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EVM&TJD:amn
2021 - 2022 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 238
April 13, 2021 - Offered by Representatives Anderson, Baldeh, Billings, Bowen,
Brostoff, Cabrera, Conley, Considine, Doyle, Drake, Emerson, Goyke,
Haywood, Hebl, Hesselbein, Hintz, Hong, McGuire, B. Meyers, Milroy,
Moore Omokunde, L. Myers, Neubauer, Ohnstad, Ortiz-Velez, Pope,
Riemer, S. Rodriguez, Shankland, Shelton, Sinicki, Snodgrass, Spreitzer,
Stubbs, Subeck, Vining and Vruwink.
AB238-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 20.395 (2) (fd), 49.471 (1) (cr), 49.471 (4) (a) 8.,
449.471 (4g) and 86.313 of the statutes; relating to: local highways and bridges
5supplement, eligibility expansion under the Medical Assistance program, and
6making an appropriation.
Analysis by the Legislative Reference Bureau
This bill expands eligibility under the state's Medical Assistance program and
creates a local highways and bridges supplement program.
Medicaid expansion
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. 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. 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 the 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, as a separate
program.
Local highways and bridges supplement
This bill requires the Department of Transportation to administer a local
highways and bridges supplement program. Under the program, DOT awards
grants to municipalities and counties to fund qualifying improvement projects on
highways or bridges under the jurisdiction of the municipality or county. A
qualifying improvement project under the program is a highway or bridge
construction project for which no federal funds are expended and that is any of the
following:
1. Eligible for funding under the local bridge improvement assistance program.
2. Eligible for funding under the local roads improvement discretionary grant
program.
3. A project to increase the load-bearing capacity of a bridge.
The bill appropriates $617,039,600 from the general fund for this program. The
bill provides $288,000,000 for grants to counties. Not more than $4,000,000 of this
amount may be paid to each county. The bill also provides $329,039,600 for grants
to municipalities. Each municipality may be paid no more than the amount
calculated by multiplying the number of miles of highways under the jurisdiction of
the municipality for calendar year 2020 by $4,000. Under the bill, DOT may not
provide grants under the program after December 31, 2024.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB238-ASA1,1 1Section 1 . 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
2the following amounts for the purposes indicated: - See PDF for table PDF - See PDF for table PDF - See PDF for table PDF - See PDF for table PDF
AB238-ASA1,2 1Section 2 . 20.395 (2) (fd) of the statutes is created to read:
AB238-ASA1,3,42 20.395 (2) (fd) Local highways and bridges supplement. From the general fund,
3as a continuing appropriation, the amounts in the schedule for the local highways
4and bridges supplement program under s. 86.313.
AB238-ASA1,3 5Section 3. 20.435 (4) (jw) of the statutes is amended to read:
AB238-ASA1,3,136 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received
7from payment of enrollment fees under the program under s. 49.45 (23), all
moneys
8transferred under s. 50.38 (9), all moneys transferred from the appropriation account
9under par. (jz), and 10 percent of all moneys received from penalty assessments
10under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to
11provide a portion of the state share of administrative costs for the BadgerCare Plus
12Medical Assistance program under s. 49.471, and for administration of the hospital
13assessment under s. 50.38.
AB238-ASA1,4 14Section 4. 49.45 (2p) of the statutes is repealed.
AB238-ASA1,5 15Section 5. 49.45 (23) of the statutes is repealed.
AB238-ASA1,6 16Section 6. 49.45 (23b) (title) of the statutes is amended to read:
AB238-ASA1,3,1817 49.45 (23b) (title) Childless adults demonstration project reform waiver
18implementation required.
AB238-ASA1,7 19Section 7. 49.45 (23b) (b) of the statutes is amended to read:
AB238-ASA1,4,4
149.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and
2ending no sooner than December 31, 2023, the department shall do all of the
3following with regard to the childless adults demonstration project under sub. (23)
4s. 49.471 (4) (a) 8.:
AB238-ASA1,4,105 1. Require in each month persons, except exempt individuals, who are eligible
6to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least
719 years of age but have not attained the age of 50 to participate in, document, and
8report 80 hours per calendar month of community engagement activities. The
9department, after finding good cause, may grant a temporary exemption from the
10requirement under this subdivision upon request of a Medical Assistance recipient.
AB238-ASA1,4,1311 2. Require persons with incomes of at least 50 percent of the poverty line to pay
12premiums in accordance with par. (c) as a condition of eligibility for Medical
13Assistance under sub. (23) s. 49.471 (4) (a) 8.
AB238-ASA1,4,1514 3. Require as a condition of eligibility for Medical Assistance under sub. (23)
15s. 49.471 (4) (a) 8. completion of a health risk assessment.
AB238-ASA1,4,1816 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
17an $8 copayment for nonemergency use of the emergency department in accordance
18with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.
AB238-ASA1,4,2319 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6
20months any individual who does not pay a required premium under subd. 2. and any
21individual who is required under subd. 1. to participate in a community engagement
22activity but who does not participate for 48 aggregate months in the community
23engagement activity.
AB238-ASA1,8 24Section 8. 49.45 (23b) (c) of the statutes is amended to read:
AB238-ASA1,5,6
149.45 (23b) (c) 1. Persons who are eligible for the demonstration project under
2sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds
350 percent of the poverty line shall pay a monthly premium amount of $8 per
4household. A person who is eligible to receive an item or service furnished by an
5Indian health care provider is exempt from the premium requirement under this
6subdivision.
AB238-ASA1,5,127 2. The department may disenroll under par. (b) 5. a person for nonpayment of
8a required monthly premium only at annual eligibility redetermination after
9providing notice and reasonable opportunity for the person to pay. If a person who
10is disenrolled for nonpayment of premiums pays all owed premiums or becomes
11exempt from payment of premiums, he or she may reenroll in Medical Assistance
12under sub. (23) s. 49.471 (4) (a) 8.
AB238-ASA1,5,1613 3. The department shall reduce the amount of the required household premium
14by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
15who does not engage in certain behaviors that increase health risks or who attests
16to actively managing certain unhealthy behaviors.
AB238-ASA1,9 17Section 9. 49.45 (23b) (e) of the statutes is amended to read:
AB238-ASA1,5,2218 49.45 (23b) (e) Before December 31, 2023, the demonstration project
19requirements under this subsection may not be withdrawn and the department may
20not request from the federal government withdrawal, suspension, or termination of
21the demonstration project requirements under this subsection unless legislation has
22been enacted specifically allowing for the withdrawal, suspension, or termination.
AB238-ASA1,10 23Section 10. 49.471 (1) (cr) of the statutes is created to read:
AB238-ASA1,5,2524 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
25federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB238-ASA1,11
1Section 11. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB238-ASA1,6,42 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
3percent of the poverty line before application of the 5 percent income disregard under
442 CFR 435.603 (d)
.
AB238-ASA1,12 5Section 12. 49.471 (4) (a) 8. of the statutes is created to read:
AB238-ASA1,6,66 49.471 (4) (a) 8. An individual who meets all of the following criteria:
AB238-ASA1,6,77 a. The individual is an adult under the age of 65.
AB238-ASA1,6,98 b. The individual has a family income that does not exceed 133 percent of the
9poverty line, except as provided in sub. (4g).
AB238-ASA1,6,1110 c. The individual is not otherwise eligible for the Medical Assistance program
11under this subchapter or the Medicare program under 42 USC 1395 et seq.
AB238-ASA1,13 12Section 13. 49.471 (4g) of the statutes is created to read:
AB238-ASA1,6,2213 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
14services provided to individuals described under sub. (4) (a) 8., the department shall
15comply with all federal requirements to qualify for the highest available enhanced
16federal medical assistance percentage. The department shall submit any
17amendment to the state medical assistance plan, request for a waiver of federal
18Medicaid law, or other approval request required by the federal government to
19provide services to the individuals described under sub. (4) (a) 8. and qualify for the
20highest available enhanced federal medical assistance percentage. Sections 20.940
21and 49.45 (2t) do not apply to a submission to the federal government under this
22subsection.
AB238-ASA1,14 23Section 14. 49.686 (3) (d) of the statutes is amended to read:
AB238-ASA1,7,424 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
25for medical assistance within 12 months prior to application for reimbursement

1under sub. (2). This paragraph does not apply to an individual who is eligible for
2benefits under the demonstration project for childless adults under s. 49.45 (23) or
3to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471
4(4) (a) 8. or (11).
AB238-ASA1,15 5Section 15. 86.313 of the statutes is created to read:
AB238-ASA1,7,6 686.313 Local highways and bridges supplement. (1) In this section:
AB238-ASA1,7,77 (a) “Municipality” means a city, village, or town.
AB238-ASA1,7,88 (b) “Political subdivision” means a city, village, town, or county.
AB238-ASA1,7,109 (c) “Qualifying improvement project” means a highway or bridge construction
10project for which no federal funds are expended and that is any of the following:
AB238-ASA1,7,1111 1. Eligible for funding under s. 84.18.
AB238-ASA1,7,1212 2. Eligible for funding under s. 86.31 (3g) to (3r).
AB238-ASA1,7,1313 3. A project to increase the load-bearing capacity of a bridge.
AB238-ASA1,7,21 14(2) The department shall administer a local highways and bridges supplement
15program. Subject to sub. (3), from the appropriation under s. 20.395 (2) (fd), the
16department shall, upon application, award grants to political subdivisions to fund
17qualifying improvement projects on highways or bridges under the jurisdiction of the
18political subdivision. The department shall make a grant award determination as
19soon as practicable after receiving a complete application for a grant under this
20section. The department may not provide grants under this section after December
2131, 2024.
AB238-ASA1,7,24 22(3) (a) 1. From the appropriation under s. 20.395 (2) (fd), the department shall
23allocate $288,000,000 to fund qualifying improvement projects on highways or
24bridges under the jurisdiction of counties.
AB238-ASA1,8,2
12. The total amount of grants that may be paid by the department to each
2county under this section may not exceed $4,000,000.
AB238-ASA1,8,53 (b) 1. From the appropriation under s. 20.395 (2) (fd), the department shall
4allocate $329,039,600 to fund qualifying improvement projects on highways or
5bridges under the jurisdiction of municipalities.
AB238-ASA1,8,96 2. The total amount of grants that may be paid by the department to each
7municipality under this section may not exceed the amount calculated by
8multiplying the number of miles of highways under the jurisdiction of the
9municipality, as determined under s. 86.302 for calendar year 2020, by $4,000.
AB238-ASA1,8,11 10(4) Amounts received under this section may not be included in cost
11calculations under s. 86.303.
AB238-ASA1,9119 12Section 9119. Nonstatutory provisions; Health Services.
AB238-ASA1,8,2113 (1) Childless adults demonstration project. The department of health
14services shall submit any necessary request to the federal department of health and
15human services for a state plan amendment or waiver of federal Medicaid law or to
16modify or withdraw from any waiver of federal Medicaid law relating to the childless
17adults demonstration project under s. 49.45 (23), 2019 stats., to reflect the
18incorporation of recipients of Medical Assistance under the demonstration project
19into the BadgerCare Plus program under s. 49.471 and the termination of the
20demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission
21to the federal government under this subsection.
AB238-ASA1,9219 22Section 9219. Fiscal changes; Health Services.
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