2017 - 2018 LEGISLATURE
February 13, 2018 - Offered by Joint Committee on Finance.
SB770-SA2,1,11 At the locations indicated, amend the bill as follows:
SB770-SA2,1,2 21. Page 5, line 6: after that line insert:
SB770-SA2,1,3 3 Section 3c. 49.45 (23) (a) of the statutes is amended to read:
SB770-SA2,1,114 49.45 (23) (a) The department shall request a waiver from the secretary of the
5federal department of health and human services to permit the department to
6conduct a demonstration project to provide health care coverage to adults who are
7under the age of 65, who have family incomes not to exceed 100 133 percent of the
8poverty line before application of the 5 percent income disregard under 42 CFR
9435.603 (d)
, except as provided in s. 49.471 (4g), and who are not otherwise eligible
10for medical assistance under this subchapter, the Badger Care health care program
11under s. 49.665, or Medicare under 42 USC 1395 et seq.
SB770-SA2,3d 12Section 3d. 49.471 (1) (cr) of the statutes is created to read:
149.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
2federal medical assistance percentage described under 42 USC 1396d (y) or (z).
SB770-SA2,3e 3Section 3e. 49.471 (4) (a) 4. b. of the statutes is amended to read:
SB770-SA2,2,64 49.471 (4) (a) 4. b. The Except as provided in sub. (4g), the individual's family
5income does not exceed 100 133 percent of the poverty line before application of the
65 percent income disregard under 42 CFR 435.603 (d)
SB770-SA2,3f 7Section 3f. 49.471 (4g) of the statutes is created to read:
SB770-SA2,2,168 49.471 (4g) Medicaid expansion; federal medical assistance percentage. (a)
9For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23),
10the department shall comply with all federal requirements to qualify for the highest
11available enhanced federal medical assistance percentage. The department shall
12submit any amendment to the state medical assistance plan, request for a waiver of
13federal Medicaid law, or other approval request required by the federal government
14to provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23)
15and qualify for the highest available enhanced federal medical assistance
SB770-SA2,3,317 (b) If the department does not qualify for an enhanced federal medical
18assistance percentage, or if the enhanced federal medical assistance percentage
19obtained by the department is lower than printed in federal law as of July 1, 2013,
20for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall
21submit to the joint committee on finance a fiscal analysis comparing the cost to
22maintain coverage for adults who are not pregnant and not elderly with family
23incomes up to 133 percent of the poverty line to the cost of limiting eligibility to those
24adults with family incomes up to 100 percent of the poverty line. The department
25may reduce income eligibility for adults who are not pregnant and not elderly from

1family incomes of up to 133 percent of the poverty line to family incomes of up to 100
2percent of the poverty line only if this reduction in income eligibility levels is
3approved by the joint committee on finance.
SB770-SA2,3g 4Section 3g. 49.471 (4m) of the statutes is created to read:
SB770-SA2,3,185 49.471 (4m) Purchase options for BadgerCare Plus and the assistance for
6childless adults demonstration project.
(a) 1. The department shall, if required,
7request a waiver from or submit amendments to the state Medical Assistance plan
8to the secretary of the federal department of health and human services to establish
9a program that allows individuals with income above the maximum income
10eligibility limit applicable under this section or the assistance for childless adults
11demonstration project under s. 49.45 (23), and who otherwise meet the eligibility
12requirements under this section or under s. 49.45 (23), the option of purchasing
13coverage 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
15department shall also include a request for any federal waiver or state Medical
16Assistance plan amendments necessary to allow an option for small businesses to
17purchase coverage for their employees under this section as part of the small
18business health options program through an exchange under 42 USC 18031.
SB770-SA2,3,2219 2. The department shall seek any federal waiver and state Medical Assistance
20plan amendments necessary to allow individuals who qualify under subd. 1. to use
21advanced tax credits and cost-sharing credits, if eligible, to purchase one of the
22options described under subd. 1.
SB770-SA2,4,623 (b) 1. The department shall coordinate the administration of the purchase
24options under this subsection with the programs under this section and s. 49.45 (23)
25to maximize efficiency and improve the continuity of care, consistent with the

1requirements of this section and s. 49.45 (23). The department shall seek to
2implement mechanisms to ensure the long-term financial sustainability of the
3programs under this section and s. 49.45 (23). These mechanisms must address
4issues related to minimizing adverse selection, the state financial risk and
5contribution, and negative impacts to premiums in the individual and group
6insurance markets.
SB770-SA2,4,87 2. The purchase option program shall include, at a minimum, all of the
8following attributes:
SB770-SA2,4,109 a. Establishment of an annual per enrollee premium rate similar to the average
10rate paid by the state to managed care plan contractors.
SB770-SA2,4,1211 b. Establishment of a benefit set equal to the benefits covered under this section
12and s. 49.45 (23).
SB770-SA2,4,1413 c. Annual enrollment that is limited to the same annual open enrollment
14periods established for the programs under this section and s. 49.45 (23).
SB770-SA2,4,1615 d. The ability for the department to adjust the purchase option's actuarial value
16to a value no lower than 87 percent.
SB770-SA2,4,1817 e. Reimbursement mechanisms for addressing potential increased costs to the
18programs under this section and s. 49.45 (23).
SB770-SA2,4,2319 (c) By March 1, 2019, the department of health services shall submit a report
20to the appropriate standing committee in each house of the legislature under s.
2113.172 (3) that provides information on the status of the request for a federal waiver
22and the results from actuarial and economic analyses that are necessary for a waiver
SB770-SA2,5,424 (d) If any necessary waiver or amendments to the state plan described under
25par. (a) 1. are approved, the department shall implement the program. If the

1department is authorized to implement the program, and if any waiver or state plan
2amendment described under par. (a) 2. is necessary and is approved, or if the
3department determines neither a waiver nor state plan amendment is necessary, the
4department shall allow the purchase options described under par. (a) 2.”.
SB770-SA2,5,5 52. Page 14, line 4: after that line insert:
SB770-SA2,5,9 6(2m) Increasing Medical Assistance reimbursement rates. The department
7of health services shall amend the state Medicaid plan to increase reimbursement
8rates for providers of medical and long-term care services providers under the
9Medical Assistance program for dates of service on and after July 1, 2018.”.
SB770-SA2,5,10 103. Page 14, line 9: after that line insert:
SB770-SA2,5,15 11(2m) Medicaid expansion. In the schedule under section 20.005 (3) of the
12statutes for the appropriation to the department of health services under section
1320.435 (4) (b) of the statutes, the dollar amount for fiscal year 2018-19 is decreased
14by $203,000,000 to provide Medical Assistance to certain adults with family incomes
15up to 133 percent of the federal poverty line.
SB770-SA2,5,20 16(3m) Medical Assistance reimbursement rates. In the schedule under section
1720.005 (3) of the statutes for the appropriation to the department of health services
18under section 20.435 (4) (b) of the statutes, the dollar amount for fiscal year 2018-19
19is increased by $203,000,000 to provide a purchase option under BadgerCare Plus
20under section 49.471 (4m) of the statutes.
SB770-SA2,13m 21Section 13m. Effective dates. This act takes effect on the day after
22publication, except as follows:
1(1) Medicaid expansion. 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
3effect on July 1, 2018, or on the day after publication, whichever is later.”.