LRB-3510/2
PJK:bjk&kjf:rs
2007 - 2008 LEGISLATURE
February 20, 2008 - Introduced by Senator Erpenbach. Referred to Committee on
Health, Human Services, Insurance, and Job Creation.
SB518,1,10
1An Act to repeal 49.471 (6) (e);
to renumber 46.286 (1) (b) (intro.), 46.286 (1)
2(b) 1m. and 46.286 (1) (b) 3.;
to renumber and amend 49.45 (18) (am), 49.471
3(5) (c) and 49.471 (6) (a);
to amend 46.286 (3) (a) 4m., 49.45 (18) (b) 2., 49.471
4(2), 49.471 (3) (a) 1., 49.471 (3) (b) 1. (intro.), 49.471 (3) (b) 1. c., 49.471 (3) (b)
52., 49.471 (4) (a) 4. a., 49.471 (4) (b) 4. a., 49.471 (5) (b) 1., 49.471 (5) (b) 2., 49.471
6(7) (b) 1., 49.471 (7) (b) 2., 49.471 (7) (b) 3., 49.471 (7) (c) 1., 49.471 (8) (d) 2. c.,
749.471 (10) (a), 49.471 (10) (b) 5. and 49.471 (12) (b); and
to create 46.286 (1)
8(b) 1c., 49.45 (18) (am) 2., 49.471 (4) (a) 7., 49.471 (5) (c) 1., 49.471 (6) (a) 1.,
949.471 (8) (d) 1. f. and 49.471 (10) (b) 4. g. of the statutes;
relating to: changes
10to BadgerCare Plus.
Analysis by the Legislative Reference Bureau
BadgerCare Plus (BC+) is a Medical Assistance (MA) program that was
approved in the biennial budget act. BC+, which will be administered by the
Department of Health and Family Services (DHFS), provides health care benefits
under two different plans, depending on the basis for a recipient's eligibility, to
recipients who satisfy financial and nonfinancial eligibility criteria. The first plan
provides the same benefits that are provided under regular MA. Individuals eligible
for BC+ benefits under that plan (regular MA plan) include: a pregnant woman
whose family income does not exceed 200 percent of the poverty level (poverty); a
child under one year of age whose mother, on the day on which the child was born,
was eligible for and receiving benefits under MA or BC+ under the regular MA plan;
any child whose family income does not exceed 200 percent of poverty; an individual
whose family income does not exceed 200 percent of poverty and who is the parent
or caretaker relative of a child who is, generally, living in the home of the parent or
caretaker relative; certain migrant workers and their dependents; and an individual
between 18 and 21 years of age who was in foster care on his or her 18th birthday.
The second plan, called the Benchmark Plan, provides specified benefits,
including, but not limited to, coverage for prescription drugs; physicians' services;
inpatient and outpatient hospital services; home health services; physical,
occupational, and speech therapy; treatment for nervous and mental disorders and
alcoholism and other drug abuse problems; durable medical equipment; and
transportation to obtain emergency medical care. Individuals eligible for BC+
benefits under the Benchmark Plan include: a pregnant woman whose family income
exceeds 200 percent, but does not exceed 300 percent, of poverty; a child under one
year of age whose mother, on the day on which the child was born, was eligible for
and receiving BC+ benefits under the Benchmark Plan; any child whose family
income exceeds 200 percent, but does not exceed 300 percent, of poverty; and an
individual whose family income exceeds 200 percent, but does not exceed 300
percent, of poverty and who is the parent or caretaker relative of a child who is,
generally, living in the home of the parent or caretaker relative. In addition, any
child whose family income exceeds 300 percent of poverty may purchase coverage
under the Benchmark Plan at the full per member per month cost of the coverage.
This bill makes a number of changes to BC+, including the following:
1) Specifies that DHFS will provide prenatal care services under the regular
MA plan for a pregnant woman with presumptive eligibility (has not applied for
benefits but satisfies the eligibility criteria) whose income is not greater than 200
percent of the poverty level (poverty) and will provide prenatal care services under
the Benchmark Plan for a pregnant woman with presumptive eligibility whose
income is greater than 200 percent but not greater than 300 percent of poverty.
2) Specifies that any pregnant woman is eligible for benefits for any of the three
months before applying for benefits if she met the eligibility criteria during that
month. Under current law, only a pregnant woman whose income is less than 150
percent of poverty is eligible for benefits for any of the three months before she
applied for benefits.
3) Specifies that only a pregnant woman with income greater than 300 percent
of poverty may obtain eligibility for BC+ benefits if medical expenses reduce her
income to the applicable limit for eligibility. Current law provides that any pregnant
woman or unborn child may obtain eligibility if medical expenses reduce income.
4) Provides that for determining financial eligibility, a person's income will be
reduced by the amount of a court-ordered obligation, up to amount of the person's
income. Current law reduces income by the amount the person pays in child support.
5) Provides that a person who loses eligibility for six months for failure to pay
a premium retains eligibility in any month during that six-month period when their
family income is not more than 150 percent of poverty.
6) Extends eligibility for MA coverage for 12, rather than 18, months for a
person over 18 years of age who was receiving MA when BC+ was implemented, who
lost eligibility for MA solely because of the implementation of BC+, and who does not
meet the income eligibility criteria of BC+.
7) Clarifies that a parent or caretaker relative of a child may be eligible for BC+
if the child is absent from the home but the parent or caretaker relative is complying
with a permanency plan prepared under the juvenile justice code provisions of the
statutes, as well as under the children's code provisions of the statutes.
8) Provides that certain persons who are eligible for an extension of MA benefits
when their household incomes increase above poverty are eligible for BC+ benefits
under the regular MA plan, are not required to pay a premium for the extension of
benefits, and do not lose eligibility due to having access to employer-sponsored
health insurance.
9) Clarifies that a child whose family income exceeds 150 percent of poverty and
who may obtain eligibility if the difference between his or her family income and 150
percent of poverty is obligated or expended for medical care or health insurance
premiums is one who is ineligible solely for reasons related to having certain types
of access to certain types of health insurance coverage.
10) Provides that, if approval of the state plan amendments do not allow for
federal funding for benefits for any part or all of one or more of the eligibility groups,
DHFS may in its discretion pay for benefits for any part of any group for which
federal funding is denied with moneys from a specified general purpose revenue
appropriation.
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:
SB518, s. 2
3Section
2. 46.286 (1) (b) 1c. of the statutes is created to read:
SB518,3,54
46.286
(1) (b) 1c. In this paragraph, "medical assistance" does not include
5coverage of the benefits under s. 49.471 (11).
SB518,4,65
46.286
(3) (a) 4m. The person is financially eligible under sub. (1) (b)
1m. 2m.
6a., and fulfills any applicable cost-sharing requirements.
SB518,4,129
49.45
(18) (am) 1.
No Except as provided in subd. 2., no person is liable under
10this subsection for services provided through prepayment contracts.
This paragraph
11does not apply to a person who is eligible for the benefits under s. 49.46 (2) (a) and
12(b) under s. 49.471.
SB518, s. 7
13Section
7. 49.45 (18) (am) 2. of the statutes is created to read:
SB518,4,1714
49.45
(18) (am) 2. A person who is eligible for the benefits under s. 49.46 (2) (a)
15and (b) under s. 49.471 is liable under this subsection for services provided through
16a prepayment contract in the amounts and according to the procedures specified by
17the department.
SB518, s. 8
18Section
8. 49.45 (18) (b) 2. of the statutes is amended to read:
SB518,4,2219
49.45
(18) (b) 2. Any service provided to a person who is less than 18 years old.
20This subdivision does not apply if the person's family income exceeds 100 percent of
21the poverty line and he or she is eligible for the benefits under s. 49.46 (2) (a) and (b)
22under s. 49.471.
SB518,5,18
149.471
(2) Waiver and state plan amendments. The department shall request
2a waiver from, and submit amendments to the state Medical Assistance plan to, the
3secretary of the federal department of health and human services to implement
4BadgerCare Plus. If the state plan amendments are approved and a waiver that is
5substantially consistent with the provisions of this section, excluding sub. (2m), is
6granted and in effect, the department shall implement BadgerCare Plus beginning
7on January 1, 2008, the effective date of the state plan amendments, or the effective
8date of the waiver, whichever is latest.
If the state plan amendments are approved
9but the terms of approval do not allow for federal funding of the cost of benefits for
10all or any part of one or more of the eligibility categories under sub. (4) (b), the
11department may at its discretion pay for the cost of benefits for all or any part of any
12group for which federal funding was denied exclusively with moneys from the
13appropriation under s. 20.435 (4) (b). If the state plan amendments are not approved
14or if a waiver that is substantially consistent with the provisions of this section,
15excluding sub. (2m), is not granted, BadgerCare Plus may not be implemented. If
16the state plan amendments are approved but approval is not continued or if a waiver
17that is substantially consistent with the provisions of this section, excluding sub.
18(2m), is granted but not continued in effect, BadgerCare Plus shall be discontinued.
SB518,6,321
49.471
(3) (a) 1. Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4),
22if the amendments to the state plan under sub. (2) are approved and a waiver under
23sub. (2) that is
substantially consistent with
all of the provisions of this section,
24excluding sub. (2m), is granted and in effect, an individual described in sub. (4) (a)
25or (b) or (5) is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical
1Assistance or BadgerCare health program benefits. The eligibility of an individual
2described in sub. (4) (a) or (b) or (5) for Medical Assistance benefits shall be
3determined under this section.
SB518,6,126
49.471
(3) (b) 1. (intro.) If an individual over 18 years of age who is eligible for
7and receiving Medical Assistance benefits under s. 49.46, 49.47, or 49.665 in the
8month before BadgerCare Plus is implemented loses that eligibility solely due to the
9implementation of BadgerCare Plus and, because of his or her income, is not eligible
10for BadgerCare Plus, the individual shall continue receiving for
18 12 consecutive
11months the medical assistance he or she was receiving before the implementation of
12BadgerCare Plus if all of the following are satisfied:
SB518,6,1715
49.471
(3) (b) 1. c. The individual
continues to meet meets all nonfinancial
16eligibility requirements
for the coverage that he or she had in the month before the
17implementation of BadgerCare Plus under this section.
SB518,6,2320
49.471
(3) (b) 2. Notwithstanding subd. 1., if at any time during an individual's
2118-month 12-month eligibility extension under subd. 1. any criterion under subd.
221. a. to d. is not satisfied, the individual's eligibility for the extended coverage is
23terminated and any time remaining in the eligibility period is lost.
SB518,7,6
149.471
(4) (a) 4. a. The individual is a parent or caretaker relative of a child who
2is living in the home with the parent or caretaker relative or who is temporarily
3absent from the home for not more than 6 months or, if the child has been removed
4from the home for more than 6 months, the parent or caretaker relative is working
5toward unifying the family by complying with a permanency plan under s. 48.38
or
6938.38.
SB518, s. 15
7Section
15. 49.471 (4) (a) 7. of the statutes is created to read:
SB518,7,108
49.471
(4) (a) 7. Individuals who qualify for a medical assistance eligibility
9extension under s. 49.46 (1) (c), (cg), or (co) when their income increases above the
10poverty line.
SB518,7,1813
49.471
(4) (b) 4. a. The individual is a parent or caretaker relative of a child who
14is living in the home with the parent or caretaker relative or who is temporarily
15absent from the home for not more than 6 months or, if the child has been removed
16from the home for more than 6 months, the parent or caretaker relative is working
17toward unifying the family by complying with a permanency plan under s. 48.38
or
18938.38.
SB518,7,2521
49.471
(5) (b) 1. Except as provided in sub. (6) (a)
1., a pregnant woman is
22eligible for the benefits specified in par. (c) during the period beginning on the day
23on which a qualified provider determines, on the basis of preliminary information,
24that the woman's family income does not exceed 300 percent of the poverty line and
25ending on the applicable day specified in subd. 3.
SB518,8,73
49.471
(5) (b) 2. Except as provided in sub. (6) (a)
2., a child who is not an unborn
4child is eligible for the benefits described in s. 49.46 (2) (a) and (b) during the period
5beginning on the day on which a qualified entity determines, on the basis of
6preliminary information, that the child's family income does not exceed 150 percent
7of the poverty line and ending on the applicable day specified in subd. 3.
SB518,8,1310
49.471
(5) (c) 2. On behalf of a woman under par. (b) 1.
whose family income
11exceeds 200 percent of the poverty line, the department shall audit and pay allowable
12charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory prenatal
13care services under the benefits under sub. (11).
SB518, s. 20
14Section
20. 49.471 (5) (c) 1. of the statutes is created to read:
SB518,8,1815
49.471
(5) (c) 1. On behalf of a woman under par. (b) 1. whose family income
16does not exceed 200 percent of the poverty line, the department shall audit and pay
17allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory
18prenatal care services under the benefits described in s. 49.46 (2) (a) and (b).
SB518,9,221
49.471
(6) (a) 2. Any
pregnant woman, including a pregnant woman under sub
22(5) (b) 1., child who is not an unborn child, including a child under sub. (5) (b) 2.,
23parent, or caretaker relative whose family income is less than 150 percent of the
24poverty line is eligible for medical assistance under this section for any of the 3
25months prior to the month of application if the individual met the eligibility criteria
1under this section and had a family income of less than 150 percent of the poverty
2line in that month.
SB518, s. 22
3Section
22. 49.471 (6) (a) 1. of the statutes is created to read:
SB518,9,74
49.471
(6) (a) 1. Any pregnant woman, including a pregnant woman under sub.
5(5) (b) 1., is eligible for medical assistance under this section for any of the 3 months
6prior to the month of application if she met the eligibility criteria under this section
7in that month.
SB518,9,2312
49.471
(7) (b) 1. A pregnant woman
, or an unborn child, whose family income
13exceeds 300 percent of the poverty line may become eligible for coverage under this
14section if the difference between the pregnant woman's
or unborn child's family
15income and the applicable income limit under sub. (4) (b) is obligated or expended
16for any member of the pregnant woman's
or unborn child's family for medical care
17or any other type of remedial care recognized under state law or for personal health
18insurance premiums or for both. Eligibility obtained under this subdivision
19continues without regard to any change in family income for the balance of the
20pregnancy and
, for a pregnant woman but not for an unborn child, to the last day of
21the month in which the 60th day after the last day of the woman's pregnancy falls.
22Eligibility obtained by a pregnant woman under this subdivision extends to all
23pregnant women in the pregnant woman's family.
SB518,10,9
149.471
(7) (b) 2. A child who is not an unborn child
and, whose family income
2exceeds 150 percent of the poverty line
, and who is ineligible under this section solely
3because of sub. (8) (b) may obtain eligibility under this section if the difference
4between the child's family income and 150 percent of the poverty line is obligated or
5expended on behalf of the child or any member of the child's family for medical care
6or any other type of remedial care recognized under state law or for personal health
7insurance premiums or for both. Eligibility obtained under this subdivision during
8any 6-month period, as determined by the department, continues for the remainder
9of the 6-month period and extends to all children in the family.
SB518,10,2012
49.471
(7) (b) 3. For a pregnant woman
or an unborn child to obtain eligibility
13under subd. 1., the amount that must be obligated or expended in any 6-month
14period is equal to the sum of the differences in each of those 6 months between the
15pregnant woman's
or unborn child's monthly family income and the monthly family
16income that is 300 percent of the poverty line. For a child to obtain eligibility under
17subd. 2., the amount that must be obligated or expended in any 6-month period is
18equal to the sum of the differences in each of those 6 months between the child's
19monthly family income and the monthly family income that is 150 percent of the
20poverty line.
SB518,10,2523
49.471
(7) (c) 1. Deduct from
family
the individual's income
, up to the amount
24of the individual's income, any
payments made by
amount the individual
is obligated
25to pay for court-ordered child or family support or maintenance.
SB518, s. 28
1Section
28. 49.471 (8) (d) 1. f. of the statutes is created to read: