Currently, the Department of Health and Family Services (DHFS) administers
the Medical Assistance (MA) and Badger Care programs to provide comprehensive
health care coverage to program enrollees. Generally, children under the age of six
whose family income does not exceed 185 percent of the federal poverty level (FPL)
and children over age six whose family income does not exceed 100 percent of the FPL
are eligible for MA. Also certain disabled or blind children are eligible for MA.
Children, regardless of age, whose family income does not exceed 185 percent of FPL
and who do not have access to an employer-subsidized health insurance plan for
which the employer subsidizes at least 80 percent of the cost are generally eligible
for Badger Care. (Family income may increase up to 200 percent of FPL before a
family already enrolled in Badger Care loses eligibility). Badger Care enrollees with
family income in excess of 150 percent of the FPL must pay a monthly premium. The
benefits under MA and Badger Care include: physician services; early periodic
screening, diagnosis, and treatment; inpatient and outpatient hospital services;
dental services; optometrist or optician services; mental health services; and
prescription and over-the-counter drugs.
This bill requires DHFS to administer a program (All Kids) to provide health
care coverage to certain children under the age of 19 regardless of the child's family
income. A child is eligible if he or she is a resident of Wisconsin; if he or she is not
eligible for MA or Badger Care; if he or she is not a resident of an institution for
mental diseases or an inmate of a public institution; and if he or she satisfies at least
one of the following health care coverage conditions: 1) the child has been without
health insurance coverage for a period of time established by DHFS (at least six
months upon program implementation, incrementally increasing to at least 12
months); 2) the child's parent lost access to affordable employer-sponsored health
insurance for the child as a result of job loss; 3) the child is a newborn without access
to affordable employer-sponsored health insurance; or 4) the child lost eligibility for
MA or Badger Care in the previous 12 months.
The bill authorizes DHFS to establish cost-sharing requirements for enrollees
including monthly premiums (based on family income), copayments, or coinsurance.
If a required monthly premium is not timely paid, the child is terminated from All
Kids and is not eligible to reenroll for at least three months.
The benefits under All Kids are the same as the benefits under MA, except that
All Kids does not cover nonemergency transportation services. However, the bill
authorizes DHFS to subsidize a health insurance plan for an enrollee rather than
providing the MA benefits if the subsidy is cost-effective. Further, the bill authorizes
DHFS to provide a limited package of health care benefits to children who satisfy all
of the eligibility criteria except the health care coverage conditions and are either
enrolled in a high-deductible health insurance plan or a health insurance plan that
does not cover all of the benefits covered under All Kids. The bill creates a general
purpose revenue appropriation and a program revenue appropriation to fund
benefits under the All Kids program.
Under the bill, the All Kids program is effective January 1, 2007. The bill
requires DHFS to promulgate emergency rules for the program.
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:
AB959, s. 1
1Section
1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
2the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
AB959, s. 2
1Section
2. 20.435 (4) (c) of the statutes is created to read:
AB959,3,32
20.435
(4) (c)
All Kids benefits. Biennially, the amounts in the schedule for
3benefits under s. 49.67.
AB959, s. 3
4Section
3. 20.435 (4) (jk) of the statutes is created to read:
AB959,3,65
20.435
(4) (jk)
All Kids cost sharing. All moneys received from payments under
6s. 49.67 (6) for benefits under s. 49.67.
AB959, s. 4
7Section
4. 49.67 of the statutes is created to read:
AB959,3,9
849.67 All Kids. (1) In this section, "child" means a person who is under the
9age of 19.
AB959,3,11
10(2) Administration. (a) The department shall administer a program to provide
11benefits under sub. (5) to children eligible under sub. (3).
AB959,3,1412
(b) The department shall promulgate rules to administer the program under
13this section including rules for determining affordability of health insurance plans,
14rules specifying reenrollment procedures, and rules for cost-sharing.
AB959,3,16
15(3) Eligibility. A child is eligible for the program under this section if all of the
16following apply:
AB959,3,1717
(a) The child is a resident of this state.
AB959,4,1
1(b) The child is not eligible to receive benefits under s. 49.45 or 49.665.
AB959,4,32
(c) The child is not a resident of an institution for mental diseases, as defined
3in s. 49.43 (6m).
AB959,4,54(d) The child is not an inmate of a public institution, as defined in
42 CFR
5435.1009.
AB959,4,66
(e) At the time of eligibility determination, any of the following applies:
AB959,4,137
1. The child has been without health insurance coverage for a period
8established by the department by rule that is not less than 6 months during the first
9month of operation of the program under this section, 7 months during the 2nd
10month of operation, 8 months during the 3rd month of operation, 9 months during
11the 4th month of operation, 10 months during the 5th month of operation, 11 months
12during the 6th month of operation, and 12 months for any month after the 6th month
13of operation.
AB959,4,1714
2. As a result of losing employment, the child's parent lost access to affordable
15employer-sponsored health insurance coverage for the child and the parent remains
16without access to affordable employer-sponsored health insurance coverage for the
17child.
AB959,4,1918
3. The child is a newborn and affordable private or employer-sponsored health
19insurance coverage is not available for the child.
AB959,4,2120
4. The child lost eligibility for benefits under s. 49.45 or 49.665 within the 12
21months before applying for benefits under this section.
AB959,5,2
22(4) Enrollment duration. A child who is determined to be eligible under sub.
23(3) remains eligible for 12 months except if sub. (3) (a), (c), or (d) no longer applies
24or if a monthly premium required under sub. (6) is not timely paid. A child for whom
1the monthly premium is not timely paid is ineligible to reenroll in the program under
2this section for 3 months.
AB959,5,5
3(5) Benefits. (a) Except as provided in par. (b), the benefits under this section
4are the same as those described under s. 49.46 (2), except that nonemergency
5transportation services are not covered under this section.
AB959,5,86
(b) As an alternative to providing the benefits under par. (a), the department
7may subsidize the cost of health insurance coverage for a child, including
8employer-sponsored coverage, if paying the subsidy is cost-effective.
AB959,5,13
9(6) Cost sharing. (a) Except as provided in par. (b), a child receiving benefits
10under sub. (5) (a) is subject to any copayment, coinsurance, or monthly premium
11established by the department. The department shall determine copayment,
12coinsurance, and monthly premium amounts on a sliding scale based on family
13income.
AB959,5,1514
(b) The department may not require a copayment for the benefit described
15under s. 49.46 (2) (a) 2.
AB959,5,1716
(c) A child enrolled in a privately sponsored health plan as provided under sub.
17(5) (b) is subject to the cost-sharing provisions stated in the plan.
AB959,5,23
18(7) Alternatives. Notwithstanding subs. (3) (e) and (5), if cost-effective, the
19department may, as an alternative to the benefits under sub. (5), provide a limited
20package of the services under sub. (5) (a) to a child who satisfies the eligibility criteria
21under sub. (3) (a), (b), (c), and (d) and is enrolled in a high-deductible health
22insurance plan or a health insurance plan that does not cover all of the benefits under
23sub. (5) (a).
AB959,5,24
24(8) Information about applicants and enrollees. (a) In this subsection:
AB959,5,2525
1. "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
AB959,6,1
12. "Insurer" has the meaning given in s. 600.03 (27)
AB959,6,62
(b) An insurer that issues or delivers a disability insurance policy that provides
3coverage to a resident of this state shall provide to the department, upon the
4department's request, information contained in the insurer's records that the
5department needs to verify the eligibility of program applicants and enrollees under
6this section.
AB959,6,97
(c) Upon requesting an insurer to provide the information under par. (b), the
8department shall enter into a written agreement with the insurer that satisfies all
9of the following:
AB959,6,1010
1. Identifies in detail the information to be disclosed.
AB959,6,1211
2. Includes provisions that adequately safeguard the confidentiality of the
12information to be disclosed.
AB959,6,1513
(d) 1. An insurer shall provide the information requested under par. (b) within
14180 days after receiving the department's request if it is the first time that the
15department has requested the insurer to disclose information under this subsection.
AB959,6,1816
2. An insurer shall provide the information requested under par. (b) within 30
17days after receiving the department's request if the department has previously
18requested the insurer to disclose information under this subsection.
AB959,6,2119
3. If an insurer fails to comply with subd. 1. or 2., the department may notify
20the commissioner of insurance and the commissioner of insurance may initiate
21enforcement proceedings against the insurer under s. 601.41 (4) (a).
AB959,7,823
(1)
Emergency rules. Using the procedure under section 227.24 of the statutes,
24the department of health and family services shall promulgate the rules required
25under section 49.67 (2) (b) of the statutes, as created by this act. Notwithstanding
1section 227.24 (1) (c) and (2) of the statues, emergency rules promulgated under this
2subsection remain in effect until the effective date of the permanent rules
3promulgated under section 49.67 (2) of the statues, as created by this act, or until
4January 1, 2008, whichever is sooner. Notwithstanding section 227.24 (1) (a), (2) (b),
5and (3) of the statutes, the department is not required to provide evidence that
6promulgating a rule under this subsection as an emergency rule is necessary for the
7preservation of the public peace, health, safety, or welfare and is not required to
8provide a finding of emergency for a rule promulgated under this subsection.
AB959, s. 6
9Section
6.
Effective dates. This act takes effect on the day after publication,
10except as follows:
AB959,7,1211
(1)
The treatment of section 49.67 (2) (b) of the statutes and
Section
5 (1
) of this
12act take effect on the day after publication.