Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB745 Compare Versions

Only one version of the bill is available at this time.

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3	3	2023 - 2024 LEGISLATURE
4	4	2023 ASSEMBLY BILL 745
5	5	December 6, 2023 - Introduced by Representatives RIEMER, VINING, J. ANDERSON,
6	6	ANDRACA, BARE, CLANCY, CONLEY, EMERSON, HONG, JACOBSON, JOERS, MADISON,
7	7	MOORE OMOKUNDE, NEUBAUER, OHNSTAD, ORTIZ-VELEZ, PALMERI, RATCLIFF,
8	8	SHANKLAND, SHELTON, SINICKI, SUBECK and HAYWOOD, cosponsored by Senators
9	9	HESSELBEIN, SMITH, AGARD, CARPENTER, L. JOHNSON, LARSON, PFAFF, ROYS,
10	10	SPREITZER, TAYLOR and WIRCH. Referred to Committee on Health, Aging and
11	11	Long-Term Care.
12	12	*AUTHORS SUBJECT TO CHANGE*
13	13	AN ACT to repeal 49.45 (2p), 49.45 (23) and 49.45 (23b); to amend 20.435 (4) (jw),
14	14	49.471 (4) (a) 4. b. and 49.686 (3) (d); to create 49.471 (1) (cr), 49.471 (4) (a) 8.
15	15	and 49.471 (4g) of the statutes; and to affect 2017 Wisconsin Act 370, section
16	16	44 (2) and (3); relating to: expanding eligibility for the Medical Assistance
17	17	program and making an appropriation.
18	18	Analysis by the Legislative Reference Bureau
19	19	BadgerCare Plus and BadgerCare Plus Core are programs under the state's
20	20	Medical Assistance program, which provides health services to individuals who have
21	21	limited financial resources. The federal Patient Protection and Affordable Care Act
22	22	allows a state to receive an enhanced federal medical assistance percentage payment
23	23	for providing benefits to certain individuals through a state's Medical Assistance
24	24	program. This bill changes the family income eligibility level to up to 133 percent
25	25	of the federal poverty line for parents and caretaker relatives under BadgerCare Plus
26	26	and for childless adults currently covered under BadgerCare Plus Core and who are
27	27	incorporated into BadgerCare Plus in the bill. The bill requires the Department of
28	28	Health Services to comply with all federal requirements and to request any
29	29	amendment to the state Medical Assistance plan, waiver of Medicaid law, or other
30	30	federal approval necessary to qualify for the highest available enhanced federal
31	31	medical assistance percentage for childless adults under the BadgerCare Plus
32	32	program.
33	33	Under current law, certain parents and caretaker relatives with incomes of not
34	34	more than 100 percent of the federal poverty line, before a 5 percent income disregard
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42	42	is applied, are eligible for BadgerCare Plus benefits. Under current law, childless
43	43	adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent
44	44	of the federal poverty line, before a 5 percent income disregard is applied; and 3) are
45	45	not otherwise eligible for Medical Assistance, including BadgerCare Plus, are
46	46	eligible for benefits under BadgerCare Plus Core. The bill eliminates the childless
47	47	adults demonstration project, known as BadgerCare Plus Core, as a separate
48	48	program as of October 1, 2023.
49	49	2017 Wisconsin Act 370 requires by statute that DHS implement the
50	50	BadgerCare Reform waiver as it relates to childless adults as approved by the federal
51	51	Department of Health and Human Services effective October 31, 2018. The 2015-17
52	52	and 2017-19 biennial budget acts required DHS to submit a waiver request to the
53	53	federal Department of Health and Human Services authorizing DHS to take certain
54	54	actions, including imposing premiums on, requiring a health risk assessment of, and
55	55	limiting the time of eligibility for recipients of BadgerCare Plus under the childless
56	56	adults demonstration project waiver. Act 370 required DHS to implement the
57	57	childless adults BadgerCare Reform waiver by no later than November 1, 2019. If
58	58	the Joint Committee on Finance determines that DHS has not complied with the
59	59	implementation deadline, has not made sufficient progress in implementing the
60	60	BadgerCare Reform waiver, or has not complied with other requirements relating to
61	61	approved waiver implementation, Act 370 allows JCF to reduce from moneys
62	62	allocated for state operations or administrative functions DHS's appropriation or
63	63	expenditure authority, whichever is applicable, or change the authorized level of
64	64	full-time equivalent positions for DHS related to the Medical Assistance program.
65	65	The bill eliminates the statutory implementation requirement for the BadgerCare
66	66	Reform waiver, including the deadline and penalties, eliminates the statutory
67	67	requirement for DHS to seek the waiver, and allows DHS to modify or withdraw the
68	68	waiver.
69	69	For further information see the state fiscal estimate, which will be printed as
70	70	an appendix to this bill.
71	71	The people of the state of Wisconsin, represented in senate and assembly, do
72	72	enact as follows:
73	73	SECTION 1. 20.435 (4) (jw) of the statutes, as affected by 2023 Wisconsin Act 30,
74	74	is amended to read:
75	75	20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received
76	76	from payment of enrollment fees under the program under s. 49.45 (23), all moneys
77	77	transferred under s. 50.38 (9), all moneys transferred under s. 256.23 (6), all moneys
78	78	transferred from the appropriation account under par. (jz), and 10 percent of all
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87	87	SECTION 1
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89	89	moneys received from penalty assessments under s. 49.471 (9) (c), for administration
90	90	of the program under s. 49.45 (23), to provide a portion of the state share of
91	91	administrative costs for the BadgerCare Plus Medical Assistance program under s.
92	92	49.471, for administration of the hospital assessment under s. 50.38, and for
93	93	administration of the ambulance service provider fee under s. 256.23.
94	94	SECTION 2. 49.45 (2p) of the statutes is repealed.
95	95	SECTION 3. 49.45 (23) of the statutes is repealed.
96	96	SECTION 4. 49.45 (23b) of the statutes is repealed.
97	97	SECTION 5. 49.471 (1) (cr) of the statutes is created to read:
98	98	49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
99	99	federal medical assistance percentage described under 42 USC 1396d (y) or (z).
100	100	SECTION 6. 49.471 (4) (a) 4. b. of the statutes is amended to read:
101	101	49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
102	102	percent of the poverty line before application of the 5 percent income disregard under
103	103	42 CFR 435.603 (d).
104	104	SECTION 7. 49.471 (4) (a) 8. of the statutes is created to read:
105	105	49.471 (4) (a) 8. An individual who meets all of the following criteria:
106	106	a. The individual is an adult under the age of 65.
107	107	b. The adult has a family income that does not exceed 133 percent of the poverty
108	108	line, except as provided in sub. (4g).
109	109	c. The adult is not otherwise eligible for the Medical Assistance program under
110	110	this subchapter or the Medicare program under 42 USC 1395 et seq.
111	111	SECTION 8. 49.471 (4g) of the statutes is created to read:
112	112	49.471 (4g) MEDICAID EXPANSION; FEDERAL MEDICAL ASSISTANCE PERCENTAGE. For
113	113	services provided to individuals described under sub. (4) (a) 8., the department shall
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140	140	SECTION 8 ASSEMBLY BILL 745
141	141	comply with all federal requirements to qualify for the highest available enhanced
142	142	federal medical assistance percentage. The department shall submit any
143	143	amendment to the state medical assistance plan, request for a waiver of federal
144	144	Medicaid law, or other approval request required by the federal government to
145	145	provide services to the individuals described under sub. (4) (a) 8. and qualify for the
146	146	highest available enhanced federal medical assistance percentage. Sections 20.940
147	147	and 49.45 (2t) do not apply to a submission to the federal government under this
148	148	subsection.
149	149	SECTION 9. 49.686 (3) (d) of the statutes is amended to read:
150	150	49.686 (3) (d) Has applied for coverage under and has been denied eligibility
151	151	for medical assistance within 12 months prior to application for reimbursement
152	152	under sub. (2). This paragraph does not apply to an individual who is eligible for
153	153	benefits under the demonstration project for childless adults under s. 49.45 (23) or
154	154	to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471
155	155	(4) (a) 8. or (11).
156	156	SECTION 10. 2017 Wisconsin Act 370, section 44 (2) and (3) are repealed.
157	157	SECTION 11.0Nonstatutory provisions.
158	158	(1) CHILDLESS ADULTS DEMONSTRATION PROJECT. The department of health
159	159	services shall submit any necessary request to the federal department of health and
160	160	human services for a state plan amendment or waiver of federal Medicaid law or to
161	161	modify or withdraw from any waiver of federal Medicaid law relating to the childless
162	162	adults demonstration project under s. 49.45 (23), 2021 stats., to reflect the
163	163	incorporation of recipients of Medical Assistance under the demonstration project
164	164	into the BadgerCare Plus program under s. 49.471 and the termination of the
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191	191	SECTION 11
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193	193	demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a request under
194	194	this subsection.
195	195	SECTION 12.0Fiscal changes.
196	196	(1) MEDICAID EXPANSION. In the schedule under s. 20.005 (3) for the
197	197	appropriation to the department of health services under s. 20.435 (4) (b), the dollar
198	198	amount for fiscal year 2023-24 is decreased by $250,000,000 as a result of expanding
199	199	eligibility for the Medical Assistance program. In the schedule under s. 20.005 (3)
200	200	for the appropriation to the department of health services under s. 20.435 (4) (b), the
201	201	dollar amount for fiscal year 2024-25 is decreased by $230,000,000 as a result of
202	202	expanding eligibility for the Medical Assistance program.
203	203	(2) FEDERAL MEDICAL ASSISTANCE PERCENTAGE INCENTIVE LAPSE. Notwithstanding
204	204	s. 20.001 (3) (b), on July 1, 2025, there is lapsed to the general fund $1,020,000,000
205	205	from the appropriation account of the department of health services under s. 20.435
206	206	(4) (b).
207	207	(3) INCOME MAINTENANCE. In the schedule under s. 20.005 (3) for the
208	208	appropriation to the department of health services under s. 20.435 (4) (bn), the dollar
209	209	amount for fiscal year 2023-24 is increased by $340,500 and the dollar amount for
210	210	fiscal year 2024-25 is increased by $342,200.
211	211	SECTION 13.0Effective dates. This act takes effect on the day after publication,
212	212	except as follows:
213	213	(1) MEDICAID EXPANSION. The treatment of ss. 20.435 (4) (jw), 49.45 (23) and
214	214	(23b), 49.471 (1) (cr), (4) (a) 4. b. and 8., and (4g), and 49.686 (3) (d) and 2017
215	215	Wisconsin Act 370, section 44 (2) and (3) and SECTION 11 (1) of this act take effect
216	216	retroactively to October 1, 2023.
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