(1) Childless adults demonstration project.
The department of health 6
services shall submit any necessary request to the federal department of health and 7
human services for a state plan amendment or waiver of federal Medicaid law or to 8
modify or withdraw from any waiver of federal Medicaid law relating to the childless 9
adults demonstration project under s. 49.45 (23), 2017 stats., to reflect the 10
incorporation of recipients of Medical Assistance under the demonstration project 11
into the BadgerCare Plus program under s. 49.471 and the termination of the 12
demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission 13
to the federal government under this subsection.
(2) Funding for health care.
The department of health services shall ensure 15
that any increased funding that results from this act is used to improve access to and 16
affordability of health care and to support health care quality for residents of this 17
Fiscal changes; Health Services.
(1) Medicaid expansion.
In the schedule under s. 20.005 (3) for the 20
appropriation to the department of health services under s. 20.435 (4) (b), the dollar 21
amount for fiscal year 2019-20 is decreased by $159,473,300 to expand eligibility 22
under the Medical Assistance program under s. 49.471 (4) (a) 4. and 8. In the 23
schedule under s. 20.005 (3) for the appropriation to the department of health 24
services under s. 20.435 (4) (b), the dollar amount for fiscal year 2020-21 is decreased
by $165,011,600 to expand eligibility under the Medical Assistance program under 2
s. 49.471 (4) (a) 4. and 8.
Effective dates; Health Services. This act takes effect on the
430th day after the day of publication, except as follows: