Public Notices

public_notices Wisconsin Administrative Register No. 699, 3/31/2014

Public Notices

Health Services

Changes to Cost Sharing Requirements for Medicaid Recipients

The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss. 49.665 and 49.471 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.

Change in Payment Methods

To assist the State in providing these services, recipients have been required to contribute certain cost sharing amounts, including co-payments and premiums. Changes are being made to these requirements.

Two changes regarding co-payments are as follows:

1. Copayments will be charged to Continuously Eligible Newborns with income between 150% and 200% of the Federal Poverty Limit (FPL).

2. Co-payments will no longer be required of children 6 to 18 years of age with incomes at or below 133% of the FPL.

These changes will be effective for dates of service on and after January 1, 2014.

The change relating to co-payments no longer being required of children 6 to 18 years of age with incomes at or below 133% of the FPL is the result of a change in federal law. 42 USC 1396a(l)(2)(C) was amended to make children aged 6 to 18 with incomes at or below 133% of the FPL a mandatory eligibility group under section 1396a(a)(10)(A)(i)(VII), effective January 1, 2014. Under 42 USC 1396o-1(b)(3)(B)(i), States are not allowed to impose any cost sharing on children eligible as one of the mandatory groups under 1396a(a)(10)(A)(i). Thus, the Department intends to modify the State Plan to reflect the fact that, as of January 1, co-payments will no longer be collected from children with incomes from 100% to 133% of the FPL.

A third change regarding co-payments is the following:

3. References to Benchmark Plan copayment levels will be removed from the state plan.

The references to the Benchmark Plan will be removed because coverage under the Benchmark Plan is scheduled to terminate as of April 1, with those covered under that Plan shifting to other sources of coverage.

This change will be effective for dates of service on and after April 1, 2014.

The change regarding premiums is as follows:

The Department will no longer charge premiums to infants under one year of age with incomes over 200% of the FPL.

The change to premium requirements will be effective for dates of service on and after February 1, 2014.

An estimate of the fiscal impact of these changes has not been calculated.

Copies of Changes

Copies of the state plan changes revising cost sharing requirements may be obtained free of charge by calling or writing as follows:

Regular Mail:

John LaPhilliph

Bureau of Enrollment Policy and Systems

Division of Health Care Access and Accountability

P.O. Box 309

Madison, WI 53701-0309

Fax:

[phone]

Attention: John LaPhilliph

Telephone:

John LaPhilliph

Bureau of Enrollment Policy and Systems

[phone]

E-Mail:

[e-mail]

Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.

Written Comments

Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is [phone]. The e-mail address is [e-mail]. Regular mail can be sent to the above address. All written comments will be reviewed and considered.

The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.