AB959: Bill Text

LRB-4198/1

RLR:kjf:pg

2005 - 2006 LEGISLATURE

2005 Assembly BILL 959

January 31, 2006 - Introduced by Representatives Zepnick, Sinicki, Grigsby, Fields, Vruwink, Seidel, Cullen, Benedict, Turner, Parisi, Pocan, Pope-Roberts, Berceau, Boyle, Hebl and Black, cosponsored by Senators Miller, Coggs, Hansen, Erpenbach and Risser. Referred to Committee on Insurance.

AB959,1,5 An Act to create 20.435 (4) (c), 20.435 (4) (jk) and 49.67 of the statutes; relating to: health insurance coverage for children, extending the time limit for emergency rule procedures, providing an exemption from emergency rule procedures, requiring the exercise of rule-making authority, and making appropriations.

Analysis by the Legislative Reference Bureau

Currently, the Department of Health and Family Services (DHFS) administers the Medical Assistance (MA) and Badger Care programs to provide comprehensive health care coverage to program enrollees. Generally, children under the age of six whose family income does not exceed 185 percent of the federal poverty level (FPL) and children over age six whose family income does not exceed 100 percent of the FPL are eligible for MA. Also certain disabled or blind children are eligible for MA. Children, regardless of age, whose family income does not exceed 185 percent of FPL and who do not have access to an employer-subsidized health insurance plan for which the employer subsidizes at least 80 percent of the cost are generally eligible for Badger Care. (Family income may increase up to 200 percent of FPL before a family already enrolled in Badger Care loses eligibility). Badger Care enrollees with family income in excess of 150 percent of the FPL must pay a monthly premium. The benefits under MA and Badger Care include: physician services; early periodic screening, diagnosis, and treatment; inpatient and outpatient hospital services; dental services; optometrist or optician services; mental health services; and prescription and over-the-counter drugs.

This bill requires DHFS to administer a program (All Kids) to provide health care coverage to certain children under the age of 19 regardless of the child's family income. A child is eligible if he or she is a resident of Wisconsin; if he or she is not eligible for MA or Badger Care; if he or she is not a resident of an institution for mental diseases or an inmate of a public institution; and if he or she satisfies at least one of the following health care coverage conditions: 1) the child has been without health insurance coverage for a period of time established by DHFS (at least six months upon program implementation, incrementally increasing to at least 12 months); 2) the child's parent lost access to affordable employer-sponsored health insurance for the child as a result of job loss; 3) the child is a newborn without access to affordable employer-sponsored health insurance; or 4) the child lost eligibility for MA or Badger Care in the previous 12 months.

The bill authorizes DHFS to establish cost-sharing requirements for enrollees including monthly premiums (based on family income), copayments, or coinsurance. If a required monthly premium is not timely paid, the child is terminated from All Kids and is not eligible to reenroll for at least three months.

The benefits under All Kids are the same as the benefits under MA, except that All Kids does not cover nonemergency transportation services. However, the bill authorizes DHFS to subsidize a health insurance plan for an enrollee rather than providing the MA benefits if the subsidy is cost-effective. Further, the bill authorizes DHFS to provide a limited package of health care benefits to children who satisfy all of the eligibility criteria except the health care coverage conditions and are either enrolled in a high-deductible health insurance plan or a health insurance plan that does not cover all of the benefits covered under All Kids. The bill creates a general purpose revenue appropriation and a program revenue appropriation to fund benefits under the All Kids program.

Under the bill, the All Kids program is effective January 1, 2007. The bill requires DHFS to promulgate emergency rules for the program.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB959, s. 1 Section 1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

AB959, s. 2 Section 2. 20.435 (4) (c) of the statutes is created to read:

AB959,3,3 20.435 (4) (c) All Kids benefits. Biennially, the amounts in the schedule for benefits under s. 49.67.

AB959, s. 3 Section 3. 20.435 (4) (jk) of the statutes is created to read:

AB959,3,6 20.435 (4) (jk) All Kids cost sharing. All moneys received from payments under s. 49.67 (6) for benefits under s. 49.67.

AB959, s. 4 Section 4. 49.67 of the statutes is created to read:

AB959,3,9 49.67 All Kids. (1) In this section, "child" means a person who is under the age of 19.

AB959,3,11 (2) Administration. (a) The department shall administer a program to provide benefits under sub. (5) to children eligible under sub. (3).

AB959,3,14 (b) The department shall promulgate rules to administer the program under this section including rules for determining affordability of health insurance plans, rules specifying reenrollment procedures, and rules for cost-sharing.

AB959,3,16 (3) Eligibility. A child is eligible for the program under this section if all of the following apply:

AB959,3,17 (a) The child is a resident of this state.

AB959,4,1 (b) The child is not eligible to receive benefits under s. 49.45 or 49.665.

AB959,4,3 (c) The child is not a resident of an institution for mental diseases, as defined in s. 49.43 (6m).

AB959,4,5 (d) The child is not an inmate of a public institution, as defined in 42 CFR 435.1009.

AB959,4,6 (e) At the time of eligibility determination, any of the following applies:

AB959,4,13 1. The child has been without health insurance coverage for a period established by the department by rule that is not less than 6 months during the first month of operation of the program under this section, 7 months during the 2nd month of operation, 8 months during the 3rd month of operation, 9 months during the 4th month of operation, 10 months during the 5th month of operation, 11 months during the 6th month of operation, and 12 months for any month after the 6th month of operation.

AB959,4,17 2. As a result of losing employment, the child's parent lost access to affordable employer-sponsored health insurance coverage for the child and the parent remains without access to affordable employer-sponsored health insurance coverage for the child.

AB959,4,19 3. The child is a newborn and affordable private or employer-sponsored health insurance coverage is not available for the child.

AB959,4,21 4. The child lost eligibility for benefits under s. 49.45 or 49.665 within the 12 months before applying for benefits under this section.

AB959,5,2 (4) Enrollment duration. A child who is determined to be eligible under sub. (3) remains eligible for 12 months except if sub. (3) (a), (c), or (d) no longer applies or if a monthly premium required under sub. (6) is not timely paid. A child for whom the monthly premium is not timely paid is ineligible to reenroll in the program under this section for 3 months.

AB959,5,5 (5) Benefits. (a) Except as provided in par. (b), the benefits under this section are the same as those described under s. 49.46 (2), except that nonemergency transportation services are not covered under this section.

AB959,5,8 (b) As an alternative to providing the benefits under par. (a), the department may subsidize the cost of health insurance coverage for a child, including employer-sponsored coverage, if paying the subsidy is cost-effective.

AB959,5,13 (6) Cost sharing. (a) Except as provided in par. (b), a child receiving benefits under sub. (5) (a) is subject to any copayment, coinsurance, or monthly premium established by the department. The department shall determine copayment, coinsurance, and monthly premium amounts on a sliding scale based on family income.

AB959,5,15 (b) The department may not require a copayment for the benefit described under s. 49.46 (2) (a) 2.

AB959,5,17 (c) A child enrolled in a privately sponsored health plan as provided under sub. (5) (b) is subject to the cost-sharing provisions stated in the plan.

AB959,5,23 (7) Alternatives. Notwithstanding subs. (3) (e) and (5), if cost-effective, the department may, as an alternative to the benefits under sub. (5), provide a limited package of the services under sub. (5) (a) to a child who satisfies the eligibility criteria under sub. (3) (a), (b), (c), and (d) and is enrolled in a high-deductible health insurance plan or a health insurance plan that does not cover all of the benefits under sub. (5) (a).

AB959,5,24 (8) Information about applicants and enrollees. (a) In this subsection:

AB959,5,25 1. "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

AB959,6,1 2. "Insurer" has the meaning given in s. 600.03 (27)

AB959,6,6 (b) An insurer that issues or delivers a disability insurance policy that provides coverage to a resident of this state shall provide to the department, upon the department's request, information contained in the insurer's records that the department needs to verify the eligibility of program applicants and enrollees under this section.

AB959,6,9 (c) Upon requesting an insurer to provide the information under par. (b), the department shall enter into a written agreement with the insurer that satisfies all of the following:

AB959,6,10 1. Identifies in detail the information to be disclosed.

AB959,6,12 2. Includes provisions that adequately safeguard the confidentiality of the information to be disclosed.

AB959,6,15 (d) 1. An insurer shall provide the information requested under par. (b) within 180 days after receiving the department's request if it is the first time that the department has requested the insurer to disclose information under this subsection.

AB959,6,18 2. An insurer shall provide the information requested under par. (b) within 30 days after receiving the department's request if the department has previously requested the insurer to disclose information under this subsection.