2021 - 2022 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 241
April 13, 2021 - Offered by Representatives Anderson, Baldeh,
Brostoff, Cabrera, Conley, Considine, Doyle, Drake, Emerson, Goyke,
Haywood, Hebl, Hesselbein, Hintz, Hong, McGuire, B. Meyers, Milroy,
Moore Omokunde, L. Myers, Neubauer, Ohnstad, Ortiz-Velez, Pope,
Riemer, S. Rodriguez, Shankland, Shelton, Sinicki, Snodgrass, Spreitzer,
Stubbs, Subeck, Vining and Vruwink.
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: retiring public debt and transportation revenue
5bonds, eligibility expansion under the Medical Assistance program, and
6making an appropriation.
Analysis by the Legislative Reference Bureau
Retiring public debt and transportation revenue bonds
This bill appropriates in the 2021-22 fiscal year $500,000,000 in general
purpose revenue to retire public debt and $500,000,000 in general purpose revenue
to retire transportation revenue obligations.
Eligibility expansion under the Medical Assistance program
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. 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. 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 Plus
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 the 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, as a separate
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 5
ending no sooner than December 31, 2023, the department shall do all of the 6
following with regard to the
under sub. (23)
7s. 49.471 (4) (a) 8.
1. Require in each month persons, except exempt individuals, who are eligible 9
to receive Medical Assistance under sub. (23)
s. 49.471 (4) (a) 8.
and who are at least 10
19 years of age but have not attained the age of 50 to participate in, document, and 11
report 80 hours per calendar month of community engagement activities. The 12
department, after finding good cause, may grant a temporary exemption from the 13
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 15
premiums in accordance with par. (c) as a condition of eligibility for Medical 16
Assistance under sub. (23) s. 49.471 (4) (a) 8
3. Require as a condition of eligibility for Medical Assistance under
sub. (23) 18s. 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. 20
an $8 copayment for nonemergency use of the emergency department in accordance 21
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 23
months any individual who does not pay a required premium under subd. 2. and any 24
individual who is required under subd. 1. to participate in a community engagement
activity but who does not participate for 48 aggregate months in the community 2
49.45 (23b) (c) of the statutes is amended to read:
(c) 1. Persons who are eligible for the demonstration project
under 5sub. (23) s. 49.471 (4) (a) 8.
and who have monthly household income that exceeds 6
50 percent of the poverty line shall pay a monthly premium amount of $8 per 7
household. A person who is eligible to receive an item or service furnished by an 8
Indian health care provider is exempt from the premium requirement under this 9
2. The department may disenroll under par. (b) 5. a person for nonpayment of 11
a required monthly premium only at annual eligibility redetermination after 12
providing notice and reasonable opportunity for the person to pay. If a person who 13
is disenrolled for nonpayment of premiums pays all owed premiums or becomes 14
exempt from payment of premiums, he or she may reenroll in Medical Assistance 15
under sub. (23) s. 49.471 (4) (a) 8
3. The department shall reduce the amount of the required household premium 17
by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. 18
who does not engage in certain behaviors that increase health risks or who attests 19
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 22
requirements under this subsection may not be withdrawn and the department may 23
not request from the federal government withdrawal, suspension, or termination of 24
the demonstration project
requirements under this subsection unless legislation has 25
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 3
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 6
percent of the poverty line before application of the 5 percent income disregard under
742 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 individual has a family income that does not exceed 133 percent of the 12
poverty line, except as provided in sub. (4g).
c. The individual is not otherwise eligible for the Medical Assistance program 14
under 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 18
comply with all federal requirements to qualify for the highest available enhanced 19
federal medical assistance percentage. The department shall submit any 20
amendment to the state medical assistance plan, request for a waiver of federal 21
Medicaid law, or other approval request required by the federal government to 22
provide services to the individuals described under sub. (4) (a) 8. and qualify for the 23
highest available enhanced federal medical assistance percentage. Sections 20.940 24
and 49.45 (2t) do not apply to a submission to the federal government under this 25
49.686 (3) (d) of the statutes is amended to read:
(d) Has applied for coverage under and has been denied eligibility 3
for medical assistance within 12 months prior to application for reimbursement 4
under sub. (2). This paragraph does not apply to an individual
who is eligible for
5benefits under the demonstration project for childless adults under s. 49.45 (23) or
6to an individual
who is eligible for benefits under BadgerCare Plus under s. 49.471 7(4) (a) 8. or
Retiring public debt.
From the appropriation under s. 20.505 (1) (a), the 10
department of administration shall expend $500,000,000 for the payment, in the 11
2021-22 fiscal year, of principal and interest costs on outstanding public debt, as 12
defined in s. 18.01 (4).
Retiring transportation revenue obligations.
From the appropriation 14
under s. 20.505 (1) (a), the department of administration shall expend $500,000,000, 15
in the 2021-22 fiscal year, for the purpose of retiring revenue obligations issued 16
under s. 84.59.