2019 - 2020 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 76
May 15, 2019 - Offered by Representatives Anderson, Billings, Bowen,
Cabrera, Considine, Crowley, Doyle, Emerson, Fields, Goyke, Gruszynski,
Haywood, Hebl, Hesselbein, Hintz, Kolste, McGuire, B. Meyers, Milroy, L.
Myers, Neubauer, Ohnstad, Pope, Riemer, Sargent, Shankland, Sinicki,
Spreitzer, Stubbs, Stuck, Subeck, C. Taylor, Vining, Vruwink and
1An Act to repeal
49.45 (2p) and 49.45 (23); to amend
20.435 (4) (jw), 49.45 (23b) 2
(title), 49.45 (23b) (b), 49.45 (23b) (c), 49.45 (23b) (e), 49.471 (4) (a) 4. b. and 3
49.686 (3) (d); and to create
49.471 (1) (cr), 49.471 (4) (a) 8. and 49.471 (4g) of 4
the statutes; relating to: eligibility expansion under the Medical Assistance
5program, increasing reimbursement rates for certain direct care workers, and
6making an appropriation.
Analysis by the Legislative Reference Bureau
This bill implements the Medicaid expansion and increases reimbursement
rates under the Medical Assistance program for certain direct care workers.
This bill changes the family income eligibility level to up to 133 percent of the
federal poverty line for parents and caretaker relatives under BadgerCare Plus and
for childless adults currently covered under BadgerCare Plus Core and who are
incorporated into BadgerCare Plus in this bill. BadgerCare Plus and BadgerCare
Plus Core are programs under the state's Medical Assistance program, which
provides health services to individuals who have limited financial resources. The
federal Patient Protection and Affordable Care Act allows a state to receive an
enhanced federal medical assistance percentage payment for providing benefits to
certain individuals through a state's Medical Assistance program. The bill requires
the Department of Health Services to comply with all federal requirements and to
request any amendment to the state Medical Assistance plan, waiver of Medicaid
law, or other federal approval necessary to qualify for the highest available enhanced
federal medical assistance percentage for childless adults under the BadgerCare
Under current law, certain parents and caretaker relatives with incomes of not
more than 100 percent of the federal poverty line, before a 5 percent income disregard
is applied, are eligible for BadgerCare Plus benefits. Under current law, childless
adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent
of the federal poverty line, before a 5 percent income disregard is applied; and 3) are
not otherwise eligible for Medical Assistance, including BadgerCare Plus, are
eligible for benefits under BadgerCare Plus Core. The bill eliminates the childless
adults demonstration project known as BadgerCare Plus Core.
This bill requires DHS to increase the rates paid for direct care to nursing
homes, also known as nursing facilities, and intermediate care facilities for persons
with an intellectual disability. A portion of the increase is related to an increase in
patient acuity in those facilities and an additional increase is designated to support
staff in those facilities who perform direct care. This bill also requires DHS to
increase the rates paid for direct care to agencies that provide personal care services.
A 1.5 percent increase per year is designated to support staff in those agencies who
perform direct care.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
20.435 (4) (jw) of the statutes is amended to read:
(jw) BadgerCare Plus and hospital assessment.
All moneys received
3from payment of enrollment fees under the program under s. 49.45 (23), all
transferred under s. 50.38 (9), all moneys transferred from the appropriation account 5
under par. (jz), and 10 percent of all moneys received from penalty assessments 6
under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23),
provide a portion of the state share of administrative costs for the BadgerCare Plus 8
Medical Assistance program under s. 49.471,
and for administration of the hospital 9
assessment under s. 50.38.
49.45 (2p) of the statutes is repealed.
49.45 (23) of the statutes is repealed.
49.45 (23b) (title) of the statutes is amended to read:
(title) Childless adults
demonstration project reform waiver
49.45 (23b) (b) of the statutes is amended to read:
(b) Beginning as soon as practicable after October 31, 2018, and 7
ending no sooner than December 31, 2023, the department shall do all of the 8
following with regard to the
under sub. (23)
9s. 49.471 (4) (a) 8.
1. Require in each month persons, except exempt individuals, who are eligible 11
to receive Medical Assistance under sub. (23)
s. 49.471 (4) (a) 8.
and who are at least 12
19 years of age but have not attained the age of 50 to participate in, document, and 13
report 80 hours per calendar month of community engagement activities. The 14
department, after finding good cause, may grant a temporary exemption from the 15
requirement under this subdivision upon request of a Medical Assistance recipient.
2. Require persons with incomes of at least 50 percent of the poverty line to pay 17
premiums in accordance with par. (c) as a condition of eligibility for Medical 18
Assistance under sub. (23) s. 49.471 (4) (a) 8
3. Require as a condition of eligibility for Medical Assistance under
sub. (23) 20s. 49.471 (4) (a) 8.
completion of a health risk assessment.
4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
an $8 copayment for nonemergency use of the emergency department in accordance 23
with 42 USC 1396o-1
(e) (1) and 42 CFR 447.54
5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
for 6 25
months any individual who does not pay a required premium under subd. 2. and any
individual who is required under subd. 1. to participate in a community engagement 2
activity but who does not participate for 48 aggregate months in the community 3
49.45 (23b) (c) of the statutes is amended to read:
(c) 1. Persons who are eligible for the demonstration project
under 6sub. (23) s. 49.471 (4) (a) 8.
and who have monthly household income that exceeds 7
50 percent of the poverty line shall pay a monthly premium amount of $8 per 8
household. A person who is eligible to receive an item or service furnished by an 9
Indian health care provider is exempt from the premium requirement under this 10
2. The department may disenroll under par. (b) 5. a person for nonpayment of 12
a required monthly premium only at annual eligibility redetermination after 13
providing notice and reasonable opportunity for the person to pay. If a person who 14
is disenrolled for nonpayment of premiums pays all owed premiums or becomes 15
exempt from payment of premiums, he or she may reenroll in Medical Assistance 16
under sub. (23) s. 49.471 (4) (a) 8
3. The department shall reduce the amount of the required household premium 18
by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. 19
who does not engage in certain behaviors that increase health risks or who attests 20
to actively managing certain unhealthy behaviors.
49.45 (23b) (e) of the statutes is amended to read:
(e) Before December 31, 2023, the
demonstration project 23
requirements under this subsection may not be withdrawn and the department may 24
not request from the federal government withdrawal, suspension, or termination of
the demonstration project
requirements under this subsection unless legislation has 2
been enacted specifically allowing for the withdrawal, suspension, or termination.
49.471 (1) (cr) of the statutes is created to read:
(cr) “Enhanced federal medical assistance percentage" means a 5
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 individual's family income does not exceed 100 133 8
percent of the poverty line before application of the 5 percent income disregard under
942 CFR 435.603 (d)
49.471 (4) (a) 8. of the statutes is created to read:
(a) 8. An individual who meets all of the following criteria:
a. The individual is an adult under the age of 65.
b. The adult has a family income that does not exceed 133 percent of the poverty 14
line, except as provided in sub. (4g).
c. The adult is not otherwise eligible for the Medical Assistance program under 16
this subchapter or the Medicare program under 42 USC 1395
49.471 (4g) of the statutes is created to read:
49.471 (4g) Medicaid expansion; federal medical assistance percentage.
services provided to individuals described under sub. (4) (a) 8., the department shall 20
comply with all federal requirements to qualify for the highest available enhanced 21
federal medical assistance percentage. The department shall submit any 22
amendment to the state medical assistance plan, request for a waiver of federal 23
Medicaid law, or other approval request required by the federal government to 24
provide services to the individuals described under sub. (4) (a) 8. and qualify for the 25
highest available enhanced federal medical assistance percentage. Sections 20.940
and 49.45 (2t) do not apply to a submission to the federal government under this 2
49.686 (3) (d) of the statutes is amended to read:
(d) Has applied for coverage under and has been denied eligibility 5
for medical assistance within 12 months prior to application for reimbursement 6
under sub. (2). This paragraph does not apply to an individual who is eligible for 7
benefits under the demonstration project for childless adults under s. 49.45 (23) 8BadgerCare Plus under s. 49.471 (4) (a) 8.
or to an individual who is eligible for 9
benefits under BadgerCare Plus under s. 49.471 (11).
Nonstatutory provisions; Health Services.
Medical Assistance reimbursement rate increase for direct care.
department of health services shall increase the Medical Assistance rates paid for 13
direct care to nursing facilities and intermediate care facilities for persons with an 14
intellectual disability with a 1 percent annual rate increase related to an increase 15
in acuity of patients in those facilities and an additional 1.5 percent annual rate 16
increase to support staff in those facilities who perform direct care.
Medical Assistance reimbursement rate increase for direct care in
18personal care agencies.
The department of health services shall increase the 19
Medical Assistance rates paid for direct care to agencies that provide personal care 20
services by 1.5 percent annually to support staff in those agencies who perform direct 21
(3) Childless adults demonstration project.
The department of health 23
services shall submit any necessary request to the federal department of health and 24
human services for a state plan amendment or waiver of federal Medicaid law or to 25
modify or withdraw from any waiver of federal Medicaid law relating to the childless
adults demonstration project under s. 49.45 (23), 2017 stats., to reflect the 2
incorporation of recipients of Medical Assistance under the demonstration project 3
into the BadgerCare Plus program under s. 49.471 and the termination of the 4
demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission 5
to the federal government under this subsection.