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2019 - 2020 LEGISLATURE
June 26, 2019 - Offered by Senator Larson.
AB56-SA13,1,21 At the locations indicated, amend the bill, as shown by assembly substitute
2amendment 1, as follows:
AB56-SA13,1,3 31. At the appropriate places, insert all of the following:
AB56-SA13,1,4 4 Section 1. 49.471 (4m) of the statutes is created to read:
AB56-SA13,2,55 49.471 (4m) Purchase options for BadgerCare Plus and the assistance for
6childless adults demonstration project.
(a) 1. The department shall, if required,
7request a waiver from or submit amendments to the state Medical Assistance plan
8to the secretary of the federal department of health and human services to establish
9a program that allows individuals with income above the maximum income
10eligibility limit applicable under this section or the assistance for childless adults
11demonstration project under s. 49.45 (23), and who otherwise meet the eligibility
12requirements under this section or under s. 49.45 (23), the option of purchasing
13coverage through this section or through the demonstration project under s. 49.45

1(23) instead of purchasing an individual health plan through private insurance. The
2department shall also include a request for any federal waiver or state Medical
3Assistance plan amendments necessary to allow an option for small businesses to
4purchase coverage for their employees under this section as part of the small
5business health options program through an exchange under 42 USC 18031.
AB56-SA13,2,96 2. The department shall seek any federal waiver and state Medical Assistance
7plan amendments necessary to allow individuals who qualify under subd. 1. to use
8advanced tax credits and cost-sharing credits, if eligible, to purchase one of the
9options described under subd. 1.
AB56-SA13,2,1810 (b) 1. The department shall coordinate the administration of the purchase
11options under this subsection with the programs under this section and s. 49.45 (23)
12to maximize efficiency and improve the continuity of care, consistent with the
13requirements of this section and s. 49.45 (23). The department shall seek to
14implement mechanisms to ensure the long-term financial sustainability of the
15programs under this section and s. 49.45 (23). These mechanisms must address
16issues related to minimizing adverse selection, the state financial risk and
17contribution, and negative impacts to premiums in the individual and group
18insurance markets.
AB56-SA13,2,2019 2. The purchase option program shall include, at a minimum, all of the
20following attributes:
AB56-SA13,2,2221 a. Establishment of an annual per enrollee premium rate similar to the average
22rate paid by the state to managed care plan contractors.
AB56-SA13,2,2423 b. Establishment of a benefit set equal to the benefits covered under this section
24and s. 49.45 (23).
1c. Annual enrollment that is limited to the same annual open enrollment
2periods established for the programs under this section and s. 49.45 (23).
AB56-SA13,3,43 d. The ability for the department to adjust the purchase option's actuarial value
4to a value no lower than 87 percent.
AB56-SA13,3,65 e. Reimbursement mechanisms for addressing potential increased costs to the
6programs under this section and s. 49.45 (23).
AB56-SA13,3,117 (c) By March 1, 2018, the department of health services shall submit a report
8to the appropriate standing committee in each house of the legislature under s.
913.172 (3) that provides information on the status of the request for a federal waiver
10and the results from actuarial and economic analyses that are necessary for a waiver
AB56-SA13,3,1712 (d) If any necessary waiver or amendments to the state plan described under
13par. (a) 1. are approved, the department shall implement the program. If the
14department is authorized to implement the program, and if any waiver or state plan
15amendment described under par. (a) 2. is necessary and is approved, or if the
16department determines neither a waiver nor state plan amendment is necessary, the
17department shall allow the purchase options described under par. (a) 2.”.