LRB-4127/1
FFK&TJD:jld&emw
2015 - 2016 LEGISLATURE
February 3, 2016 - Introduced by Representatives Pope and Barca. Referred to
Committee on State Affairs and Government Operations.
AB855,1,5 1An Act to amend 49.45 (23) (a) and 49.471 (4) (a) 4. b.; and to create 49.471 (1)
2(cr), 49.471 (4g), 118.60 (10m), 119.23 (10m) and 946.94 of the statutes;
3relating to: fraud in parental choice programs, Medicaid expansion, eligibility
4for BadgerCare Plus and BadgerCare Plus Core, and providing a criminal
5penalty.
Analysis by the Legislative Reference Bureau
This bill subjects certain acts and omissions related to a Parental Choice
Program (PCP) to criminal penalties and changes the family income eligibility level
to up to 133 percent of the federal poverty line (FPL) for parents and caretaker
relatives under BadgerCare Plus (BC+) and for childless adults under BadgerCare
Plus Core (BC+ Core).
Under the bill, intentionally making a false statement or representation in an
application to participate in a PCP is a Class A misdemeanor. The bill makes
concealing or failing to disclose an event with an intent to fraudulently participate
in a PCP or using a payment received under a PCP for an unauthorized purpose
either a Class G or Class H felony, depending on the payment a person received under
the PCP. Additionally, under the bill, a statement in a written application for a PCP
is considered to be an admission of the existence, correctness, or validity of the
statement. This bill authorizes the Department of Justice or a district attorney to
prosecute violations of criminal laws affecting a PCP, including laws affecting the
health, safety, and welfare of pupils attending a private school participating in a PCP.

Currently, the Department of Health Services (DHS) administers the Medical
Assistance (MA) 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 BC+ and BC+ Core programs. Certain
parents and caretaker relatives with incomes of not more than 100 percent of the
FPL, before a 5 percent income disregard is applied, are eligible for BC+ benefits.
Adults who are under age 65, who have family incomes that do not exceed 100 percent
of the FPL, before a 5 percent income disregard is applied, and who are not otherwise
eligible for MA, including BC+ (childless adults), are eligible for benefits under BC+
Core.
The federal Patient Protection and Affordable Care Act allows a state to receive
an enhanced federal medical assistance percentage (FMAP) payment for providing
benefits to certain individuals through a state's MA program. The bill expands the
income eligibility level for parents and caretaker relatives under BC+ and for
childless adults under BC+ Core. The bill requires DHS to comply with all federal
requirements and to submit any amendment to the state MA plan, request for a
waiver of Medicaid law, or other federal approval necessary to qualify for the highest
available enhanced FMAP for parents and caretaker relatives and childless adults
eligible for BC+ Core (collectively nonpregnant, nonelderly adults). If DHS does not
qualify for the enhanced FMAP or if the FMAP is reduced, DHS is required to submit
to the Joint Committee on Finance (JCF) a fiscal analysis comparing the cost of
covering nonpregnant, nonelderly adults under the MA program at up to 133 percent
of the FPL to the cost of limiting income eligibility to those adults to up to 100 percent
of the FPL. DHS may reduce income eligibility levels for nonpregnant, nonelderly
adults to up to 100 percent of the FPL only if JCF approves.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB855,1 1Section 1. 49.45 (23) (a) of the statutes is amended to read:
AB855,3,22 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

1for medical assistance under this subchapter, the Badger Care health care program
2under s. 49.665, or Medicare under 42 USC 1395 et seq.
AB855,2 3Section 2. 49.471 (1) (cr) of the statutes is created to read:
AB855,3,54 49.471 (1) (cr) "Enhanced federal medical assistance percentage" means a
5federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB855,3 6Section 3. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB855,3,97 49.471 (4) (a) 4. b. The Except as provided in sub. (4g), the individual's family
8income does not exceed 100 133 percent of the poverty line before application of the
95 percent income disregard under 42 CFR 435.603 (d)
.
AB855,4 10Section 4. 49.471 (4g) of the statutes is created to read:
AB855,3,1811 49.471 (4g) Medicaid expansion; federal medical assistance percentage. (a)
12For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23),
13the department shall comply with all federal requirements to qualify for the highest
14available enhanced federal medical assistance percentage. The department shall
15submit any amendment to the state medical assistance plan, request for a waiver of
16federal Medicaid law, or other approval required by the federal government to
17provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23) and
18qualify for the highest available enhanced federal medical assistance percentage.
AB855,4,419 (b) If the department does not qualify for an enhanced federal medical
20assistance percentage, or if the enhanced federal medical assistance percentage
21obtained by the department is lower than printed in federal law as of July 1, 2013,
22for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall
23submit to the joint committee on finance a fiscal analysis comparing the cost to
24maintain coverage for adults who are not pregnant and not elderly at up to 133
25percent of the poverty line to the cost of limiting eligibility to those adults with family

1incomes up to 100 percent of the poverty line. The department may reduce income
2eligibility for adults who are not pregnant and not elderly from up to 133 percent of
3the poverty line to up to 100 percent of the poverty line only if this reduction in income
4eligibility levels is approved by the joint committee on finance.
AB855,5 5Section 5. 118.60 (10m) of the statutes is created to read:
AB855,4,156 118.60 (10m) The department of justice or the district attorney may institute,
7manage, control, and direct, in the proper county, any prosecution for violation of
8criminal laws affecting a parental choice program under this section, including laws
9relating to parental choice programs under ch. 946 and laws affecting the health,
10safety, and welfare of pupils attending private schools under parental choice
11programs. For this purpose the department of justice shall have and exercise all
12powers conferred upon district attorneys in such cases. The department of justice
13or district attorney shall notify the department of public instruction of any such
14prosecution of a person holding a license granted by the department of public
15instruction.
AB855,6 16Section 6. 119.23 (10m) of the statutes is created to read:
AB855,5,217 119.23 (10m) The department of justice or the district attorney may institute,
18manage, control, and direct, in the proper county, any prosecution for violation of
19criminal laws affecting a parental choice program under this section, including laws
20relating to parental choice programs under ch. 946 and laws affecting the health,
21safety, and welfare of pupils attending private schools under parental choice
22programs. For this purpose the department of justice shall have and exercise all
23powers conferred upon district attorneys in such cases. The department of justice
24or district attorney shall notify the department of public instruction of any such

1prosecution of a person holding a license granted by the department of public
2instruction.
AB855,7 3Section 7. 946.94 of the statutes is created to read:
AB855,5,5 4946.94 Parental choice program fraud. (1) In this section, "parental choice
5program" means a parental choice program under s. 118.60 or 119.23.
AB855,5,8 6(2) Whoever intentionally makes or causes to be made any false statement or
7representation of material fact in any application to participate in a parental choice
8program is guilty of a Class A misdemeanor.
AB855,5,9 9(3) No person may do any of the following:
AB855,5,1210 (a) Having knowledge of an event affecting the person's eligibility to participate
11in a parental choice program, conceal or fail to disclose that event with an intent to
12fraudulently participate in a parental choice program.
AB855,5,1413 (b) Receive a payment under a parental choice program and use the funding
14for purposes that are not authorized under the parental choice program.
AB855,5,1515 (c) Whoever violates par. (a) or (b) is subject to the following penalties:
AB855,5,1716 1. If the value of the payment that is obtained as the result of the violation is
17more than $5,000 but does not exceed $10,000, a Class H felony.
AB855,5,1918 2. If the value of the payment that is obtained as the result of the violation is
19more than $10,000, a Class G felony.
AB855,5,24 20(4) Whoever makes any statement in a written application to participate in a
21parental choice program is considered to have made an admission as to the existence,
22correctness, or validity of any fact stated. Such a statement is prima facie evidence
23against the person who made it in any complaint, information, or indictment, or in
24any action brought for enforcement of any provision of this section.
AB855,8 25Section 8. Fiscal changes.
AB855,6,9
1(1) In the schedule under section 20.005 (3) of the statutes for the appropriation
2to the department of health services under section 20.435 (4) (b) of the statutes, as
3affected by the acts of 2015, the dollar amount for fiscal year 2015-16 is decreased
4by $102,900,000 to provide Medical Assistance to certain adults with incomes up to
5133 percent of the federal poverty line. In the schedule under section 20.005 (3) of
6the statutes for the appropriation to the department of health services under section
720.435 (4) (b) of the statutes, as affected by the acts of 2015, the dollar amount for
8fiscal year 2016-17 is decreased by $220,600,000 to provide Medical Assistance to
9certain adults with incomes up to 133 percent of the federal poverty line.
AB855,9 10Section 9. Initial applicability.
AB855,6,1311 (1) Parental choice program fraud. The treatment of section 946.94 of the
12statutes first applies to acts and omissions that occur on the effective date of this
13subsection.
AB855,10 14Section 10. Effective dates. This act takes effect on the day after publication,
15except as follows:
AB855,6,1816 (1) The treatment of sections 49.45 (23) (a) and 49.471 (1) (cr), (4) (a) 4. b., and
17(4g) takes effect on January 1, 2016, or on the day after publication, whichever is
18later.
AB855,6,1919 (End)
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