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LRBs0033/1
TJD:amn&ahe
2019 - 2020 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 76
May 15, 2019 - Offered by Representatives Anderson, Billings, Bowen, Brostoff,
Cabrera, Considine, Crowley, Doyle, Emerson, Fields, Goyke, Gruszynski,
Haywood, Hebl, Hesselbein, Hintz, Kolste, McGuire, B. Meyers, Milroy, L.
Myers
, Neubauer, Ohnstad, Pope, Riemer, Sargent, Shankland, Sinicki,
Spreitzer, Stubbs, Stuck, Subeck, C. Taylor, Vining, Vruwink and
Zamarripa.
AB76-ASA1,1,6 1An Act to repeal 49.45 (2p) and 49.45 (23); to amend 20.435 (4) (jw), 49.45 (23b)
2(title), 49.45 (23b) (b), 49.45 (23b) (c), 49.45 (23b) (e), 49.471 (4) (a) 4. b. and
349.686 (3) (d); and to create 49.471 (1) (cr), 49.471 (4) (a) 8. and 49.471 (4g) of
4the statutes; relating to: eligibility expansion under the Medical Assistance
5program, increasing reimbursement rates for certain direct care workers, and
6making an appropriation.
Analysis by the Legislative Reference Bureau
This bill implements the Medicaid expansion and increases reimbursement
rates under the Medical Assistance program for certain direct care workers.
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 this bill. 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. 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.
This bill requires DHS to increase the rates paid for direct care to nursing
homes, also known as nursing facilities, and intermediate care facilities for persons
with an intellectual disability. A portion of the increase is related to an increase in
patient acuity in those facilities and an additional increase is designated to support
staff in those facilities who perform direct care. This bill also requires DHS to
increase the rates paid for direct care to agencies that provide personal care services.
A 1.5 percent increase per year is designated to support staff in those agencies who
perform direct care.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB76-ASA1,1 1Section 1 . 20.435 (4) (jw) of the statutes is amended to read:
AB76-ASA1,2,92 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received
3from payment of enrollment fees under the program under s. 49.45 (23), all
moneys
4transferred under s. 50.38 (9), all moneys transferred from the appropriation account
5under par. (jz), and 10 percent of all moneys received from penalty assessments
6under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to
7provide a portion of the state share of administrative costs for the BadgerCare Plus
8Medical Assistance program under s. 49.471, and for administration of the hospital
9assessment under s. 50.38.
AB76-ASA1,2 10Section 2. 49.45 (2p) of the statutes is repealed.
AB76-ASA1,3
1Section 3. 49.45 (23) of the statutes is repealed.
AB76-ASA1,4 2Section 4 . 49.45 (23b) (title) of the statutes is amended to read:
AB76-ASA1,3,43 49.45 (23b) (title) Childless adults demonstration project reform waiver
4implementation required.
AB76-ASA1,5 5Section 5. 49.45 (23b) (b) of the statutes is amended to read:
AB76-ASA1,3,96 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and
7ending no sooner than December 31, 2023, the department shall do all of the
8following with regard to the childless adults demonstration project under sub. (23)
9s. 49.471 (4) (a) 8.:
AB76-ASA1,3,1510 1. Require in each month persons, except exempt individuals, who are eligible
11to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least
1219 years of age but have not attained the age of 50 to participate in, document, and
13report 80 hours per calendar month of community engagement activities. The
14department, after finding good cause, may grant a temporary exemption from the
15requirement under this subdivision upon request of a Medical Assistance recipient.
AB76-ASA1,3,1816 2. Require persons with incomes of at least 50 percent of the poverty line to pay
17premiums in accordance with par. (c) as a condition of eligibility for Medical
18Assistance under sub. (23) s. 49.471 (4) (a) 8.
AB76-ASA1,3,2019 3. Require as a condition of eligibility for Medical Assistance under sub. (23)
20s. 49.471 (4) (a) 8. completion of a health risk assessment.
AB76-ASA1,3,2321 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
22an $8 copayment for nonemergency use of the emergency department in accordance
23with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.
AB76-ASA1,4,324 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6
25months any individual who does not pay a required premium under subd. 2. and any

1individual who is required under subd. 1. to participate in a community engagement
2activity but who does not participate for 48 aggregate months in the community
3engagement activity.
AB76-ASA1,6 4Section 6. 49.45 (23b) (c) of the statutes is amended to read:
AB76-ASA1,4,105 49.45 (23b) (c) 1. Persons who are eligible for the demonstration project under
6sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds
750 percent of the poverty line shall pay a monthly premium amount of $8 per
8household. A person who is eligible to receive an item or service furnished by an
9Indian health care provider is exempt from the premium requirement under this
10subdivision.
AB76-ASA1,4,1611 2. The department may disenroll under par. (b) 5. a person for nonpayment of
12a required monthly premium only at annual eligibility redetermination after
13providing notice and reasonable opportunity for the person to pay. If a person who
14is disenrolled for nonpayment of premiums pays all owed premiums or becomes
15exempt from payment of premiums, he or she may reenroll in Medical Assistance
16under sub. (23) s. 49.471 (4) (a) 8.
AB76-ASA1,4,2017 3. The department shall reduce the amount of the required household premium
18by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
19who does not engage in certain behaviors that increase health risks or who attests
20to actively managing certain unhealthy behaviors.
AB76-ASA1,7 21Section 7 . 49.45 (23b) (e) of the statutes is amended to read:
AB76-ASA1,5,222 49.45 (23b) (e) Before December 31, 2023, the demonstration project
23requirements under this subsection may not be withdrawn and the department may
24not request from the federal government withdrawal, suspension, or termination of

1the demonstration project requirements under this subsection unless legislation has
2been enacted specifically allowing for the withdrawal, suspension, or termination.
AB76-ASA1,8 3Section 8 . 49.471 (1) (cr) of the statutes is created to read:
AB76-ASA1,5,54 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
5federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB76-ASA1,9 6Section 9 . 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB76-ASA1,5,97 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
8percent of the poverty line before application of the 5 percent income disregard under
942 CFR 435.603 (d)
.
AB76-ASA1,10 10Section 10 . 49.471 (4) (a) 8. of the statutes is created to read:
AB76-ASA1,5,1111 49.471 (4) (a) 8. An individual who meets all of the following criteria:
AB76-ASA1,5,1212 a. The individual is an adult under the age of 65.
AB76-ASA1,5,1413 b. The adult has a family income that does not exceed 133 percent of the poverty
14line, except as provided in sub. (4g).
AB76-ASA1,5,1615 c. The adult is not otherwise eligible for the Medical Assistance program under
16this subchapter or the Medicare program under 42 USC 1395 et seq.
AB76-ASA1,11 17Section 11 . 49.471 (4g) of the statutes is created to read:
AB76-ASA1,6,218 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
19services provided to individuals described under sub. (4) (a) 8., the department shall
20comply with all federal requirements to qualify for the highest available enhanced
21federal medical assistance percentage. The department shall submit any
22amendment to the state medical assistance plan, request for a waiver of federal
23Medicaid law, or other approval request required by the federal government to
24provide services to the individuals described under sub. (4) (a) 8. and qualify for the
25highest available enhanced federal medical assistance percentage. Sections 20.940

1and 49.45 (2t) do not apply to a submission to the federal government under this
2subsection.
AB76-ASA1,12 3Section 12 . 49.686 (3) (d) of the statutes is amended to read:
AB76-ASA1,6,94 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
5for medical assistance within 12 months prior to application for reimbursement
6under sub. (2). This paragraph does not apply to an individual who is eligible for
7benefits under the demonstration project for childless adults under s. 49.45 (23)
8BadgerCare Plus under s. 49.471 (4) (a) 8. or to an individual who is eligible for
9benefits under BadgerCare Plus under s. 49.471 (11).
AB76-ASA1,9119 10Section 9119. Nonstatutory provisions; Health Services.
AB76-ASA1,6,1611 (1) Medical Assistance reimbursement rate increase for direct care. The
12department of health services shall increase the Medical Assistance rates paid for
13direct care to nursing facilities and intermediate care facilities for persons with an
14intellectual disability with a 1 percent annual rate increase related to an increase
15in acuity of patients in those facilities and an additional 1.5 percent annual rate
16increase to support staff in those facilities who perform direct care.
AB76-ASA1,6,2117 (2) Medical Assistance reimbursement rate increase for direct care in
18personal care agencies.
The department of health services shall increase the
19Medical Assistance rates paid for direct care to agencies that provide personal care
20services by 1.5 percent annually to support staff in those agencies who perform direct
21care.
AB76-ASA1,7,522 (3) Childless adults demonstration project. The department of health
23services shall submit any necessary request to the federal department of health and
24human services for a state plan amendment or waiver of federal Medicaid law or to
25modify or withdraw from any waiver of federal Medicaid law relating to the childless

1adults demonstration project under s. 49.45 (23), 2017 stats., to reflect the
2incorporation of recipients of Medical Assistance under the demonstration project
3into the BadgerCare Plus program under s. 49.471 and the termination of the
4demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission
5to the federal government under this subsection.
AB76-ASA1,9219 6Section 9219. Fiscal changes; Health Services.
AB76-ASA1,7,147 (1) Medicaid expansion. In the schedule under s. 20.005 (3) for the
8appropriation to the department of health services under s. 20.435 (4) (b), the dollar
9amount for fiscal year 2019-20 is decreased by $159,473,300 to expand eligibility
10under the Medical Assistance program under s. 49.471 (4) (a) 4. and 8. In the
11schedule under s. 20.005 (3) for the appropriation to the department of health
12services under s. 20.435 (4) (b), the dollar amount for fiscal year 2020-21 is decreased
13by $165,011,600 to expand eligibility under the Medical Assistance program under
14s. 49.471 (4) (a) 4. and 8.
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