MPG&TJD:wlj/cjs/emw
2021 - 2022 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 234
April 13, 2021 - Offered by Representatives Anderson, Baldeh, Billings, Bowen,
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.
AB234-ASA1,1,5 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
349.686 (3) (d); and to create 49.471 (1) (cr), 49.471 (4) (a) 8. and 49.471 (4g) of
4the statutes; relating to: tourism industry grants, eligibility expansion under
5the Medical Assistance program, and making an appropriation.
Analysis by the Legislative Reference Bureau
Tourism promotion and development organization grants
This bill requires the Department of Tourism to award grants to nonprofit
organizations whose primary purpose is the promotion and development of tourism
in Wisconsin to assist those organizations to remain operational in the wake of the
COVID-19 global pandemic. The bill further requires the Department of Tourism
to award grants to such nonprofit organizations and to certain governmental
organizations also having that same primary purpose for purposes of tourism
marketing in connection with Wisconsin's recovery from the COVID-19 global
pandemic.
A nonprofit or governmental organization receiving a grant under the bill, as
specified above, may not receive grants totalling more than $1,000,000 or 50 percent
of the organization's average annual tourism marketing budget over the previous

three years, not including 2020. The bill appropriates $100,000,000 in general
purpose revenue for the grants.
Amusement industry grants
The bill requires the Department of Tourism to award grants to organizations
that own or operate amusement or theme parks in Wisconsin for purposes of
short-term tourism marketing in connection with the organization's recovery from
the COVID-19 global pandemic. The bill limits each grant to 50 percent of the
organization's average annual tourism marketing budget over the previous three
years, not including 2020. The bill appropriates $50,000,000 in general purpose
revenue for the grants.
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. The 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 the 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
program.
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
program.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB234-ASA1,1 1Section 1 . 20.435 (4) (jw) of the statutes is amended to read:
AB234-ASA1,3,62 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received
3from payment of enrollment fees under the program under s. 49.45 (23), all
moneys

1transferred under s. 50.38 (9), all moneys transferred from the appropriation account
2under par. (jz), and 10 percent of all moneys received from penalty assessments
3under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to
4provide a portion of the state share of administrative costs for the BadgerCare Plus
5Medical Assistance program under s. 49.471, and for administration of the hospital
6assessment under s. 50.38.
AB234-ASA1,2 7Section 2 . 49.45 (2p) of the statutes is repealed.
AB234-ASA1,3 8Section 3 . 49.45 (23) of the statutes is repealed.
AB234-ASA1,4 9Section 4 . 49.45 (23b) (title) of the statutes is amended to read:
AB234-ASA1,3,1110 49.45 (23b) (title) Childless adults demonstration project reform waiver
11implementation required.
AB234-ASA1,5 12Section 5 . 49.45 (23b) (b) of the statutes is amended to read:
AB234-ASA1,3,1613 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and
14ending no sooner than December 31, 2023, the department shall do all of the
15following with regard to the childless adults demonstration project under sub. (23)
16s. 49.471 (4) (a) 8.:
AB234-ASA1,3,2217 1. Require in each month persons, except exempt individuals, who are eligible
18to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least
1919 years of age but have not attained the age of 50 to participate in, document, and
20report 80 hours per calendar month of community engagement activities. The
21department, after finding good cause, may grant a temporary exemption from the
22requirement under this subdivision upon request of a Medical Assistance recipient.
AB234-ASA1,3,2523 2. Require persons with incomes of at least 50 percent of the poverty line to pay
24premiums in accordance with par. (c) as a condition of eligibility for Medical
25Assistance under sub. (23) s. 49.471 (4) (a) 8.
AB234-ASA1,4,2
13. Require as a condition of eligibility for Medical Assistance under sub. (23)
2s. 49.471 (4) (a) 8. completion of a health risk assessment.
AB234-ASA1,4,53 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
4an $8 copayment for nonemergency use of the emergency department in accordance
5with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.
AB234-ASA1,4,106 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6
7months any individual who does not pay a required premium under subd. 2. and any
8individual who is required under subd. 1. to participate in a community engagement
9activity but who does not participate for 48 aggregate months in the community
10engagement activity.
AB234-ASA1,6 11Section 6 . 49.45 (23b) (c) of the statutes is amended to read:
AB234-ASA1,4,1712 49.45 (23b) (c) 1. Persons who are eligible for the demonstration project under
13sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds
1450 percent of the poverty line shall pay a monthly premium amount of $8 per
15household. A person who is eligible to receive an item or service furnished by an
16Indian health care provider is exempt from the premium requirement under this
17subdivision.
AB234-ASA1,4,2318 2. The department may disenroll under par. (b) 5. a person for nonpayment of
19a required monthly premium only at annual eligibility redetermination after
20providing notice and reasonable opportunity for the person to pay. If a person who
21is disenrolled for nonpayment of premiums pays all owed premiums or becomes
22exempt from payment of premiums, he or she may reenroll in Medical Assistance
23under sub. (23) s. 49.471 (4) (a) 8.
AB234-ASA1,5,224 3. The department shall reduce the amount of the required household premium
25by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.

1who does not engage in certain behaviors that increase health risks or who attests
2to actively managing certain unhealthy behaviors.
AB234-ASA1,7 3Section 7 . 49.45 (23b) (e) of the statutes is amended to read:
AB234-ASA1,5,84 49.45 (23b) (e) Before December 31, 2023, the demonstration project
5requirements under this subsection may not be withdrawn and the department may
6not request from the federal government withdrawal, suspension, or termination of
7the demonstration project requirements under this subsection unless legislation has
8been enacted specifically allowing for the withdrawal, suspension, or termination.
AB234-ASA1,8 9Section 8 . 49.471 (1) (cr) of the statutes is created to read:
AB234-ASA1,5,1110 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
11federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB234-ASA1,9 12Section 9 . 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB234-ASA1,5,1513 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
14percent of the poverty line before application of the 5 percent income disregard under
1542 CFR 435.603 (d)
.
AB234-ASA1,10 16Section 10 . 49.471 (4) (a) 8. of the statutes is created to read:
AB234-ASA1,5,1717 49.471 (4) (a) 8. An individual who meets all of the following criteria:
AB234-ASA1,5,1818 a. The individual is an adult under the age of 65.
AB234-ASA1,5,2019 b. The individual has a family income that does not exceed 133 percent of the
20poverty line, except as provided in sub. (4g).
AB234-ASA1,5,2221 c. The individual is not otherwise eligible for the Medical Assistance program
22under this subchapter or the Medicare program under 42 USC 1395 et seq.
AB234-ASA1,11 23Section 11 . 49.471 (4g) of the statutes is created to read:
AB234-ASA1,6,824 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
25services provided to individuals described under sub. (4) (a) 8., the department shall

1comply with all federal requirements to qualify for the highest available enhanced
2federal medical assistance percentage. The department shall submit any
3amendment to the state medical assistance plan, request for a waiver of federal
4Medicaid law, or other approval request required by the federal government to
5provide services to the individuals described under sub. (4) (a) 8. and qualify for the
6highest available enhanced federal medical assistance percentage. Sections 20.940
7and 49.45 (2t) do not apply to a submission to the federal government under this
8subsection.
AB234-ASA1,12 9Section 12 . 49.686 (3) (d) of the statutes is amended to read:
AB234-ASA1,6,1510 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
11for medical assistance within 12 months prior to application for reimbursement
12under sub. (2). This paragraph does not apply to an individual who is eligible for
13benefits under the demonstration project for childless adults under s. 49.45 (23) or
14to an individual
who is eligible for benefits under BadgerCare Plus under s. 49.471
15(4) (a) 8. or (11).
AB234-ASA1,9119 16Section 9119. Nonstatutory provisions; Health Services.
AB234-ASA1,6,2517 (1) Childless adults demonstration project. The department of health
18services shall submit any necessary request to the federal department of health and
19human services for a state plan amendment or waiver of federal Medicaid law or to
20modify or withdraw from any waiver of federal Medicaid law relating to the childless
21adults demonstration project under s. 49.45 (23), 2019 stats., to reflect the
22incorporation of recipients of Medical Assistance under the demonstration project
23into the BadgerCare Plus program under s. 49.471 and the termination of the
24demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission
25to the federal government under this subsection.
AB234-ASA1,9143
1Section 9143. Nonstatutory provisions; Tourism.
AB234-ASA1,7,22 (1) Tourism promotion and development organization grants.
AB234-ASA1,7,33 (a) Definitions. In this subsection:
AB234-ASA1,7,5 41. “Governmental organization” means a department or a subunit of a county,
5city, village, town, or federally recognized American Indian tribe or band in this state.
AB234-ASA1,7,9 62. “Tourism promotion and development organization” means a nonprofit
7organization or a governmental organization whose primary purpose is the
8promotion and development of tourism to or within this state or a particular region
9in this state.
AB234-ASA1,7,1410 (b) Continuation of operations grants. From the appropriation under s. 20.380
11(1) (a), the department of tourism shall award grants to tourism promotion and
12development organizations, other than governmental organizations, adversely
13affected by the COVID-19 global pandemic to assist those organizations to remain
14operational.
AB234-ASA1,7,1815 (c) Tourism marketing grants. From the appropriation under s. 20.380 (1) (a),
16the department of tourism shall award grants to tourism promotion and
17development organizations for purposes of short-term tourism marketing in
18connection with this state's recovery from the COVID-19 global pandemic.
AB234-ASA1,7,2019 (d) Grant limits. No organization may receive grants under pars. (b ) and (c)
20that in the aggregate exceed the lesser of the following:
AB234-ASA1,7,21 211. $1,000,000.
AB234-ASA1,7,23 222. Fifty percent of the organization's average annual tourism marketing budget
23for the preceding 3 years, not including 2020.
AB234-ASA1,7,2424 (2) Amusement industry tourism marketing grants.
AB234-ASA1,8,4
1(a) Grants. From the appropriation under s. 20.380 (1) (a), the department of
2tourism shall award grants to organizations that own or operate amusement or
3theme parks in this state for purposes of short-term tourism marketing in
4connection with the organization's recovery from the COVID-19 global pandemic.
AB234-ASA1,8,75 (b) Grant limit. No organization may receive a grant under par. (a ) that exceeds
650 percent of the organization's average annual tourism marketing budget for the
7preceding 3 years, not including 2020.
AB234-ASA1,9219 8Section 9219. Fiscal changes; Health Services.
AB234-ASA1,8,159 (1) Medicaid expansion. In the schedule under s. 20.005 (3) for the
10appropriation to the department of health services under s. 20.435 (4) (b), the dollar
11amount for fiscal year 2021-22 is decreased by $849,788,000 as a result of expanding
12eligibility for the Medical Assistance program. In the schedule under s. 20.005 (3)
13for the appropriation to the department of health services under s. 20.435 (4) (b), the
14dollar amount for fiscal year 2022-23 is decreased by $841,925,400 as a result of
15expanding eligibility for the Medical Assistance program.
AB234-ASA1,9243 16Section 9243. Fiscal changes; Tourism.
AB234-ASA1,8,2017 (1) Tourism promotion and development organization grants. In the schedule
18under s. 20.005 (3) for the appropriation to the the department of tourism under s.
1920.380 (1) (a), the dollar amount for fiscal year 2021-22 is increased by $100,000,000
20to provide grants under Section 9143 (1) of this act.
AB234-ASA1,8,2421 (2) Amusement industry tourism marketing grants. In the schedule under s.
2220.005 (3) for the appropriation to the the department of tourism under s. 20.380 (1)
23(a), the dollar amount for fiscal year 2021-22 is increased by $50,000,000 to provide
24grants under Section 9143 (2 ) of this act.
AB234-ASA1,9419
1Section 9419. Effective dates; Health Services. This act takes effect on the
2day after publication, except as follows:
AB234-ASA1,9,53 (1) Medicaid expansion. The treatment of ss. 20.435 (4) (jw), 49.45 (2p), (23),
4and (23b) (title), (b), (c), and (e), 49.471 (1) (cr), (4) (a) 4. b. and 8., and (4g), and 49.686
5(3) (d) and Sections 9119 (1 ) and 9219 (1) of this act take effect on July 1, 2021.
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