Analysis by the Legislative Reference Bureau
Payments to long-term care facilities and their staff
This bill requires the Department of Health Services to distribute $300,000,000
to nursing homes and assisted living facilities that apply to DHS for a onetime
payment. The payment may be used for purposes including capital projects and for
integration into the statewide health information exchange system. The bill defines
assisted living facilities to be community-based residential facilities, adult family
homes, and residential care apartment complexes. To receive a payment, the nursing
home or assisted living facility must ensure that no less than 50 percent of the
payment provides bonuses to employees.
Medicaid expansion
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 DHS 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:
AB236-ASA1,1 1Section 1 . 20.435 (4) (jw) of the statutes is amended to read:
AB236-ASA1,2,92 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
4transferred under s. 50.38 (9), all moneys transferred from the appropriation account
5under par. (jz), and 10 percent of all moneys received from penalty assessments
6under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to
7provide a portion of the state share of administrative costs for the BadgerCare Plus
8Medical Assistance program under s. 49.471, and for administration of the hospital
9assessment under s. 50.38.
AB236-ASA1,2 10Section 2. 49.45 (2p) of the statutes is repealed.
AB236-ASA1,3 11Section 3 . 49.45 (23) of the statutes is repealed.
AB236-ASA1,4
1Section 4. 49.45 (23b) (title) of the statutes is amended to read:
AB236-ASA1,3,32 49.45 (23b) (title) Childless adults demonstration project reform waiver
3implementation required.
AB236-ASA1,5 4Section 5 . 49.45 (23b) (b) of the statutes is amended to read:
AB236-ASA1,3,85 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and
6ending no sooner than December 31, 2023, the department shall do all of the
7following with regard to the childless adults demonstration project under sub. (23)
8s. 49.471 (4) (a) 8.:
AB236-ASA1,3,149 1. Require in each month persons, except exempt individuals, who are eligible
10to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least
1119 years of age but have not attained the age of 50 to participate in, document, and
12report 80 hours per calendar month of community engagement activities. The
13department, after finding good cause, may grant a temporary exemption from the
14requirement under this subdivision upon request of a Medical Assistance recipient.
AB236-ASA1,3,1715 2. Require persons with incomes of at least 50 percent of the poverty line to pay
16premiums in accordance with par. (c) as a condition of eligibility for Medical
17Assistance under sub. (23) s. 49.471 (4) (a) 8.
AB236-ASA1,3,1918 3. Require as a condition of eligibility for Medical Assistance under sub. (23)
19s. 49.471 (4) (a) 8. completion of a health risk assessment.
AB236-ASA1,3,2220 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
21an $8 copayment for nonemergency use of the emergency department in accordance
22with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.
AB236-ASA1,4,223 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6
24months any individual who does not pay a required premium under subd. 2. and any
25individual who is required under subd. 1. to participate in a community engagement

1activity but who does not participate for 48 aggregate months in the community
2engagement activity.
AB236-ASA1,6 3Section 6 . 49.45 (23b) (c) of the statutes is amended to read:
AB236-ASA1,4,94 49.45 (23b) (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
650 percent of the poverty line shall pay a monthly premium amount of $8 per
7household. A person who is eligible to receive an item or service furnished by an
8Indian health care provider is exempt from the premium requirement under this
9subdivision.
AB236-ASA1,4,1510 2. The department may disenroll under par. (b) 5. a person for nonpayment of
11a required monthly premium only at annual eligibility redetermination after
12providing notice and reasonable opportunity for the person to pay. If a person who
13is disenrolled for nonpayment of premiums pays all owed premiums or becomes
14exempt from payment of premiums, he or she may reenroll in Medical Assistance
15under sub. (23) s. 49.471 (4) (a) 8.
AB236-ASA1,4,1916 3. The department shall reduce the amount of the required household premium
17by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
18who does not engage in certain behaviors that increase health risks or who attests
19to actively managing certain unhealthy behaviors.
AB236-ASA1,7 20Section 7 . 49.45 (23b) (e) of the statutes is amended to read:
AB236-ASA1,4,2521 49.45 (23b) (e) Before December 31, 2023, the demonstration project
22requirements under this subsection may not be withdrawn and the department may
23not request from the federal government withdrawal, suspension, or termination of
24the demonstration project requirements under this subsection unless legislation has
25been enacted specifically allowing for the withdrawal, suspension, or termination.
AB236-ASA1,8
1Section 8. 49.471 (1) (cr) of the statutes is created to read:
AB236-ASA1,5,32 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
3federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB236-ASA1,9 4Section 9 . 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB236-ASA1,5,75 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
6percent of the poverty line before application of the 5 percent income disregard under
742 CFR 435.603 (d)
.
AB236-ASA1,10 8Section 10 . 49.471 (4) (a) 8. of the statutes is created to read:
AB236-ASA1,5,99 49.471 (4) (a) 8. An individual who meets all of the following criteria:
AB236-ASA1,5,1010 a. The individual is an adult under the age of 65.
AB236-ASA1,5,1211 b. The individual has a family income that does not exceed 133 percent of the
12poverty line, except as provided in sub. (4g).
AB236-ASA1,5,1413 c. The individual is not otherwise eligible for the Medical Assistance program
14under this subchapter or the Medicare program under 42 USC 1395 et seq.
AB236-ASA1,11 15Section 11 . 49.471 (4g) of the statutes is created to read:
AB236-ASA1,5,2516 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
17services provided to individuals described under sub. (4) (a) 8., the department shall
18comply with all federal requirements to qualify for the highest available enhanced
19federal medical assistance percentage. The department shall submit any
20amendment to the state medical assistance plan, request for a waiver of federal
21Medicaid law, or other approval request required by the federal government to
22provide services to the individuals described under sub. (4) (a) 8. and qualify for the
23highest available enhanced federal medical assistance percentage. Sections 20.940
24and 49.45 (2t) do not apply to a submission to the federal government under this
25subsection.
AB236-ASA1,12
1Section 12. 49.686 (3) (d) of the statutes is amended to read:
AB236-ASA1,6,72 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
3for medical assistance within 12 months prior to application for reimbursement
4under 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 (11).
AB236-ASA1,9119 8Section 9119. Nonstatutory provisions; Health Services.
AB236-ASA1,6,179 (1) Childless adults demonstration project. The department of health
10services shall submit any necessary request to the federal department of health and
11human services for a state plan amendment or waiver of federal Medicaid law or to
12modify or withdraw from any waiver of federal Medicaid law relating to the childless
13adults demonstration project under s. 49.45 (23), 2019 stats., to reflect the
14incorporation of recipients of Medical Assistance under the demonstration project
15into the BadgerCare Plus program under s. 49.471 and the termination of the
16demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission
17to the federal government under this subsection.
AB236-ASA1,6,1818 (2) Payments to long-term care facilities.
AB236-ASA1,6,2119 (a) In this subsection, “assisted living facility” means a community-based
20residential facility, as defined in s. 50.01 (1g), an adult family home, as defined in s.
2150.01 (1), or a residential care apartment complex, as defined in s. 50.01 (6d).
AB236-ASA1,7,722 (b) From the appropriation under s. 20.435 (6) (ky), in fiscal year 2021-22, the
23department of health services shall distribute $300,000,000 to nursing homes, as
24defined in s. 50.01 (3), and assisted living facilities that apply to the department a
25onetime payment, which may be used by the nursing home or assisted living facility

1for purposes including capital projects and for assisting with integration into the
2statewide health information exchange system. To receive a payment under this
3paragraph, the nursing home or assisted living facility shall ensure that no less than
450 percent of the payment received by the nursing home or assisted living facility
5provides bonus payments to its employees, with an emphasis on providing bonuses
6to those employees who have direct contact with residents of the nursing home or
7assisted living facility.
AB236-ASA1,9219 8Section 9219. Fiscal changes; Health Services.
AB236-ASA1,7,159 (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.
AB236-ASA1,7,1816 (2) Payments to long-term care facilities and staff. In fiscal year 2021-22,
17there is transferred from the general fund to the appropriation account under s.
1820.435 (6) (ky), $300,000,000.
AB236-ASA1,9419 19Section 9419. Effective dates; Health Services.
AB236-ASA1,7,2120 (1) Medicaid expansion; long-term care facility payments. This act takes
21effect on July 1, 2021.
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