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2023 - 2024 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 148
April 25, 2023 - Offered by Representative Neubauer.
AB148-ASA1,1,5 1An Act to repeal 49.45 (2p), 49.45 (23) and 49.45 (23b); to amend 20.435 (4) (jw),
249.471 (4) (a) 4. b. and 49.686 (3) (d); to create 49.471 (1) (cr), 49.471 (4) (a) 8.
3and 49.471 (4g) of the statutes; and to affect 2017 Wisconsin Act 370, section
444 (2) and (3); relating to: expanding eligibility for the Medical Assistance
5program.
Analysis by the Legislative Reference Bureau
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 the 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 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, as a separate
program on July 1, 2023.
2017 Wisconsin Act 370 requires by statute that DHS implement the
BadgerCare Reform waiver as it relates to childless adults as approved by the federal
Department of Health and Human Services effective October 31, 2018. The 2015-17
and 2017-19 biennial budget acts required DHS to submit a waiver request to the
federal Department of Health and Human Services authorizing DHS to take certain
actions, including imposing premiums on, requiring a health risk assessment of, and
limiting the time of eligibility for recipients of BadgerCare Plus under the childless
adults demonstration project waiver. Act 370 required DHS to implement the
childless adults BadgerCare Reform waiver by no later than November 1, 2019. If
the Joint Committee on Finance determines that DHS has not complied with the
implementation deadline, has not made sufficient progress in implementing the
BadgerCare Reform waiver, or has not complied with other requirements relating to
approved waiver implementation, Act 370 allows JCF to reduce from moneys
allocated for state operations or administrative functions DHS's appropriation or
expenditure authority, whichever is applicable, or change the authorized level of
full-time equivalent positions for DHS related to the Medical Assistance program.
The bill eliminates the statutory implementation requirement for the BadgerCare
Reform waiver, including the deadline and penalties, eliminates the statutory
requirement for DHS to seek the waiver, and allows DHS to modify or withdraw the
waiver.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB148-ASA1,1 1Section 1 . 20.435 (4) (jw) of the statutes is amended to read:
AB148-ASA1,3,42 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

1under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to
2provide a portion of the state share of administrative costs for the BadgerCare Plus
3Medical Assistance program under s. 49.471, and for administration of the hospital
4assessment under s. 50.38.
AB148-ASA1,2 5Section 2 . 49.45 (2p) of the statutes is repealed.
AB148-ASA1,3 6Section 3 . 49.45 (23) of the statutes is repealed.
AB148-ASA1,4 7Section 4 . 49.45 (23b) of the statutes is repealed.
AB148-ASA1,5 8Section 5 . 49.471 (1) (cr) of the statutes is created to read:
AB148-ASA1,3,109 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
10federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB148-ASA1,6 11Section 6 . 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB148-ASA1,3,1412 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
13percent of the poverty line before application of the 5 percent income disregard under
1442 CFR 435.603 (d)
.
AB148-ASA1,7 15Section 7 . 49.471 (4) (a) 8. of the statutes is created to read:
AB148-ASA1,3,1616 49.471 (4) (a) 8. An individual who meets all of the following criteria:
AB148-ASA1,3,1717 a. The individual is an adult under the age of 65.
AB148-ASA1,3,1918 b. The adult has a family income that does not exceed 133 percent of the poverty
19line, except as provided in sub. (4g).
AB148-ASA1,3,2120 c. The adult is not otherwise eligible for the Medical Assistance program under
21this subchapter or the Medicare program under 42 USC 1395 et seq.
AB148-ASA1,8 22Section 8 . 49.471 (4g) of the statutes is created to read:
AB148-ASA1,4,723 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For
24services provided to individuals described under sub. (4) (a) 8., the department shall
25comply with all federal requirements to qualify for the highest available enhanced

1federal medical assistance percentage. The department shall submit any
2amendment to the state medical assistance plan, request for a waiver of federal
3Medicaid law, or other approval request required by the federal government to
4provide services to the individuals described under sub. (4) (a) 8. and qualify for the
5highest available enhanced federal medical assistance percentage. Sections 20.940
6and 49.45 (2t) do not apply to a submission to the federal government under this
7subsection.
AB148-ASA1,9 8Section 9 . 49.686 (3) (d) of the statutes is amended to read:
AB148-ASA1,4,149 49.686 (3) (d) Has applied for coverage under and has been denied eligibility
10for medical assistance within 12 months prior to application for reimbursement
11under sub. (2). This paragraph does not apply to an individual who is eligible for
12benefits under the demonstration project for childless adults under s. 49.45 (23) or
13to an individual
who is eligible for benefits under BadgerCare Plus under s. 49.471
14(4) (a) 8. or (11).
AB148-ASA1,10 15Section 10 . 2017 Wisconsin Act 370, section 44 (2) and (3) are repealed.
AB148-ASA1,11 16Section 11 . Nonstatutory provisions.
AB148-ASA1,4,2517 (1) Childless adults demonstration project. The department of health
18services shall submit any necessary request to the federal department of health and
19human services for a state plan amendment or waiver of federal Medicaid law or to
20modify or withdraw from any waiver of federal Medicaid law relating to the childless
21adults demonstration project under s. 49.45 (23), 2021 stats., to reflect the
22incorporation of recipients of Medical Assistance under the demonstration project
23into the BadgerCare Plus program under s. 49.471 and the termination of the
24demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a request under
25this subsection.
AB148-ASA1,12
1Section 12 . Fiscal changes.
AB148-ASA1,5,82 (1) Medicaid expansion. In the schedule under s. 20.005 (3) for the
3appropriation to the department of health services under s. 20.435 (4) (b), the dollar
4amount for fiscal year 2023-24 is decreased by $841,240,100 as a result of expanding
5eligibility for the Medical Assistance program. In the schedule under s. 20.005 (3)
6for the appropriation to the department of health services under s. 20.435 (4) (b), the
7dollar amount for fiscal year 2024-25 is decreased by $759,177,800 as a result of
8expanding eligibility for the Medical Assistance program.
AB148-ASA1,13 9Section 13. Effective dates. This act takes effect on the day after publication,
10except as follows:
AB148-ASA1,5,1411 (1) Medicaid expansion. The treatment of ss. 20.435 (4) (jw), 49.45 (23) and
12(23b), 49.471 (1) (cr), (4) (a) 4. b. and 8., and (4g), and 49.686 (3) (d) and 2017
13Wisconsin Act 370
, section 44 (2) and (3) and Sections 11 (1) and 12 (1) of this act take
14effect on July 1, 2023.
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