LRB-2871/1
SWB:emw/amn/cjs
2023 - 2024 LEGISLATURE
November 21, 2023 - Introduced by Senators Hesselbein, Smith,
Agard,
Carpenter, L. Johnson, Larson, Pfaff, Roys, Spreitzer, Taylor and Wirch,
cosponsored by Representatives
Riemer, Vining, J. Anderson, Andraca, Bare,
Clancy, Conley, Emerson, Hong, Jacobson, Joers, Madison, Moore
Omokunde, Neubauer, Ohnstad, Ortiz-Velez, Palmeri, Ratcliff,
Shankland, Shelton, Sinicki and Subeck. Referred to Committee on
Insurance and Small Business.
SB716,1,5
1An Act to repeal 49.45 (2p), 49.45 (23) and 49.45 (23b);
to amend 20.435 (4) (jw),
249.471 (4) (a) 4. b. and 49.686 (3) (d);
to create 49.471 (1) (cr), 49.471 (4) (a) 8.
3and 49.471 (4g) of the statutes; and
to affect 2017 Wisconsin Act 370, section
444 (2) and (3);
relating to: expanding eligibility for the Medical Assistance
5program and making an appropriation.
Analysis by the Legislative Reference Bureau
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 the 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 a 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 as of October 1, 2023.
2017 Wisconsin Act 370 requires by statute that DHS implement the
BadgerCare Reform waiver as it relates to childless adults as approved by the federal
Department of Health and Human Services effective October 31, 2018. The 2015-17
and 2017-19 biennial budget acts required DHS to submit a waiver request to the
federal Department of Health and Human Services authorizing DHS to take certain
actions, including imposing premiums on, requiring a health risk assessment of, and
limiting the time of eligibility for recipients of BadgerCare Plus under the childless
adults demonstration project waiver. Act 370 required DHS to implement the
childless adults BadgerCare Reform waiver by no later than November 1, 2019. If
the Joint Committee on Finance determines that DHS has not complied with the
implementation deadline, has not made sufficient progress in implementing the
BadgerCare Reform waiver, or has not complied with other requirements relating to
approved waiver implementation, Act 370 allows JCF to reduce from moneys
allocated for state operations or administrative functions DHS's appropriation or
expenditure authority, whichever is applicable, or change the authorized level of
full-time equivalent positions for DHS related to the Medical Assistance program.
The bill eliminates the statutory implementation requirement for the BadgerCare
Reform waiver, including the deadline and penalties, eliminates the statutory
requirement for DHS to seek the waiver, and allows DHS to modify or withdraw the
waiver.
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:
SB716,3,53
20.435
(4) (jw)
BadgerCare Plus and hospital assessment. Alle
moneys received
4from payment of enrollment fees under the program under s. 49.45 (23), all moneys
5transferred under s. 50.38 (9), all moneys transferred under s. 256.23 (6), all moneys
6transferred from the appropriation account under par. (jz), and 10 percent of all
1moneys received from penalty assessments under s. 49.471 (9) (c),
for administration
2of the program under s. 49.45 (23), to provide a portion of the state share of
3administrative costs for the BadgerCare Plus Medical Assistance program under s.
449.471, for administration of the hospital assessment under s. 50.38, and for
5administration of the ambulance service provider fee under s. 256.23.
SB716,2
6Section 2
. 49.45 (2p) of the statutes is repealed.
SB716,3
7Section 3
. 49.45 (23) of the statutes is repealed.
SB716,4
8Section 4
. 49.45 (23b) of the statutes is repealed.
SB716,5
9Section 5
. 49.471 (1) (cr) of the statutes is created to read:
SB716,3,1110
49.471
(1) (cr) “Enhanced federal medical assistance percentage" means a
11federal medical assistance percentage described under
42 USC 1396d (y) or (z).
SB716,6
12Section 6
. 49.471 (4) (a) 4. b. of the statutes is amended to read:
SB716,3,1513
49.471
(4) (a) 4. b. The individual's family income does not exceed
100 133 14percent of the poverty line
before application of the 5 percent income disregard under
1542 CFR 435.603 (d).
SB716,7
16Section 7
. 49.471 (4) (a) 8. of the statutes is created to read:
SB716,3,1717
49.471
(4) (a) 8. An individual who meets all of the following criteria:
SB716,3,1818
a. The individual is an adult under the age of 65.
SB716,3,2019
b. The adult has a family income that does not exceed 133 percent of the poverty
20line, except as provided in sub. (4g).
SB716,3,2221
c. The adult is not otherwise eligible for the Medical Assistance program under
22this subchapter or the Medicare program under
42 USC 1395 et seq.
SB716,8
23Section 8
. 49.471 (4g) of the statutes is created to read:
SB716,4,824
49.471
(4g) Medicaid expansion; federal medical assistance percentage. For
25services provided to individuals described under sub. (4) (a) 8., the department shall
1comply with all federal requirements to qualify for the highest available enhanced
2federal medical assistance percentage. The department shall submit any
3amendment to the state medical assistance plan, request for a waiver of federal
4Medicaid law, or other approval request required by the federal government to
5provide services to the individuals described under sub. (4) (a) 8. and qualify for the
6highest available enhanced federal medical assistance percentage. Sections 20.940
7and 49.45 (2t) do not apply to a submission to the federal government under this
8subsection.
SB716,9
9Section 9
. 49.686 (3) (d) of the statutes is amended to read:
SB716,4,1510
49.686
(3) (d) Has applied for coverage under and has been denied eligibility
11for medical assistance within 12 months prior to application for reimbursement
12under sub. (2). This paragraph does not apply to an individual
who is eligible for
13benefits under the demonstration project for childless adults under s. 49.45 (23) or
14to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471
15(4) (a) 8. or (11).
SB716,11
17Section 11
.
Nonstatutory provisions.
SB716,5,218
(1)
Childless adults demonstration project. The department of health
19services shall submit any necessary request to the federal department of health and
20human services for a state plan amendment or waiver of federal Medicaid law or to
21modify or withdraw from any waiver of federal Medicaid law relating to the childless
22adults demonstration project under s. 49.45 (23), 2021 stats., to reflect the
23incorporation of recipients of Medical Assistance under the demonstration project
24into the BadgerCare Plus program under s. 49.471 and the termination of the
1demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a request under
2this subsection.
SB716,5,104
(1)
Medicaid expansion. In the schedule under s. 20.005 (3) for the
5appropriation to the department of health services under s. 20.435 (4) (b), the dollar
6amount for fiscal year 2023-24 is decreased by $250,000,000 as a result of expanding
7eligibility for the Medical Assistance program. In the schedule under s. 20.005 (3)
8for the appropriation to the department of health services under s. 20.435 (4) (b), the
9dollar amount for fiscal year 2024-25 is decreased by $230,000,000 as a result of
10expanding eligibility for the Medical Assistance program.
SB716,5,1411
(2)
Federal medical assistance percentage incentive lapse. Notwithstanding
12s. 20.001 (3) (b), on July 1, 2025, there is lapsed to the general fund $1,020,000,000
13from the appropriation account of the department of health services under s. 20.435
14(4) (b).
SB716,5,1815
(3)
Income maintenance. In the schedule under s. 20.005 (3) for the
16appropriation to the department of health services under s. 20.435 (4) (bn), the dollar
17amount for fiscal year 2023-24 is increased by $340,500 and the dollar amount for
18fiscal year 2024-25 is increased by $342,200.
SB716,13
19Section
13.
Effective dates. This act takes effect on the day after publication,
20except as follows:
SB716,5,2421
(1)
Medicaid expansion. The treatment of ss. 20.435 (4) (jw), 49.45 (23) and
22(23b), 49.471 (1) (cr), (4) (a) 4. b. and 8., and (4g), and 49.686 (3) (d) and
2017
23Wisconsin Act 370, section
44 (2) and (3) and
Section 11 (1) of this act take effect
24retroactively to October 1, 2023.