AB955: Bill Text

Medicaid expansion

This bill accepts the Medicaid expansion by changing 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. 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. The bill requires DHS 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. DHS must ensure that any increased funding resulting from the bill is used to improve access to and affordability of health care and to support health care quality for Wisconsin residents.

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.

This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.

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:

AB955,1 Section 1 . 16.34 of the statutes is created to read:

AB955,3,5 16.34 Hazard pay during a public health emergency; paid medical leave for frontline health care workers. (1) Definition. In this section, “frontline health care worker” means an individual who is any of the following, who is not exempt under 29 USC 213, and whose annual pay does not exceed $99,999:

AB955,3,7 (a) A provider of direct care to patients in a hospital, nursing home, or residence or for an ambulance service provider, as defined in s. 256.01 (3).

AB955,3,9 (b) An employee who works in a patient care area of a facility that provides direct patient care.

AB955,3,11 (c) An individual who handles patient specimens within this state within the scope of the individual's employment.

AB955,3,13 (d) An employee who works in an area where patient specimens are handled at a facility that handles patient specimens within this state.

AB955,4,2 (2) Hazard pay grant program for work during a public health emergency. (a) From the appropriation under s. 20.505 (1) (ft), the department shall award grants to employers for the payment of hazard pay to frontline health care workers who work during a public health emergency declared by the governor under s. 323.10 or the secretary of health services under s. 252.02, as set forth in s. 103.025 (3).

AB955,4,8 (b) The department shall establish and administer a program to subsidize, as provided in s. 103.025 (3), the hazard pay costs for frontline health care workers. The department shall require, at a minimum, that the employer provide a sworn affidavit of compliance, and payroll records if requested by the department. The governor or his or her designee within the department may determine the period of applicability of this subsection.

AB955,4,12 (3) Paid medical leave grant program for frontline health care workers. (a) From the appropriation under s. 20.505 (1) (ft), the department shall award grants to employers for the provision of paid medical leave to frontline health care workers who contract a communicable disease, as set forth in s. 103.10 (4m).

AB955,4,18 (b) The department shall establish and administer a program to subsidize, as provided in s. 103.10 (4m), the paid medical leave costs for frontline health care workers. The department shall require, at a minimum, that the employer provide a sworn affidavit of compliance, and payroll records if requested by the department. The governor or his or her designee within the department may determine the period of applicability of this subsection.

AB955,4,22 (4) Coverage of COVID-19 for health care workers. (a) From the appropriation under s. 20.505 (1) (ft), the department shall award grants to insurers for the provision of health insurance coverage to frontline health care workers as set forth in s. 632.895 (14f).

AB955,5,2 (b) The department shall establish and administer a program to subsidize, as provided in s. 632.895 (14f), the costs of providing coverage for frontline health care workers at no additional cost to the covered individuals. The governor or his or her designee within the department may determine the period of applicability of this subsection.

AB955,2 Section 2 . 20.435 (4) (bu) of the statutes is created to read:

AB955,5,11 20.435 (4) (bu) COVID-19 and other communicable disease aids for frontline health care workers. A sum sufficient not to exceed, in fiscal year 2021-22, the difference between $170,000,000 and the amount after payments have been made under s. 16.34, for testing and treatment of frontline health care workers under s. 49.681 and not to exceed, in fiscal year 2022-23 and each fiscal year thereafter, the difference between $300,000,000 and the amount after payments have been made under s. 16.34, for testing and treatment of frontline health care workers under s. 49.681.

AB955,3 Section 3 . 20.435 (4) (jw) of the statutes is amended to read:

AB955,5,20 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received from payment of enrollment fees under the program under s. 49.45 (23), all moneys transferred under s. 50.38 (9), all moneys transferred from the appropriation account under par. (jz), and 10 percent of all moneys received from penalty assessments under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to provide a portion of the state share of administrative costs for the BadgerCare Plus Medical Assistance program under s. 49.471, and for administration of the hospital assessment under s. 50.38.

AB955,4 Section 4 . 20.505 (1) (ft) of the statutes is created to read:

AB955,5,25 20.505 (1) (ft) Health care coverage and employee benefits relating to COVID-19 and other communicable diseases. A sum sufficient not to exceed $170,000,000 in fiscal year 2021-22 and not to exceed $300,000,000 in each fiscal year thereafter for payments under s. 16.34 (2), (3), and (4).

AB955,5 Section 5. 49.45 (2p) of the statutes is repealed.

AB955,6 Section 6 . 49.45 (23) of the statutes is repealed.

AB955,7 Section 7 . 49.45 (23b) (title) of the statutes is amended to read:

AB955,6,5 49.45 (23b) (title) Childless adults demonstration project reform waiver implementation required.

AB955,8 Section 8 . 49.45 (23b) (b) of the statutes is amended to read:

AB955,6,10 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and ending no sooner than December 31, 2023, the department shall do all of the following with regard to the childless adults demonstration project under sub. (23) s. 49.471 (4) (a) 8.:

AB955,6,16 1. Require in each month persons, except exempt individuals, who are eligible to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least 19 years of age but have not attained the age of 50 to participate in, document, and report 80 hours per calendar month of community engagement activities. The department, after finding good cause, may grant a temporary exemption from the requirement under this subdivision upon request of a Medical Assistance recipient.

AB955,6,19 2. Require persons with incomes of at least 50 percent of the poverty line to pay premiums in accordance with par. (c) as a condition of eligibility for Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.

AB955,6,21 3. Require as a condition of eligibility for Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. completion of a health risk assessment.

AB955,6,24 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. an $8 copayment for nonemergency use of the emergency department in accordance with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.

AB955,7,5 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6 months any individual who does not pay a required premium under subd. 2. and any individual who is required under subd. 1. to participate in a community engagement activity but who does not participate for 48 aggregate months in the community engagement activity.

AB955,9 Section 9 . 49.45 (23b) (c) of the statutes is amended to read:

AB955,7,12 49.45 (23b) (c) 1. Persons who are eligible for the demonstration project under sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds 50 percent of the poverty line shall pay a monthly premium amount of $8 per household. A person who is eligible to receive an item or service furnished by an Indian health care provider is exempt from the premium requirement under this subdivision.

AB955,7,18 2. The department may disenroll under par. (b) 5. a person for nonpayment of a required monthly premium only at annual eligibility redetermination after providing notice and reasonable opportunity for the person to pay. If a person who is disenrolled for nonpayment of premiums pays all owed premiums or becomes exempt from payment of premiums, he or she may reenroll in Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.

AB955,7,22 3. The department shall reduce the amount of the required household premium by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. who does not engage in certain behaviors that increase health risks or who attests to actively managing certain unhealthy behaviors.

AB955,10 Section 10 . 49.45 (23b) (e) of the statutes is amended to read:

AB955,8,3 49.45 (23b) (e) Before December 31, 2023, the demonstration project requirements under this subsection may not be withdrawn and the department may not request from the federal government withdrawal, suspension, or termination of the demonstration project requirements under this subsection unless legislation has been enacted specifically allowing for the withdrawal, suspension, or termination.

AB955,11 Section 11 . 49.471 (1) (cr) of the statutes is created to read:

AB955,8,6 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB955,12 Section 12 . 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB955,8,10 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133 percent of the poverty line before application of the 5 percent income disregard under 42 CFR 435.603 (d).

AB955,13 Section 13 . 49.471 (4) (a) 8. of the statutes is created to read:

AB955,8,12 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB955,8,13 a. The individual is an adult under the age of 65.

AB955,8,15 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB955,8,17 c. The adult is not otherwise eligible for the Medical Assistance program under this subchapter or the Medicare program under 42 USC 1395 et seq.

AB955,14 Section 14 . 49.471 (4g) of the statutes is created to read:

AB955,9,3 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For services provided to individuals described under sub. (4) (a) 8., the department shall comply with all federal requirements to qualify for the highest available enhanced federal medical assistance percentage. The department shall submit any amendment to the state medical assistance plan, request for a waiver of federal Medicaid law, or other approval request required by the federal government to provide services to the individuals described under sub. (4) (a) 8. beginning on January 1, 2022, and qualify for the highest available enhanced federal medical assistance percentage. Sections 20.940 and 49.45 (2t) do not apply to a submission to the federal government under this subsection.

AB955,15 Section 15 . 49.681 of the statutes is created to read:

AB955,9,6 49.681 COVID-19 and other communicable disease aids for frontline health care workers. (1) In this section:

AB955,9,7 (a) “COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.

AB955,9,8 (b) “Frontline health care worker” has the meaning given in s. 16.34 (1).

AB955,9,15 (2) From the appropriation under s. 20.435 (4) (bu), subject to sub. (3), the department shall pay, at a rate determined by the department under sub. (4), for testing for and any treatment that is medically necessary and reasonably related to COVID-19 or any other communicable disease or complications from COVID-19 or other communicable disease for frontline health care workers who have been diagnosed with or are a patient under investigation of having COVID-19 or any other communicable disease.

AB955,9,23 (3) No payment may be made under this section unless the recipient has no other form of coverage available from the federal Medicare program, from private health, accident, sickness, medical, and hospital insurance coverage, from any other available state, federal, or other health care coverage program, or under any grant, contract, or other contractual arrangement. If at any time federal or private insurance aid, other health care coverage, or a grant, contract, or other contractual arrangement becomes available during the treatment period, state aid under this section shall be terminated.

AB955,9,25 (4) Payment for services provided under this section shall be at a rate determined by the department that does not exceed the allowable charges under the federal Medicare program. In no case shall state rates for individual service elements exceed the federally defined allowable costs. The rate of charges for services not covered by public and private insurance shall not exceed the reasonable charges as established by Medicare fee determination procedures. A person that provides to a patient a service for which payment is provided under this section shall accept the amount paid under this section for the service as payment in full and may not bill the patient for any amount by which the charge for the service exceeds the amount paid for the service under this section.

AB955,10,10 (5) The department may promulgate rules to establish a process for individuals to establish eligibility and apply for and receive benefits under this section.

AB955,16 Section 16 . 49.686 (3) (d) of the statutes is amended to read:

AB955,10,17 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) BadgerCare Plus under s. 49.471 (4) (a) 8. or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (11).

AB955,17 Section 17 . 103.025 (title) of the statutes is amended to read:

AB955,10,19 103.025 (title) Hours of labor; compensatory time; hazard pay.

AB955,18 Section 18 . 103.025 (1) (bm) of the statutes is created to read:

AB955,10,22 103.025 (1) (bm) “Frontline health care worker” has the meaning given in s. 16.34 (1).

AB955,19 Section 19 . 103.025 (3) of the statutes is created to read:

AB955,11,4 103.025 (3) During a public health emergency declared by the governor under s. 323.10 or pursuant to an emergency order issued by the secretary of health services under s. 252.02, an employer shall pay frontline health care workers a hazard pay premium of 1.5 times the employee's hourly rate, or an additional $15 per hour, whichever is more. An employer may apply for a grant under s. 16.34 (2) (a) to pay the hazard pay premium.

AB955,20 Section 20 . 103.10 (1) (c) of the statutes is amended to read:

AB955,11,11 103.10 (1) (c) Except as provided in sub. subs. (1m) (b) 3. and (4m) (a), “employer" means a person engaging in any activity, enterprise or business in this state employing at least 50 individuals on a permanent basis. “Employer" includes the state and any office, department, independent agency, authority, institution, association, society or other body in state government created or authorized to be created by the constitution or any law, including the legislature and the courts.

AB955,21 Section 21 . 103.10 (1) (dm) of the statutes is created to read:

AB955,11,14 103.10 (1) (dm) “Frontline health care worker” has the meaning given in s. 16.34 (1).

AB955,22 Section 22 . 103.10 (2) (c) of the statutes is amended to read:

AB955,11,19 103.10 (2) (c) This Except as provided in sub. (4m), this section only applies to an employee who has been employed by the same employer for more than 52 consecutive weeks and who worked for the employer for at least 1,000 hours during the preceding 52-week period.

AB955,23 Section 23 . 103.10 (4m) of the statutes is created to read:

AB955,12,2 103.10 (4m) Paid medical leave for frontline health care workers. (a) An employer that employs at least one employee shall provide at least 15 days of paid medical leave in addition to any leave provided under sub. (4) (a) to a frontline health care worker who is employed by the employer and who contracts a communicable disease. The employee does not need to meet the length of employment or hours-worked standard set forth in sub. (2) (c).

AB955,12,3 (b) An employer may apply for a grant under s. 16.34 (3) (a).

AB955,24 Section 24 . 103.10 (5) (a) of the statutes is amended to read:

AB955,12,6 103.10 (5) (a) This Except as provided in sub. (4m), this section does not entitle an employee to receive wages or salary while taking family leave or medical leave.

AB955,25 Section 25 . 103.10 (8) of the statutes is amended to read:

AB955,12,11 103.10 (8) Position upon return from leave. (a) Subject to par. (c), when an employee returns from family leave or, medical leave, or paid medical leave as a frontline health care worker, his or her employer shall immediately place the employee in an employment position as follows:

AB955,12,14 1. If the employment position which the employee held immediately before the family leave or, medical leave , or paid medical leave as a frontline health care worker began is vacant when the employee returns, in that position.

AB955,12,19 2. If the employment position which the employee held immediately before the family leave or, medical leave , or paid medical leave as a frontline health care worker began is not vacant when the employee returns, in an equivalent employment position having equivalent compensation, benefits, working shift, hours of employment and other terms and conditions of employment.

AB955,12,23 (b) No employer may, because an employee received family leave or, medical leave, or paid medical leave as a frontline health care worker, reduce or deny an employment benefit which accrued to the employee before his or her leave began or, consistent with sub. (9), accrued after his or her leave began.

AB955,13,3 (c) Notwithstanding par. (a), if an employee on a medical or leave, family leave, or paid medical leave as a frontline health care worker wishes to return to work before the end of the leave as scheduled, the employer shall place the employee in an employment position of the type described in par. (a) 1. or 2. within a reasonable time not exceeding the duration of the leave as scheduled.

AB955,26 Section 26 . 103.10 (9) (a) and (b) of the statutes are amended to read:

AB955,13,10 103.10 (9) (a) Except as provided in par. (b), nothing in this section entitles a returning employee to a right, employment benefit or employment position to which the employee would not have been entitled had he or she not taken family leave or, medical leave, or paid medical leave as a frontline health care worker or to the accrual of any seniority or employment benefit during a period of family leave or, medical leave, or paid medical leave as a frontline health care worker.