AB53,3,63 20.435 (4) (hm) BadgerCare Plus Basic Plan; benefits and administration. All
4moneys received from premiums under s. 49.67 (4), 2011 stats., to pay for the
5provision of services under the BadgerCare Plus Basic Plan under s. 49.67, 2011
6stats.,
and for administration of the plan.
AB53,3 7Section 3. 20.435 (4) (jw) of the statutes is amended to read:
AB53,4,48 20.435 (4) (jw) BadgerCare Plus, hospital assessment, and pharmacy benefits
9purchasing pool administrative costs.
All moneys received from payment of
10enrollment fees under the program under s. 49.45 (23), 2011 stats., all moneys
11transferred under s. 50.38 (9), all moneys transferred from the appropriation account
12under par. (jz), and 10 percent of all moneys received from penalty assessments
13under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), 2011

1stats.
, to provide a portion of the state share of administrative costs for the
2BadgerCare Plus Medical Assistance program under s. 49.471, for administration of
3the hospital assessment under s. 50.38, and to administer a contract with an entity
4to operate the pharmacy benefits purchasing pool under s. 146.45.
AB53,4 5Section 4. 25.77 (2) of the statutes is amended to read:
AB53,4,96 25.77 (2) All public funds that are related to payments under s. 49.45 and that
7are transferred or certified under 42 CFR 433.51 (b) and used as the nonfederal and
8federal share of Medical Assistance funding, except funds that are deposited into the
9appropriation accounts under s. 20.435 (4) (h), (kx) , or (ky).
AB53,5 10Section 5. 49.45 (23) of the statutes is repealed.
AB53,6 11Section 6. 49.45 (59) (b) of the statutes is amended to read:
AB53,4,2412 49.45 (59) (b) Health maintenance organizations shall pay all of the moneys
13they receive under par. (a) to eligible hospitals, as defined in s. 50.38 (1), within 15
14days after receiving the moneys. The department shall specify in contracts with
15health maintenance organizations to provide medical assistance a method that
16health maintenance organizations shall use to allocate the amounts received under
17par. (a) among eligible hospitals based on the number of discharges from inpatient
18stays and the number of outpatient visits for which the health maintenance
19organization paid such a hospital in the previous month for enrollees who are
20recipients of medical assistance, except enrollees who receive medical assistance
21under s. 49.45 (23)
. Payments under this paragraph shall be in addition to any
22amount that a health maintenance organization is required by agreement between
23the health maintenance organization and a hospital to pay the hospital for providing
24services to the health maintenance organization's enrollees.
AB53,7 25Section 7. 49.471 (1) (cr) of the statutes is created to read:
AB53,5,2
149.471 (1) (cr) "Enhanced federal medical assistance percentage" means a
2federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB53,8 3Section 8. 49.471 (4) (b) 5. of the statutes is created to read:
AB53,5,84 49.471 (4) (b) 5. Subject to sub. (4m), an adult who is under 65 years of age; who
5is not pregnant; who is not otherwise eligible for Medical Assistance under par. (a)
6or (b) 1. to 4. or s. 49.46 (1); and whose income, as determined under the method
7described in 42 USC 1396a (e) (14), does not exceed 133 percent of the poverty line
8for a family the size of the individual's family.
AB53,9 9Section 9. 49.471 (4m) of the statutes is created to read:
AB53,5,1710 49.471 (4m) Medicaid expansion. For services provided to individuals
11described under sub. (4) (b) 5., the department shall comply with all federal
12requirements to qualify for the highest available enhanced federal medical
13assistance percentage. The department shall submit any amendment to the state
14medical assistance plan, request for a waiver of federal Medicaid law, or other
15approval required by the federal government to provide services to the individuals
16described under sub. (4) (b) 5. and qualify for the highest available enhanced federal
17medical assistance percentage.
AB53,10 18Section 10. 49.471 (11) (intro.) of the statutes is amended to read:
AB53,5,2219 49.471 (11) Benchmark plan benefits and copayments. (intro.) Recipients
20Subject to sub. (11g), recipients who are not eligible for the benefits described in s.
2149.46 (2) (a) and (b) shall have coverage of the following benefits and pay the
22following copayments:
AB53,11 23Section 11 . 49.471 (11g) of the statutes is created to read:
AB53,6,424 49.471 (11g) Medicaid expansion benchmark coverage. (a) If, to obtain an
25enhanced federal medical assistance percentage, the federal department of health

1and human services prohibits charging of a copayment or premium to an individual
2described under sub (4) (b) 5., the department may not charge the copayments
3described under sub. (11) or a premium that would disqualify the department from
4obtaining an enhanced federal medical assistance percentage.
AB53,6,115 (b) If the federal department of health and human services determines that the
6benefits provided under sub. (11) are not sufficient to qualify the department to
7obtain an enhanced federal medical assistance percentage for benefits provided to
8individuals described under sub. (4) (b) 5., the department shall provide any
9benchmark coverage or benchmark equivalent coverage that complies with 42 USC
101396u-7
to qualify to obtain the highest available enhanced federal medical
11assistance percentage.
AB53,6,1512 (c) Notwithstanding sub. (13), the department may not create a policy under
13s. 49.45 (2m) (c) that affects the eligibility or benefits of the individuals described
14under sub. (4) (b) 5. such that the department fails to obtain an enhanced federal
15medical assistance percentage.
AB53,12 16Section 12 . 49.471 (11g) (c) of the statutes, as created by 2013 Wisconsin Act
17.... (this act), is repealed.
AB53,13 18Section 13. 49.67 of the statutes is repealed.
AB53,14 19Section 14. 49.686 (3) (d) of the statutes is amended to read:
AB53,6,2520 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
21for medical assistance within 12 months prior to application for reimbursement
22under sub. (2). This paragraph does not apply to an individual who is eligible for
23benefits under the demonstration project for childless adults under s. 49.45 (23) or
24to an individual who is eligible for benefits under
BadgerCare Plus under s. 49.471
25(11).
AB53,15
1Section 15. 149.12 (2) (f) 2. g. of the statutes is repealed.
AB53,16 2Section 16. 227.01 (13) (ur) of the statutes is repealed.
AB53,17 3Section 17. 227.42 (7) of the statutes is repealed.
AB53,18 4Section 18. Effective dates. This act takes effect on January 1, 2014, except
5as follows:
AB53,7,76 (1) The repeal of section 49.471 (11g) (c) of the statutes takes effect on January
71, 2015.
AB53,7,88 (End)
Loading...
Loading...