LRB-3868/1
TJD:ahe&kjf
2019 - 2020 LEGISLATURE
August 22, 2019 - Introduced by Senators Erpenbach, Carpenter, Miller,
Hansen, Ringhand, Wirch, L. Taylor, Risser, Schachtner, Shilling, Smith,
Bewley and Larson, cosponsored 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. Referred to Committee on Public Benefits, Licensing and
State-Federal Relations.
SB361,1,5 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
349.686 (3) (d); and to create 49.471 (1) (cr), 49.471 (4) (a) 8. and 49.471 (4g) of
4the statutes; relating to: eligibility expansion under the Medical Assistance
5program.
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:
SB361,1 1Section 1 . 20.435 (4) (jw) of the statutes is amended to read:
SB361,2,92 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received
3from payment of enrollment fees under the program under s. 49.45 (23), all
moneys
4transferred under s. 50.38 (9), all moneys transferred from the appropriation account
5under par. (jz), and 10 percent of all moneys received from penalty assessments
6under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to
7provide a portion of the state share of administrative costs for the BadgerCare Plus
8Medical Assistance program under s. 49.471, and for administration of the hospital
9assessment under s. 50.38.
SB361,2 10Section 2. 49.45 (2p) of the statutes is repealed.
SB361,3 11Section 3 . 49.45 (23) of the statutes is repealed.
SB361,4 12Section 4 . 49.45 (23b) (title) of the statutes is amended to read:
SB361,2,1413 49.45 (23b) (title) Childless adults demonstration project reform waiver
14implementation required.
SB361,5 15Section 5. 49.45 (23b) (b) of the statutes is amended to read:
SB361,3,216 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and
17ending no sooner than December 31, 2023, the department shall do all of the

1following with regard to the childless adults demonstration project under sub. (23)
2s. 49.471 (4) (a) 8.:
SB361,3,83 1. Require in each month persons, except exempt individuals, who are eligible
4to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least
519 years of age but have not attained the age of 50 to participate in, document, and
6report 80 hours per calendar month of community engagement activities. The
7department, after finding good cause, may grant a temporary exemption from the
8requirement under this subdivision upon request of a Medical Assistance recipient.
SB361,3,119 2. Require persons with incomes of at least 50 percent of the poverty line to pay
10premiums in accordance with par. (c) as a condition of eligibility for Medical
11Assistance under sub. (23) s. 49.471 (4) (a) 8.
SB361,3,1312 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.
SB361,3,1614 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
15an $8 copayment for nonemergency use of the emergency department in accordance
16with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.
SB361,3,2117 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6
18months any individual who does not pay a required premium under subd. 2. and any
19individual who is required under subd. 1. to participate in a community engagement
20activity but who does not participate for 48 aggregate months in the community
21engagement activity.
SB361,6 22Section 6. 49.45 (23b) (c) of the statutes is amended to read:
SB361,4,323 49.45 (23b) (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
2550 percent of the poverty line shall pay a monthly premium amount of $8 per

1household. A person who is eligible to receive an item or service furnished by an
2Indian health care provider is exempt from the premium requirement under this
3subdivision.
SB361,4,94 2. The department may disenroll under par. (b) 5. a person for nonpayment of
5a required monthly premium only at annual eligibility redetermination after
6providing notice and reasonable opportunity for the person to pay. If a person who
7is disenrolled for nonpayment of premiums pays all owed premiums or becomes
8exempt from payment of premiums, he or she may reenroll in Medical Assistance
9under sub. (23) s. 49.471 (4) (a) 8.
SB361,4,1310 3. The department shall reduce the amount of the required household premium
11by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
12who does not engage in certain behaviors that increase health risks or who attests
13to actively managing certain unhealthy behaviors.
SB361,7 14Section 7. 49.45 (23b) (e) of the statutes is amended to read:
SB361,4,1915 49.45 (23b) (e) Before December 31, 2023, the demonstration project
16requirements under this subsection may not be withdrawn and the department may
17not request from the federal government withdrawal, suspension, or termination of
18the demonstration project requirements under this subsection unless legislation has
19been enacted specifically allowing for the withdrawal, suspension, or termination.
SB361,8 20Section 8 . 49.471 (1) (cr) of the statutes is created to read:
SB361,4,2221 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
22federal medical assistance percentage described under 42 USC 1396d (y) or (z).
SB361,9 23Section 9 . 49.471 (4) (a) 4. b. of the statutes is amended to read:
SB361,5,3
149.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
2percent of the poverty line before application of the 5 percent income disregard under
342 CFR 435.603 (d)
.
SB361,10 4Section 10 . 49.471 (4) (a) 8. of the statutes is created to read:
SB361,5,55 49.471 (4) (a) 8. An individual who meets all of the following criteria:
SB361,5,66 a. The individual is an adult under the age of 65.
SB361,5,87 b. The adult has a family income that does not exceed 133 percent of the poverty
8line, except as provided in sub. (4g).
SB361,5,109 c. The adult is not otherwise eligible for the Medical Assistance program under
10this subchapter or the Medicare program under 42 USC 1395 et seq.
SB361,11 11Section 11 . 49.471 (4g) of the statutes is created to read:
SB361,5,2112 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
13services provided to individuals described under sub. (4) (a) 8., the department shall
14comply with all federal requirements to qualify for the highest available enhanced
15federal medical assistance percentage. The department shall submit any
16amendment to the state medical assistance plan, request for a waiver of federal
17Medicaid law, or other approval request required by the federal government to
18provide services to the individuals described under sub. (4) (a) 8. and qualify for the
19highest available enhanced federal medical assistance percentage. Sections 20.940
20and 49.45 (2t) do not apply to a submission to the federal government under this
21subsection.
SB361,12 22Section 12 . 49.686 (3) (d) of the statutes is amended to read:
SB361,6,323 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
24for medical assistance within 12 months prior to application for reimbursement
25under sub. (2). This paragraph does not apply to an individual who is eligible for

1benefits 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
3benefits under BadgerCare Plus under s. 49.471 (11).
SB361,9119 4Section 9119. Nonstatutory provisions; Health Services.
SB361,6,135 (1) Childless adults demonstration project. The department of health
6services shall submit any necessary request to the federal department of health and
7human services for a state plan amendment or waiver of federal Medicaid law or to
8modify or withdraw from any waiver of federal Medicaid law relating to the childless
9adults demonstration project under s. 49.45 (23), 2017 stats., to reflect the
10incorporation of recipients of Medical Assistance under the demonstration project
11into the BadgerCare Plus program under s. 49.471 and the termination of the
12demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission
13to the federal government under this subsection.
SB361,6,1714 (2) Funding for health care. The department of health services shall ensure
15that any increased funding that results from this act is used to improve access to and
16affordability of health care and to support health care quality for residents of this
17state.
SB361,9219 18Section 9219. Fiscal changes; Health Services.
SB361,7,219 (1) Medicaid expansion. In the schedule under s. 20.005 (3) for the
20appropriation to the department of health services under s. 20.435 (4) (b), the dollar
21amount for fiscal year 2019-20 is decreased by $159,473,300 to expand eligibility
22under the Medical Assistance program under s. 49.471 (4) (a) 4. and 8. In the
23schedule under s. 20.005 (3) for the appropriation to the department of health
24services under s. 20.435 (4) (b), the dollar amount for fiscal year 2020-21 is decreased

1by $165,011,600 to expand eligibility under the Medical Assistance program under
2s. 49.471 (4) (a) 4. and 8.
SB361,9419 3Section 9419. Effective dates; Health Services. This act takes effect on the
430th day after the day of publication, except as follows:
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