LRB-3728/1
SWB:emw/amn/cjs
2023 - 2024 LEGISLATURE
2023 ASSEMBLY BILL 745
December 6, 2023 - Introduced 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, SUBECK and HAYWOOD, cosponsored by Senators
HESSELBEIN, SMITH, AGARD, CARPENTER, L. JOHNSON, LARSON, PFAFF, ROYS,
SPREITZER, TAYLOR and WIRCH. Referred to Committee on Health, Aging and
Long-Term Care.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to repeal 49.45 (2p), 49.45 (23) and 49.45 (23b); to amend 20.435 (4) (jw),
49.471 (4) (a) 4. b. and 49.686 (3) (d); to create 49.471 (1) (cr), 49.471 (4) (a) 8.
and 49.471 (4g) of the statutes; and to affect 2017 Wisconsin Act 370, section
44 (2) and (3); relating to: expanding eligibility for the Medical Assistance
program 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
1
2
3
4
5 - 2 -2023 - 2024 Legislature LRB-3728/1
SWB:emw/amn/cjs
ASSEMBLY BILL 745
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:
SECTION 1. 20.435 (4) (jw) of the statutes, as affected by 2023 Wisconsin Act 30,
is amended to read:
20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received
from payment of enrollment fees under the program under s. 49.45 (23), all moneys
transferred under s. 50.38 (9), all moneys transferred under s. 256.23 (6), all moneys
transferred from the appropriation account under par. (jz), and 10 percent of all
1
2
3
4
5
6 - 3 -2023 - 2024 Legislature
LRB-3728/1
SWB:emw/amn/cjs
SECTION 1
ASSEMBLY BILL 745
moneys received from penalty assessments under s. 49.471 (9) (c), for administration
of the program under s. 49.45 (23), to provide a portion of the state share of
administrative costs for the BadgerCare Plus Medical Assistance program under s.
49.471, for administration of the hospital assessment under s. 50.38, and for
administration of the ambulance service provider fee under s. 256.23.
SECTION 2. 49.45 (2p) of the statutes is repealed.
SECTION 3. 49.45 (23) of the statutes is repealed.
SECTION 4. 49.45 (23b) of the statutes is repealed.
SECTION 5. 49.471 (1) (cr) of the statutes is created to read:
49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
federal medical assistance percentage described under 42 USC 1396d (y) or (z).
SECTION 6. 49.471 (4) (a) 4. b. of the statutes is amended to read:
49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
percent of the poverty line before application of the 5 percent income disregard under
42 CFR 435.603 (d).
SECTION 7. 49.471 (4) (a) 8. of the statutes is created to read:
49.471 (4) (a) 8. An individual who meets all of the following criteria:
a. The individual is an adult under the age of 65.
b. The adult has a family income that does not exceed 133 percent of the poverty
line, except as provided in sub. (4g).
c. The adult is not otherwise eligible for the Medical Assistance program under
this subchapter or the Medicare program under 42 USC 1395 et seq.
SECTION 8. 49.471 (4g) of the statutes is created to read:
49.471 (4g) MEDICAID EXPANSION; FEDERAL MEDICAL ASSISTANCE PERCENTAGE. For
services provided to individuals described under sub. (4) (a) 8., the department shall
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 - 4 -2023 - 2024 Legislature LRB-3728/1
SWB:emw/amn/cjs
SECTION 8 ASSEMBLY BILL 745
comply with all federal requirements to qualify for the highest available enhanced
federal medical assistance percentage. The department shall submit any
amendment to the state medical assistance plan, request for a waiver of federal
Medicaid law, or other approval request required by the federal government to
provide services to the individuals described under sub. (4) (a) 8. and qualify for the
highest available enhanced federal medical assistance percentage. Sections 20.940
and 49.45 (2t) do not apply to a submission to the federal government under this
subsection.
SECTION 9. 49.686 (3) (d) of the statutes is amended to read:
49.686 (3) (d) Has applied for coverage under and has been denied eligibility
for medical assistance within 12 months prior to application for reimbursement
under sub. (2). This paragraph does not apply to an individual who is eligible for
benefits under the demonstration project for childless adults under s. 49.45 (23) or
to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471
(4) (a) 8. or (11).
SECTION 10. 2017 Wisconsin Act 370, section 44 (2) and (3) are repealed.
SECTION 11.0Nonstatutory provisions.
(1) CHILDLESS ADULTS DEMONSTRATION PROJECT. The department of health
services shall submit any necessary request to the federal department of health and
human services for a state plan amendment or waiver of federal Medicaid law or to
modify or withdraw from any waiver of federal Medicaid law relating to the childless
adults demonstration project under s. 49.45 (23), 2021 stats., to reflect the
incorporation of recipients of Medical Assistance under the demonstration project
into the BadgerCare Plus program under s. 49.471 and the termination of the
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24 - 5 -2023 - 2024 Legislature
LRB-3728/1
SWB:emw/amn/cjs
SECTION 11
ASSEMBLY BILL 745
demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a request under
this subsection.
SECTION 12.0Fiscal changes.
(1) MEDICAID EXPANSION. In the schedule under s. 20.005 (3) for the
appropriation to the department of health services under s. 20.435 (4) (b), the dollar
amount for fiscal year 2023-24 is decreased by $250,000,000 as a result of expanding
eligibility for the Medical Assistance program. In the schedule under s. 20.005 (3)
for the appropriation to the department of health services under s. 20.435 (4) (b), the
dollar amount for fiscal year 2024-25 is decreased by $230,000,000 as a result of
expanding eligibility for the Medical Assistance program.
(2) FEDERAL MEDICAL ASSISTANCE PERCENTAGE INCENTIVE LAPSE. Notwithstanding
s. 20.001 (3) (b), on July 1, 2025, there is lapsed to the general fund $1,020,000,000
from the appropriation account of the department of health services under s. 20.435
(4) (b).
(3) INCOME MAINTENANCE. In the schedule under s. 20.005 (3) for the
appropriation to the department of health services under s. 20.435 (4) (bn), the dollar
amount for fiscal year 2023-24 is increased by $340,500 and the dollar amount for
fiscal year 2024-25 is increased by $342,200.
SECTION 13.0Effective dates. This act takes effect on the day after publication,
except as follows:
(1) MEDICAID EXPANSION. The treatment of ss. 20.435 (4) (jw), 49.45 (23) and
(23b), 49.471 (1) (cr), (4) (a) 4. b. and 8., and (4g), and 49.686 (3) (d) and 2017
Wisconsin Act 370, section 44 (2) and (3) and SECTION 11 (1) of this act take effect
retroactively to October 1, 2023.
(END)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25