Analysis by the Legislative Reference Bureau
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 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.
Broadband expansion grants
The bill also provides $1,000,000,000 in general purpose revenue funding for
the broadband expansion grant program administered by the Public Service
Commission. Under current law, the PSC makes grants to eligible applicants for
constructing broadband infrastructure in underserved areas designated by the PSC.
The bill's appropriation is in addition to appropriations from the universal service
fund for the grants under current law.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB239-ASA1,1 1Section 1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
2the following amounts for the purposes indicated: - See PDF for table PDF
AB239-ASA1,2 3Section 2. 20.155 (3) (a) of the statutes is created to read:
AB239-ASA1,3,3
120.155 (3) (a) Broadband expansion grants; general purpose revenue. As a
2continuing appropriation, the amounts in the schedule for broadband expansion
3grants under s. 196.504 (2).
AB239-ASA1,3 4Section 3. 20.435 (4) (jw) of the statutes is amended to read:
AB239-ASA1,3,125 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received
6from payment of enrollment fees under the program under s. 49.45 (23), all
moneys
7transferred under s. 50.38 (9), all moneys transferred from the appropriation account
8under par. (jz), and 10 percent of all moneys received from penalty assessments
9under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to
10provide a portion of the state share of administrative costs for the BadgerCare Plus
11Medical Assistance program under s. 49.471, and for administration of the hospital
12assessment under s. 50.38.
AB239-ASA1,4 13Section 4. 49.45 (2p) of the statutes is repealed.
AB239-ASA1,5 14Section 5. 49.45 (23) of the statutes is repealed.
AB239-ASA1,6 15Section 6. 49.45 (23b) (title) of the statutes is amended to read:
AB239-ASA1,3,1716 49.45 (23b) (title) Childless adults demonstration project reform waiver
17implementation required.
AB239-ASA1,7 18Section 7. 49.45 (23b) (b) of the statutes is amended to read:
AB239-ASA1,3,2219 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and
20ending no sooner than December 31, 2023, the department shall do all of the
21following with regard to the childless adults demonstration project under sub. (23)
22s. 49.471 (4) (a) 8.:
AB239-ASA1,4,323 1. Require in each month persons, except exempt individuals, who are eligible
24to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least
2519 years of age but have not attained the age of 50 to participate in, document, and

1report 80 hours per calendar month of community engagement activities. The
2department, after finding good cause, may grant a temporary exemption from the
3requirement under this subdivision upon request of a Medical Assistance recipient.
AB239-ASA1,4,64 2. Require persons with incomes of at least 50 percent of the poverty line to pay
5premiums in accordance with par. (c) as a condition of eligibility for Medical
6Assistance under sub. (23) s. 49.471 (4) (a) 8.
AB239-ASA1,4,87 3. Require as a condition of eligibility for Medical Assistance under sub. (23)
8s. 49.471 (4) (a) 8. completion of a health risk assessment.
AB239-ASA1,4,119 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
10an $8 copayment for nonemergency use of the emergency department in accordance
11with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.
AB239-ASA1,4,1612 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6
13months any individual who does not pay a required premium under subd. 2. and any
14individual who is required under subd. 1. to participate in a community engagement
15activity but who does not participate for 48 aggregate months in the community
16engagement activity.
AB239-ASA1,8 17Section 8. 49.45 (23b) (c) of the statutes is amended to read:
AB239-ASA1,4,2318 49.45 (23b) (c) 1. Persons who are eligible for the demonstration project under
19sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds
2050 percent of the poverty line shall pay a monthly premium amount of $8 per
21household. A person who is eligible to receive an item or service furnished by an
22Indian health care provider is exempt from the premium requirement under this
23subdivision.
AB239-ASA1,5,424 2. The department may disenroll under par. (b) 5. a person for nonpayment of
25a required monthly premium only at annual eligibility redetermination after

1providing notice and reasonable opportunity for the person to pay. If a person who
2is disenrolled for nonpayment of premiums pays all owed premiums or becomes
3exempt from payment of premiums, he or she may reenroll in Medical Assistance
4under sub. (23) s. 49.471 (4) (a) 8.
AB239-ASA1,5,85 3. The department shall reduce the amount of the required household premium
6by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
7who does not engage in certain behaviors that increase health risks or who attests
8to actively managing certain unhealthy behaviors.
AB239-ASA1,9 9Section 9. 49.45 (23b) (e) of the statutes is amended to read:
AB239-ASA1,5,1410 49.45 (23b) (e) Before December 31, 2023, the demonstration project
11requirements under this subsection may not be withdrawn and the department may
12not request from the federal government withdrawal, suspension, or termination of
13the demonstration project requirements under this subsection unless legislation has
14been enacted specifically allowing for the withdrawal, suspension, or termination.
AB239-ASA1,10 15Section 10. 49.471 (1) (cr) of the statutes is created to read:
AB239-ASA1,5,1716 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
17federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB239-ASA1,11 18Section 11. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB239-ASA1,5,2119 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
20percent of the poverty line before application of the 5 percent income disregard under
2142 CFR 435.603 (d)
.
AB239-ASA1,12 22Section 12. 49.471 (4) (a) 8. of the statutes is created to read:
AB239-ASA1,5,2323 49.471 (4) (a) 8. An individual who meets all of the following criteria:
AB239-ASA1,5,2424 a. The individual is an adult under the age of 65.
AB239-ASA1,6,2
1b. The individual has a family income that does not exceed 133 percent of the
2poverty line, except as provided in sub. (4g).
AB239-ASA1,6,43 c. The individual is not otherwise eligible for the Medical Assistance program
4under this subchapter or the Medicare program under 42 USC 1395 et seq.
AB239-ASA1,13 5Section 13. 49.471 (4g) of the statutes is created to read:
AB239-ASA1,6,156 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
7services provided to individuals described under sub. (4) (a) 8., the department shall
8comply with all federal requirements to qualify for the highest available enhanced
9federal medical assistance percentage. The department shall submit any
10amendment to the state medical assistance plan, request for a waiver of federal
11Medicaid law, or other approval request required by the federal government to
12provide services to the individuals described under sub. (4) (a) 8. and qualify for the
13highest available enhanced federal medical assistance percentage. Sections 20.940
14and 49.45 (2t) do not apply to a submission to the federal government under this
15subsection.
AB239-ASA1,14 16Section 14. 49.686 (3) (d) of the statutes is amended to read:
AB239-ASA1,6,2217 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
18for medical assistance within 12 months prior to application for reimbursement
19under sub. (2). This paragraph does not apply to an individual who is eligible for
20benefits under the demonstration project for childless adults under s. 49.45 (23) or
21to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471
22(4) (a) 8. or (11).
AB239-ASA1,15 23Section 15. 196.504 (2) (a) of the statutes is amended to read:
AB239-ASA1,7,224 196.504 (2) (a) To make broadband expansion grants to eligible applicants for
25the purpose of constructing broadband infrastructure in underserved areas

1designated under par. (d). Grants awarded under this section shall be paid from the
2appropriations under s. 20.155 (3) (a), (r), and (rm).
AB239-ASA1,16 3Section 16. Nonstatutory provisions.
AB239-ASA1,7,124 (1) Childless adults demonstration project. The department of health
5services shall submit any necessary request to the federal department of health and
6human services for a state plan amendment or waiver of federal Medicaid law or to
7modify or withdraw from any waiver of federal Medicaid law relating to the childless
8adults demonstration project under s. 49.45 (23), 2019 stats., to reflect the
9incorporation of recipients of Medical Assistance under the demonstration project
10into the BadgerCare Plus program under s. 49.471 and the termination of the
11demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission
12to the federal government under this subsection.
AB239-ASA1,17 13Section 17. Fiscal changes.
AB239-ASA1,7,2014 (1) Medicaid expansion. In the schedule under s. 20.005 (3) for the
15appropriation to the department of health services under s. 20.435 (4) (b), the dollar
16amount for fiscal year 2021-22 is decreased by $849,788,000 as a result of expanding
17eligibility for the Medical Assistance program. In the schedule under s. 20.005 (3)
18for the appropriation to the department of health services under s. 20.435 (4) (b), the
19dollar amount for fiscal year 2022-23 is decreased by $841,925,400 as a result of
20expanding eligibility for the Medical Assistance program.
AB239-ASA1,18 21Section 18. Effective dates. This act takes effect on July 1, 2021, except as
22follows:
AB239-ASA1,8,3
1(1) Broadband expansion grants. The treatment of ss. 20.155 (3) (a) and
2196.504 (2) (a) takes effect on the day after publication, or on the 2nd day after
3publication of the 2021 biennial budget act, whichever is later.
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