Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB746 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 746
5	5	December 6, 2023 - Introduced by Representatives SHELTON, MOORE OMOKUNDE,
6	6	ANDRACA, BARE, BILLINGS, C. ANDERSON, J. ANDERSON, CLANCY, CONLEY,
7	7	CONSIDINE, DOYLE, DRAKE, EMERSON, HONG, JACOBSON, JOERS, MADISON,
8	8	NEUBAUER, OHNSTAD, ORTIZ-VELEZ, PALMERI, RATCLIFF, RIEMER, SINICKI,
9	9	SNODGRASS, STUBBS, SUBECK and HAYWOOD, cosponsored by Senators L.
10	10	JOHNSON, LARSON, AGARD, CARPENTER, HESSELBEIN, ROYS, SMITH, TAYLOR,
11	11	SPREITZER and WIRCH. Referred to Committee on Insurance.
12	12	*AUTHORS SUBJECT TO CHANGE*
13	13	AN ACT to create 49.45 (59m), 49.471 (4m) and 601.59 of the statutes; relating
14	14	to: BadgerCare purchase option, basic plan, state-based insurance exchange,
15	15	and granting rule-making authority.
16	16	Analysis by the Legislative Reference Bureau
17	17	This bill requires the Department of Health Services to request federal
18	18	approval to permit certain individuals whose income is greater than the income
19	19	eligibility limit for the BadgerCare program, but who otherwise meet the eligibility
20	20	requirements, to purchase coverage through BadgerCare through a separate
21	21	purchase option that meets criteria specified in the bill, including having a premium
22	22	rate similar to the average rate paid by the state to managed care plan contractors
23	23	and a minimum actuarial value of 87 percent. The bill also requires DHS to include
24	24	an option for small groups of 50 employees or fewer to purchase coverage for group
25	25	members under the purchase program under the bill. The bill requires DHS to
26	26	submit a report providing information on the status of receiving a federal waiver and
27	27	the results from actuarial and economic analyses that are necessary for a waiver
28	28	proposal. If any necessary waiver or state plan amendments are approved, DHS
29	29	must implement the program. The bill also requires DHS to seek any federal waiver
30	30	and state Medical Assistance plan amendments necessary to allow qualified
31	31	individuals who choose to purchase the BadgerCare option to use advanced tax
32	32	credits and cost-sharing credits, if eligible, to purchase one of these options.
33	33	Currently, DHS administers the Medical Assistance program, which is a joint
34	34	federal and state program that provides health services to individuals who have
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39	39	ASSEMBLY BILL 746
40	40	limited financial resources. Some services are provided through programs that
41	41	operate under a waiver of federal Medicaid laws, including services provided through
42	42	the BadgerCare program. Under current law, certain parents and caretaker
43	43	relatives with incomes of not more than 100 percent of the federal poverty line, before
44	44	a 5 percent income disregard is applied, are eligible for BadgerCare benefits. Under
45	45	current law, childless adults who 1) are under age 65; 2) have family incomes that
46	46	do not exceed 100 percent of the FPL, before a 5 percent income disregard is applied;
47	47	and 3) are not otherwise eligible for Medical Assistance are eligible, under a
48	48	demonstration project, for BadgerCare benefits.
49	49	The bill requires DHS to develop a plan and request federal approval to create
50	50	a basic health plan that complies with the federal Patient Protection and Affordable
51	51	Care Act. The basic health plan must cover individuals whose household income
52	52	does not exceed 200 percent of the federal poverty line. The ACA allows states to
53	53	create such a basic health program.
54	54	This bill directs the Office of the Commissioner of Insurance to establish and
55	55	operate a state-based health insurance exchange, which must also include access to
56	56	the ability to enroll in the purchase option for BadgerCare. Under current law, the
57	57	ACA requires that an exchange be established in each state to facilitate the purchase
58	58	of qualified health insurance coverage by individuals and small employers. Under
59	59	the ACA, a state must operate its own state-based exchange, use the federally
60	60	facilitated exchange operated by the U.S. Department of Health and Human
61	61	Services, or adopt a hybrid approach under which the state operates a state-based
62	62	exchange but uses the federal platform, known as HealthCare.gov, to handle
63	63	eligibility and enrollment functions. Wisconsin currently uses the federally
64	64	facilitated exchange. The bill authorizes OCI to enter into any agreement with the
65	65	federal government necessary to implement the state-based exchange provisions.
66	66	For further information see the state fiscal estimate, which will be printed as
67	67	an appendix to this bill.
68	68	The people of the state of Wisconsin, represented in senate and assembly, do
69	69	enact as follows:
70	70	SECTION 1. 49.45 (59m) of the statutes is created to read:
71	71	49.45 (59m) BASIC HEALTH PLAN. The department shall develop a plan and
72	72	request a waiver, state plan amendment, or other federal approval to create a basic
73	73	health plan that complies with 42 USC 18051. A basic health plan under this
74	74	subsection shall provide coverage for individuals whose household income does not
75	75	exceed 200 percent of the poverty line.
76	76	SECTION 2. 49.471 (4m) of the statutes is created to read:
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86	86	SECTION 2
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88	88	49.471 (4m) PURCHASE OPTIONS FOR BADGERCARE. (a) 1. The department shall
89	89	request from the secretary of the federal department of health and human services
90	90	any necessary waiver or amendment to the state Medical Assistance plan to
91	91	establish a program that allows individuals with income above the maximum income
92	92	eligibility limit applicable under this section or under s. 49.45 (23), and who
93	93	otherwise meet the eligibility requirements under this section or under s. 49.45 (23),
94	94	the option of purchasing coverage through this section or through the demonstration
95	95	project under s. 49.45 (23) instead of purchasing an individual health plan through
96	96	private insurance.
97	97	2. The department shall also seek any federal waiver and state Medical
98	98	Assistance plan amendments necessary to allow individuals who qualify under subd.
99	99	1. to use advanced tax credits and cost-sharing credits, if eligible, to purchase one
100	100	of the options described under subd. 1.
101	101	(b) 1. The department shall coordinate the administration of the purchase
102	102	options under this subsection with the programs under this section and s. 49.45 (23)
103	103	to maximize efficiency and improve the continuity of care, consistent with the
104	104	requirements of this section and s. 49.45 (23). The department shall seek to
105	105	implement mechanisms to ensure the long-term financial sustainability of the
106	106	programs under this section and s. 49.45 (23). These mechanisms must address
107	107	issues related to minimizing adverse selection, the state financial risk and
108	108	contribution, and negative impacts to premiums in the individual and group
109	109	insurance markets.
110	110	2. The purchase option program shall include, at a minimum, all of the
111	111	following attributes:
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137	137	SECTION 2 ASSEMBLY BILL 746
138	138	a. Establishment of an annual per enrollee premium rate similar to the average
139	139	rate paid by the state to managed care plan contractors.
140	140	b. Establishment of a benefit set equal to the benefits covered under this section
141	141	and s. 49.45 (23).
142	142	c. Annual enrollment that is limited to the same annual open enrollment
143	143	periods established for the programs under this section and s. 49.45 (23).
144	144	d. The ability for the department to adjust the purchase option's actuarial value
145	145	to a value no lower than 87 percent.
146	146	e. Reimbursement mechanisms for addressing potential increased costs to the
147	147	programs under this section and s. 49.45 (23).
148	148	(c) By March 1, 2025, the department of health services shall submit to the
149	149	appropriate standing committee in each house of the legislature under s. 13.172 (3)
150	150	a report that provides information on the status of the request for a federal waiver
151	151	and the results from actuarial and economic analyses that are necessary for a waiver
152	152	proposal.
153	153	(d) The department shall include, in collaboration with the commissioner of
154	154	insurance if necessary, an option for small groups of 50 employees or fewer to
155	155	purchase coverage for group members under the program under this subsection.
156	156	(e) If any necessary waiver or amendments to the state plan described under
157	157	par. (a) 1. are approved, the department shall implement the program. If the
158	158	department is authorized to implement the program, and if any waiver or state plan
159	159	amendment described under par. (a) 2. is necessary and is approved, or if the
160	160	department determines neither a waiver nor state plan amendment is necessary, the
161	161	department shall allow the purchase options described under par. (a) 2.
162	162	SECTION 3. 601.59 of the statutes is created to read:
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190	190	SECTION 3
191	191	ASSEMBLY BILL 746
192	192	601.59 State-based exchange. (1) DEFINITIONS. In this section:
193	193	(a) “Exchange” has the meaning given in 45 CFR 155.20.
194	194	(b) “State-based exchange” means an exchange that is described in and meets
195	195	the requirements of 45 CFR 155.200 (f) and is approved by the federal secretary of
196	196	health and human services under 45 CFR 155.106.
197	197	(2) ESTABLISHMENT AND OPERATION OF STATE-BASED EXCHANGE. The commissioner
198	198	shall develop a plan to establish and operate a state-based exchange. The
199	199	commissioner, in collaboration, as necessary, with the department of health services,
200	200	shall ensure that individuals may access the ability to enroll in the purchase option
201	201	program under s. 49.471 (4m) through the state-based exchange.
202	202	(3) AGREEMENT WITH FEDERAL GOVERNMENT. The commissioner may enter into
203	203	any agreement with the federal government necessary to facilitate the
204	204	implementation of this section.
205	205	(4) RULES. The commissioner may promulgate rules necessary to implement
206	206	this section.
207	207	(END)
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