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2023 - 2024 LEGISLATURE
2023 ASSEMBLY BILL 746
December 6, 2023 - Introduced by Representatives SHELTON, MOORE OMOKUNDE,
ANDRACA, BARE, BILLINGS, C. ANDERSON, J. ANDERSON, CLANCY, CONLEY,
CONSIDINE, DOYLE, DRAKE, EMERSON, HONG, JACOBSON, JOERS, MADISON,
NEUBAUER, OHNSTAD, ORTIZ-VELEZ, PALMERI, RATCLIFF, RIEMER, SINICKI,
SNODGRASS, STUBBS, SUBECK and HAYWOOD, cosponsored by Senators L.
JOHNSON, LARSON, AGARD, CARPENTER, HESSELBEIN, ROYS, SMITH, TAYLOR,
SPREITZER and WIRCH. Referred to Committee on Insurance.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to create 49.45 (59m), 49.471 (4m) and 601.59 of the statutes; relating
to: BadgerCare purchase option, basic plan, state-based insurance exchange,
and granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health Services to request federal
approval to permit certain individuals whose income is greater than the income
eligibility limit for the BadgerCare program, but who otherwise meet the eligibility
requirements, to purchase coverage through BadgerCare through a separate
purchase option that meets criteria specified in the bill, including having a premium
rate similar to the average rate paid by the state to managed care plan contractors
and a minimum actuarial value of 87 percent. The bill also requires DHS to include
an option for small groups of 50 employees or fewer to purchase coverage for group
members under the purchase program under the bill. The bill requires DHS to
submit a report providing information on the status of receiving a federal waiver and
the results from actuarial and economic analyses that are necessary for a waiver
proposal. If any necessary waiver or state plan amendments are approved, DHS
must implement the program. The bill also requires DHS to seek any federal waiver
and state Medical Assistance plan amendments necessary to allow qualified
individuals who choose to purchase the BadgerCare option to use advanced tax
credits and cost-sharing credits, if eligible, to purchase one of these options.
Currently, DHS administers the Medical Assistance program, which is a joint
federal and state program that provides health services to individuals who have
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ASSEMBLY BILL 746
limited financial resources. Some services are provided through programs that
operate under a waiver of federal Medicaid laws, including services provided through
the BadgerCare 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 benefits. Under
current law, childless adults who 1) are under age 65; 2) have family incomes that
do not exceed 100 percent of the FPL, before a 5 percent income disregard is applied;
and 3) are not otherwise eligible for Medical Assistance are eligible, under a
demonstration project, for BadgerCare benefits.
The bill requires DHS to develop a plan and request federal approval to create
a basic health plan that complies with the federal Patient Protection and Affordable
Care Act. The basic health plan must cover individuals whose household income
does not exceed 200 percent of the federal poverty line. The ACA allows states to
create such a basic health program.
This bill directs the Office of the Commissioner of Insurance to establish and
operate a state-based health insurance exchange, which must also include access to
the ability to enroll in the purchase option for BadgerCare. Under current law, the
ACA requires that an exchange be established in each state to facilitate the purchase
of qualified health insurance coverage by individuals and small employers. Under
the ACA, a state must operate its own state-based exchange, use the federally
facilitated exchange operated by the U.S. Department of Health and Human
Services, or adopt a hybrid approach under which the state operates a state-based
exchange but uses the federal platform, known as HealthCare.gov, to handle
eligibility and enrollment functions. Wisconsin currently uses the federally
facilitated exchange. The bill authorizes OCI to enter into any agreement with the
federal government necessary to implement the state-based exchange provisions.
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. 49.45 (59m) of the statutes is created to read:
49.45 (59m) BASIC HEALTH PLAN. The department shall develop a plan and
request a waiver, state plan amendment, or other federal approval to create a basic
health plan that complies with 42 USC 18051. A basic health plan under this
subsection shall provide coverage for individuals whose household income does not
exceed 200 percent of the poverty line.
SECTION 2. 49.471 (4m) of the statutes is created to read:
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SECTION 2
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49.471 (4m) PURCHASE OPTIONS FOR BADGERCARE. (a) 1. The department shall
request from the secretary of the federal department of health and human services
any necessary waiver or amendment to the state Medical Assistance plan to
establish a program that allows individuals with income above the maximum income
eligibility limit applicable under this section or under s. 49.45 (23), and who
otherwise meet the eligibility requirements under this section or under s. 49.45 (23),
the option of purchasing coverage through this section or through the demonstration
project under s. 49.45 (23) instead of purchasing an individual health plan through
private insurance.
2. The department shall also seek any federal waiver and state Medical
Assistance plan amendments necessary to allow individuals who qualify under subd.
1. to use advanced tax credits and cost-sharing credits, if eligible, to purchase one
of the options described under subd. 1.
(b) 1. The department shall coordinate the administration of the purchase
options under this subsection with the programs under this section and s. 49.45 (23)
to maximize efficiency and improve the continuity of care, consistent with the
requirements of this section and s. 49.45 (23). The department shall seek to
implement mechanisms to ensure the long-term financial sustainability of the
programs under this section and s. 49.45 (23). These mechanisms must address
issues related to minimizing adverse selection, the state financial risk and
contribution, and negative impacts to premiums in the individual and group
insurance markets.
2. The purchase option program shall include, at a minimum, all of the
following attributes:
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SECTION 2 ASSEMBLY BILL 746
a. Establishment of an annual per enrollee premium rate similar to the average
rate paid by the state to managed care plan contractors.
b. Establishment of a benefit set equal to the benefits covered under this section
and s. 49.45 (23).
c. Annual enrollment that is limited to the same annual open enrollment
periods established for the programs under this section and s. 49.45 (23).
d. The ability for the department to adjust the purchase option's actuarial value
to a value no lower than 87 percent.
e. Reimbursement mechanisms for addressing potential increased costs to the
programs under this section and s. 49.45 (23).
(c) By March 1, 2025, the department of health services shall submit to the
appropriate standing committee in each house of the legislature under s. 13.172 (3)
a report that provides information on the status of the request for a federal waiver
and the results from actuarial and economic analyses that are necessary for a waiver
proposal.
(d) The department shall include, in collaboration with the commissioner of
insurance if necessary, an option for small groups of 50 employees or fewer to
purchase coverage for group members under the program under this subsection.
(e) If any necessary waiver or amendments to the state plan described under
par. (a) 1. are approved, the department shall implement the program. If the
department is authorized to implement the program, and if any waiver or state plan
amendment described under par. (a) 2. is necessary and is approved, or if the
department determines neither a waiver nor state plan amendment is necessary, the
department shall allow the purchase options described under par. (a) 2.
SECTION 3. 601.59 of the statutes is created to read:
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SECTION 3
ASSEMBLY BILL 746
601.59 State-based exchange. (1) DEFINITIONS. In this section:
(a) “Exchange” has the meaning given in 45 CFR 155.20.
(b) “State-based exchange” means an exchange that is described in and meets
the requirements of 45 CFR 155.200 (f) and is approved by the federal secretary of
health and human services under 45 CFR 155.106.
(2) ESTABLISHMENT AND OPERATION OF STATE-BASED EXCHANGE. The commissioner
shall develop a plan to establish and operate a state-based exchange. The
commissioner, in collaboration, as necessary, with the department of health services,
shall ensure that individuals may access the ability to enroll in the purchase option
program under s. 49.471 (4m) through the state-based exchange.
(3) AGREEMENT WITH FEDERAL GOVERNMENT. The commissioner may enter into
any agreement with the federal government necessary to facilitate the
implementation of this section.
(4) RULES. The commissioner may promulgate rules necessary to implement
this section.
(END)
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