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LRBs0063/1
MPG/EVM/TJD:amn
2021 - 2022 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 241
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.
AB241-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: retiring public debt and transportation revenue
5bonds, eligibility expansion under the Medical Assistance program, and
6making an appropriation.
Analysis by the Legislative Reference Bureau
Retiring public debt and transportation revenue bonds
This bill appropriates in the 2021-22 fiscal year $500,000,000 in general
purpose revenue to retire public debt and $500,000,000 in general purpose revenue
to retire transportation revenue obligations.
Eligibility expansion under the Medical Assistance program
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.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB241-ASA1,1 1Section 1 . 20.435 (4) (jw) of the statutes is amended to read:
AB241-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.
AB241-ASA1,2 10Section 2 . 49.45 (2p) of the statutes is repealed.
AB241-ASA1,3 11Section 3 . 49.45 (23) of the statutes is repealed.
AB241-ASA1,4 12Section 4 . 49.45 (23b) (title) of the statutes is amended to read:
AB241-ASA1,3,2
149.45 (23b) (title) Childless adults demonstration project reform waiver
2implementation required.
AB241-ASA1,5 3Section 5 . 49.45 (23b) (b) of the statutes is amended to read:
AB241-ASA1,3,74 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and
5ending no sooner than December 31, 2023, the department shall do all of the
6following with regard to the childless adults demonstration project under sub. (23)
7s. 49.471 (4) (a) 8.:
AB241-ASA1,3,138 1. Require in each month persons, except exempt individuals, who are eligible
9to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least
1019 years of age but have not attained the age of 50 to participate in, document, and
11report 80 hours per calendar month of community engagement activities. The
12department, after finding good cause, may grant a temporary exemption from the
13requirement under this subdivision upon request of a Medical Assistance recipient.
AB241-ASA1,3,1614 2. Require persons with incomes of at least 50 percent of the poverty line to pay
15premiums in accordance with par. (c) as a condition of eligibility for Medical
16Assistance under sub. (23) s. 49.471 (4) (a) 8.
AB241-ASA1,3,1817 3. Require as a condition of eligibility for Medical Assistance under sub. (23)
18s. 49.471 (4) (a) 8. completion of a health risk assessment.
AB241-ASA1,3,2119 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
20an $8 copayment for nonemergency use of the emergency department in accordance
21with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.
AB241-ASA1,4,222 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6
23months any individual who does not pay a required premium under subd. 2. and any
24individual who is required under subd. 1. to participate in a community engagement

1activity but who does not participate for 48 aggregate months in the community
2engagement activity.
AB241-ASA1,6 3Section 6 . 49.45 (23b) (c) of the statutes is amended to read:
AB241-ASA1,4,94 49.45 (23b) (c) 1. Persons who are eligible for the demonstration project under
5sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds
650 percent of the poverty line shall pay a monthly premium amount of $8 per
7household. A person who is eligible to receive an item or service furnished by an
8Indian health care provider is exempt from the premium requirement under this
9subdivision.
AB241-ASA1,4,1510 2. The department may disenroll under par. (b) 5. a person for nonpayment of
11a required monthly premium only at annual eligibility redetermination after
12providing notice and reasonable opportunity for the person to pay. If a person who
13is disenrolled for nonpayment of premiums pays all owed premiums or becomes
14exempt from payment of premiums, he or she may reenroll in Medical Assistance
15under sub. (23) s. 49.471 (4) (a) 8.
AB241-ASA1,4,1916 3. The department shall reduce the amount of the required household premium
17by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.
18who does not engage in certain behaviors that increase health risks or who attests
19to actively managing certain unhealthy behaviors.
AB241-ASA1,7 20Section 7 . 49.45 (23b) (e) of the statutes is amended to read:
AB241-ASA1,4,2521 49.45 (23b) (e) Before December 31, 2023, the demonstration project
22requirements under this subsection may not be withdrawn and the department may
23not request from the federal government withdrawal, suspension, or termination of
24the demonstration project requirements under this subsection unless legislation has
25been enacted specifically allowing for the withdrawal, suspension, or termination.
AB241-ASA1,8
1Section 8. 49.471 (1) (cr) of the statutes is created to read:
AB241-ASA1,5,32 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
3federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB241-ASA1,9 4Section 9 . 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB241-ASA1,5,75 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
6percent of the poverty line before application of the 5 percent income disregard under
742 CFR 435.603 (d)
.
AB241-ASA1,10 8Section 10 . 49.471 (4) (a) 8. of the statutes is created to read:
AB241-ASA1,5,99 49.471 (4) (a) 8. An individual who meets all of the following criteria:
AB241-ASA1,5,1010 a. The individual is an adult under the age of 65.
AB241-ASA1,5,1211 b. The individual has a family income that does not exceed 133 percent of the
12poverty line, except as provided in sub. (4g).
AB241-ASA1,5,1413 c. The individual is not otherwise eligible for the Medical Assistance program
14under this subchapter or the Medicare program under 42 USC 1395 et seq.
AB241-ASA1,11 15Section 11 . 49.471 (4g) of the statutes is created to read:
AB241-ASA1,5,2516 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
17services provided to individuals described under sub. (4) (a) 8., the department shall
18comply with all federal requirements to qualify for the highest available enhanced
19federal medical assistance percentage. The department shall submit any
20amendment to the state medical assistance plan, request for a waiver of federal
21Medicaid law, or other approval request required by the federal government to
22provide services to the individuals described under sub. (4) (a) 8. and qualify for the
23highest available enhanced federal medical assistance percentage. Sections 20.940
24and 49.45 (2t) do not apply to a submission to the federal government under this
25subsection.
AB241-ASA1,12
1Section 12. 49.686 (3) (d) of the statutes is amended to read:
AB241-ASA1,6,72 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
3for medical assistance within 12 months prior to application for reimbursement
4under sub. (2). This paragraph does not apply to an individual who is eligible for
5benefits under the demonstration project for childless adults under s. 49.45 (23) or
6to an individual
who is eligible for benefits under BadgerCare Plus under s. 49.471
7(4) (a) 8. or (11).
AB241-ASA1,9101 8Section 9101. Nonstatutory provisions; Administration.
AB241-ASA1,6,129 (1) Retiring public debt. From the appropriation under s. 20.505 (1) (a), the
10department of administration shall expend $500,000,000 for the payment, in the
112021-22 fiscal year, of principal and interest costs on outstanding public debt, as
12defined in s. 18.01 (4).
AB241-ASA1,6,1613 (2) Retiring transportation revenue obligations. From the appropriation
14under s. 20.505 (1) (a), the department of administration shall expend $500,000,000,
15in the 2021-22 fiscal year, for the purpose of retiring revenue obligations issued
16under s. 84.59.
AB241-ASA1,9119 17Section 9119. Nonstatutory provisions; Health Services.
AB241-ASA1,7,218 (1) Childless adults demonstration project. The department of health
19services shall submit any necessary request to the federal department of health and
20human services for a state plan amendment or waiver of federal Medicaid law or to
21modify or withdraw from any waiver of federal Medicaid law relating to the childless
22adults demonstration project under s. 49.45 (23), 2019 stats., to reflect the
23incorporation of recipients of Medical Assistance under the demonstration project
24into the BadgerCare Plus program under s. 49.471 and the termination of the

1demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission
2to the federal government under this subsection.
AB241-ASA1,9201 3Section 9201. Fiscal changes; Administration.
AB241-ASA1,7,84 (1) Retiring public debt and transportation revenue obligations. In the
5schedule under s. 20.005 (3) for the appropriation to the department of
6administration under s. 20.505 (1) (a), the dollar amount for fiscal year 2021-22 is
7increased by $1,000,000,000 to retire public debt under Section 9101 (1) and (2) of
8this act.
AB241-ASA1,9219 9Section 9219. Fiscal changes; Health Services.
AB241-ASA1,7,1610 (1) Medicaid expansion. In the schedule under s. 20.005 (3) for the
11appropriation to the department of health services under s. 20.435 (4) (b), the dollar
12amount for fiscal year 2021-22 is decreased by $849,788,000 as a result of expanding
13eligibility for the Medical Assistance program. In the schedule under s. 20.005 (3)
14for the appropriation to the department of health services under s. 20.435 (4) (b), the
15dollar amount for fiscal year 2022-23 is decreased by $841,925,400 as a result of
16expanding eligibility for the Medical Assistance program.
AB241-ASA1,9419 17Section 9419. Effective dates; Health Services. This act takes effect on the
18day after publication, except as follows:
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