2017 - 2018 LEGISLATURE
SENATE AMENDMENT 2,
TO SENATE BILL 770
February 13, 2018 - Offered by
Joint Committee on Finance.
49.45 (23) (a) of the statutes is amended to read:
(a) The department shall request a waiver from the secretary of the 5
federal department of health and human services to permit the department to 6
conduct a demonstration project to provide health care coverage to adults who are 7
under the age of 65, who have family incomes not to exceed 100 133
percent of the 8
poverty line before application of the 5 percent income disregard under 42 CFR
, except as provided in s. 49.471 (4g),
and who are not otherwise eligible 10
for medical assistance under this subchapter, the Badger Care health care program 11
under s. 49.665, or Medicare under 42 USC 1395
49.471 (1) (cr) of the statutes is created to read:
(cr) “Enhanced federal medical assistance percentage" means a 2
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 Except as provided in sub. (4g), the
individual's family 5
income does not exceed 100 133
percent of the poverty line before application of the
65 percent income disregard under 42 CFR 435.603 (d)
49.471 (4g) of the statutes is created to read:
49.471 (4g) Medicaid expansion; federal medical assistance percentage.
For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23), 10
the department shall comply with all federal requirements to qualify for the highest 11
available enhanced federal medical assistance percentage. The department shall 12
submit any amendment to the state medical assistance plan, request for a waiver of 13
federal Medicaid law, or other approval request required by the federal government 14
to provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23) 15
and qualify for the highest available enhanced federal medical assistance 16
(b) If the department does not qualify for an enhanced federal medical 18
assistance percentage, or if the enhanced federal medical assistance percentage 19
obtained by the department is lower than printed in federal law as of July 1, 2013, 20
for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall 21
submit to the joint committee on finance a fiscal analysis comparing the cost to 22
maintain coverage for adults who are not pregnant and not elderly with family 23
incomes up to 133 percent of the poverty line to the cost of limiting eligibility to those 24
adults with family incomes up to 100 percent of the poverty line. The department 25
may reduce income eligibility for adults who are not pregnant and not elderly from
family incomes of up to 133 percent of the poverty line to family incomes of up to 100 2
percent of the poverty line only if this reduction in income eligibility levels is 3
approved by the joint committee on finance.
49.471 (4m) of the statutes is created to read:
49.471 (4m) Purchase options for BadgerCare Plus and the assistance for
6childless adults demonstration project.
(a) 1. The department shall, if required, 7
request a waiver from or submit amendments to the state Medical Assistance plan 8
to the secretary of the federal department of health and human services to establish 9
a program that allows individuals with income above the maximum income 10
eligibility limit applicable under this section or the assistance for childless adults 11
demonstration project under s. 49.45 (23), and who otherwise meet the eligibility 12
requirements under this section or under s. 49.45 (23), the option of purchasing 13
coverage through this section or through the demonstration project under s. 49.45 14
(23) instead of purchasing an individual health plan through private insurance. The 15
department shall also include a request for any federal waiver or state Medical 16
Assistance plan amendments necessary to allow an option for small businesses to 17
purchase coverage for their employees under this section as part of the small 18
business health options program through an exchange under 42 USC 18031
2. The department shall seek any federal waiver and state Medical Assistance 20
plan amendments necessary to allow individuals who qualify under subd. 1. to use 21
advanced tax credits and cost-sharing credits, if eligible, to purchase one of the 22
options described under subd. 1.
(b) 1. The department shall coordinate the administration of the purchase 24
options under this subsection with the programs under this section and s. 49.45 (23) 25
to maximize efficiency and improve the continuity of care, consistent with the
requirements of this section and s. 49.45 (23). The department shall seek to 2
implement mechanisms to ensure the long-term financial sustainability of the 3
programs under this section and s. 49.45 (23). These mechanisms must address 4
issues related to minimizing adverse selection, the state financial risk and 5
contribution, and negative impacts to premiums in the individual and group 6
2. The purchase option program shall include, at a minimum, all of the 8
a. Establishment of an annual per enrollee premium rate similar to the average 10
rate paid by the state to managed care plan contractors.
b. Establishment of a benefit set equal to the benefits covered under this section 12
and s. 49.45 (23).
c. Annual enrollment that is limited to the same annual open enrollment 14
periods established for the programs under this section and s. 49.45 (23).
d. The ability for the department to adjust the purchase option's actuarial value 16
to a value no lower than 87 percent.
e. Reimbursement mechanisms for addressing potential increased costs to the 18
programs under this section and s. 49.45 (23).
(c) By March 1, 2019, the department of health services shall submit a report 20
to the appropriate standing committee in each house of the legislature under s. 21
13.172 (3) that provides information on the status of the request for a federal waiver 22
and the results from actuarial and economic analyses that are necessary for a waiver 23
(d) If any necessary waiver or amendments to the state plan described under 25
par. (a) 1. are approved, the department shall implement the program. If the
department is authorized to implement the program, and if any waiver or state plan 2
amendment described under par. (a) 2. is necessary and is approved, or if the 3
department determines neither a waiver nor state plan amendment is necessary, the 4
department shall allow the purchase options described under par. (a) 2.”.
Increasing Medical Assistance reimbursement rates.
The department 7
of health services shall amend the state Medicaid plan to increase reimbursement 8
rates for providers of medical and long-term care services providers under the 9
Medical Assistance program for dates of service on and after July 1, 2018.”.
In the schedule under section 20.005 (3) of the 12
statutes for the appropriation to the department of health services under section 13
20.435 (4) (b) of the statutes, the dollar amount for fiscal year 2018-19 is decreased 14
by $203,000,000 to provide Medical Assistance to certain adults with family incomes 15
up to 133 percent of the federal poverty line.
16(3m) Medical Assistance reimbursement rates.
In the schedule under section 17
20.005 (3) of the statutes for the appropriation to the department of health services 18
under section 20.435 (4) (b) of the statutes, the dollar amount for fiscal year 2018-19 19
is increased by $203,000,000 to provide a purchase option under BadgerCare Plus 20
under section 49.471 (4m) of the statutes.
This act takes effect on the day after 22
publication, except as follows:
The treatment of sections 49.45 (23) (a) and 49.471 (1) 2
(cr), (4) (a) 4. b., and (4g) of the statutes and Section
12 (2m) and (3m) of this act take 3
effect on July 1, 2018, or on the day after publication, whichever is later.”.