2015 - 2016 LEGISLATURE
March 5, 2015 - Introduced by Senators Erpenbach, Carpenter, Hansen,
Dodd, C. Larson, Lassa, Miller, Ringhand and Vinehout, cosponsored by
Representatives Riemer, Kolste, Hebl, Barca, Barnes, Berceau, Billings,
Bowen, Brostoff, Considine, Danou, Doyle, Genrich, Goyke, Hesselbein,
Hintz, Johnson, Jorgensen, Kahl, Kessler, Mason, Meyers, Milroy,
Ohnstad, Pope, Sargent, Shankland, Sinicki, Spreitzer, Stuck, Subeck, C.
Taylor, Wachs, Young, Zamarripa and Zepnick. Referred to Committee on
Health and Human Services.
1An Act to create
49.4713 of the statutes; relating to: premium and
2cost-sharing assistance for health plans through the Medical Assistance
Analysis by the Legislative Reference Bureau
Currently, the Department of Health Services (DHS) administers the Medical
Assistance (MA) program, which is a joint federal and state program that provides
health services to individuals who have limited financial resources. Some MA
services are provided through programs that operate under a waiver of federal
Medicaid laws, including services provided through the BadgerCare Plus (BC+) and
BadgerCare Plus Core (BC+ Core) programs. Certain parents and caretaker
relatives and certain childless adults with incomes of not more than 100 percent of
the federal poverty line (FPL), before a 5 percent income disregard is applied, are
currently eligible for BC + or BC+ Core benefits.
The federal Patient Protection and Affordable Care Act (ACA) creates
American health benefit exchanges through which individuals purchase coverage
under a qualified health plan, which is health insurance that meets certain criteria
under the ACA. Generally, under the ACA, individuals with household incomes
between 100 and 400 percent of the FPL who purchase certain qualified health plans
through the American health benefit exchanges (exchanges) qualify for income tax
credits to subsidize some of the cost of purchasing the qualified health plan.
Qualified health plans may require cost-sharing, such as deductibles or copayments,
and the ACA provides certain individuals who purchase specific plans through an
exchange with reductions in cost-sharing. The ACA also provides financial
assistance through an enhanced federal medical assistance percentage (FMAP) to
states that expand their Medicaid programs. The enhanced FMAP under the ACA
applies to certain newly eligible individuals whose family income level is up to 133
percent of the FPL.
This bill requires DHS to create a premium assistance program to pay
premiums and any cost-sharing amounts to assist eligible parents or caretaker
relatives and eligible childless adults in purchasing coverage through a qualified
health plan offered through an American health benefit exchange. Eligible parents
or caretaker relatives and eligible childless adults are those who would otherwise be
eligible for BC+ or BC+ Core except that their family income exceeds the eligibility
requirements for BC+ or BC+ Core but does not exceed 133 percent of the FPL. The
bill also requires that DHS ensure that individuals who become eligible for BC+ or
BC+ Core while having coverage under a qualified health plan that is offered by an
insurer that also offers a managed care plan for the MA program are allowed to
transition from the qualified health plan to the managed care plan. DHS must also
ensure that eligible parents, caretaker relatives, and childless adults are allowed to
enroll in qualified health plans throughout the year and not solely during open
enrollment periods determined by the federal government.
DHS is required to submit a request for any necessary approval to the federal
government to implement the premium assistance program and to qualify for the
highest available enhanced FMAP for eligible childless adults, parents, and
caretaker relatives in the premium assistance program, childless adults eligible for
BC+ Core, and, if considered newly eligible under the ACA, parents and caretaker
relatives eligible for BC+. If DHS does not receive federal approval for the premium
assistance program or does not qualify, or ceases to qualify, for an enhanced FMAP,
DHS must submit a cost analysis to the Joint Committee on Finance (JCF). If JCF
approves of eliminating the premium assistance program, DHS is not required to
implement the premium assistance program.
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:
49.4713 of the statutes is created to read:
249.4713 Premium assistance program.
(a) "Eligible 3
childless adult" means an individual who is eligible under s. 49.45 (23) (a) except that 4
his or her family income exceeds the income level described in s. 49.45 (23) (a) but 5
does not exceed 133 percent of the poverty line.
(b) "Eligible parent or caretaker" means an individual who satisfies the criteria 2
in s. 49.471 (4) (a) 4. a. and whose family income exceeds the income level described 3
in s. 49.471 (4) (a) 4. b. but does not exceed 133 percent of the poverty line.
(c) "Enhanced federal medical assistance percentage" means a federal medical 5
assistance percentage described under 42 USC 1396d
(y) or (z) on January 1, 2015.
(d) "Qualified health plan" means a plan defined in 42 USC 18021
(a) that is 7
offered through any American health benefit exchange, as described in 42 USC
, that is operating in the state.
9(2) Premium and cost-sharing assistance; managed care plans.
(a) The 10
department shall establish a premium assistance program to pay premiums and any 11
cost-sharing amounts from moneys allocated for the Medical Assistance program for 12
any eligible childless adult and any eligible parent or caretaker to purchase coverage 13
under a qualified health plan.
(b) The department, and the office of the commissioner of insurance if 15
necessary, shall ensure that an individual who becomes eligible for a program under 16
s. 49.45 (23) or s. 49.471 while having coverage under a qualified health plan that 17
is offered by an insurer that also offers a managed care plan for the Medical 18
Assistance program may transition from the qualified health plan to the managed 19
(c) The department, and the office of the commissioner of insurance if 21
necessary, shall ensure that eligible childless adults and eligible parents and 22
caretakers are allowed to enroll in qualified health plans throughout the year and 23
not solely during an open enrollment period determined by the federal government.
24(3) Federal approval.
(a) The department shall submit any amendment to the 25
state medical assistance plan, request for a waiver of federal Medicaid law, or other
request for other approval required by the federal government to implement the 2
premium assistance program under sub. (2) and to qualify for the highest available 3
enhanced federal medical assistance percentage for eligible childless adults and 4
eligible parents and caretakers under this section, for individuals described under 5
s. 49.45 (23) (a), and for any individuals described under s. 49.471 (4) (a) 4. that are 6
considered newly eligible under 42 USC 1396d
(y) (2) (A).
(b) If the department does not receive federal approval for a premium 8
assistance program substantially similar to sub. (2) or does not qualify, or ceases to 9
qualify, for an enhanced federal medical assistance percentage requested under par. 10
(a), the department shall submit to the joint committee on finance a fiscal analysis 11
comparing the cost of the premium assistance program to only providing benefits 12
under s. 49.45 (23) and s. 49.471. If the joint committee on finance approves of 13
eliminating the premium assistance program, the department is not required to 14
implement the premium assistance program under sub. (2).