Changes to BadgerCare Plus and BadgerCare Plus Core programs by the department of health services and by waiver, disallowing certain carry-forward amounts for combined reporting purposes, and making an appropriation

Under current law, BC+ provides health and medical services to eligible recipients and has a standard plan with a larger set of benefits and a Benchmark plan with fewer benefits. Recipients of standard BC+ benefits may be required to pay certain copayments for services. BC+ recipients under the standard plan, with some exceptions, are also required to pay premiums. Recipients of BC+ under the Benchmark plan have increased copayments and coinsurance for certain services and higher premiums compared to recipients under the standard plan.

Under current law, the following individuals, among others, are eligible for benefits under the BC+ standard plan: a pregnant women whose family income does not exceed 200% of the federal poverty line (FPL); a child meeting certain criteria whose family income does not exceed 200% of the FPL; a child meeting certain criteria whose family income exceeds 150% of the FPL but the difference between the actual family income and 150% of the FPL is expended on behalf of a member of the child's family or the child for certain medical or health reasons; a parent or caretaker relative of a child whose family income does not exceed 200% of the FPL; and an individual who qualifies for a transitional extension of MA benefits even though his or her income increases above the poverty line. Except for pregnant women and certain children and other individuals, individuals who are otherwise eligible for BC+ and are also eligible for a group health plan must apply for the group health plan. Those individuals are not eligible for BC+ if their family income exceeds 150% of the FPL and they have, or have had access in the previous 12 months to, health coverage that is either provided by an employer that pays at least 80% of the premium or is the state employee health plan. A child whose family income does not exceed 150% of the FPL, a pregnant woman, and certain others are retroactively eligible for benefits under BC+ for the three months before applying for BC+. A child whose family income does not exceed 150% is also presumptively eligible for BC+.

The following individuals, among others, are eligible for benefits under the BC+ Benchmark plan, under current law: a pregnant woman whose family income exceeds 200%, but does not exceed 300%, of the FPL; a pregnant woman and everyone in her family if her family income exceeds 300% of the FPL but the difference between her actual family income and 300% of the FPL is expended for any family member's or her medical or health care; a child whose family income exceeds 200%, but does not exceed 300%, of the FPL; and a parent or caretaker of a child whose income includes self-employment income but does not exceed 200% of the FPL after depreciation is deducted. A child whose family income exceeds 300% of the FPL and an adult who meets certain criteria are eligible to purchase benefits at the full per member per month cost of coverage through the BC+ Benchmark plan. A pregnant woman whose family income does not exceed 200% of the FPL is presumptively eligible for ambulatory prenatal care benefits under the BC+ standard plan. A pregnant woman whose family income exceeds 200%, but does not exceed 300%, of the FPL is presumptively eligible for ambulatory prenatal care benefits under the BC+ Benchmark plan.

Under current law, DHS also administers BC+ Core, which provides basic primary and preventive care to eligible individuals. Adults who are under age 65, who have family incomes that do not exceed 200% of the FPL, and who are not otherwise eligible for MA, including BC+, are eligible for benefits under BC+ Core.

This bill eliminates the authority of DHS to modify aspects of the BC+ and BC+ Core programs through a policy. If DHS seeks to verify the residency in the state of an applicant for BC+ or BC+ Core as a condition of eligibility, the bill requires that DHS accept any document or other source that reasonably verifies residency in the state. DHS may not require a specific source of verification of residency and may not require as the sole method of verification a government-issued identification card containing a photograph. The bill prohibits DHS from requesting or implementing a waiver of federal Medicaid laws or an amendment to the state MA plan to do any of the following: disqualify from eligibility for BC+ or BC+ Core any individual who has access to employer-sponsored health insurance that does not require a premium exceeding 9.5% of the individual's household income; disqualify from eligibility for BC+ or BC+ Core an adult who has not attained the age of 26 and who has access to coverage under a parent's employer-sponsored health insurance; apply premiums and copayment contributions for BC+ or BC+ Core that are different from or in addition to those required under current law; discontinue transitional MA benefits for those who exceed the income eligibility threshold; restrict eligibility for BC+ or BC+ Core for 12 months to anyone who has refused to pay or has been terminated for nonpayment of a premium for BC+ or BC+ Core; eliminate retroactive or presumptive eligibility; consider the income of all adults living in the household, except for grandparents not receiving MA, for purposes of eligibility for BC+ or BC+ Core; terminate or reduce eligibility within 10 days of a notice to the recipient of BC+ or BC+ Core benefits; reduce the benefits under the BC+ Benchmark plan; or require all non-pregnant individuals who have incomes exceeding 100% of the FPL to enroll in the BC+ Benchmark plan instead of the standard plan. The bill also prohibits DHS from reducing income levels for the purposes of determining eligibility for BC+ or BC+ Core to 133% of the FPL for adults who are not pregnant and not disabled.

Under current law, for each taxable year that a corporation that is a member of a combined group has net business loss carry-forward from a taxable year beginning before January 1, 2009, the corporation may, for 20 taxable years, use up to five percent of the net business loss carry-forward to offset the income of all other members of the combined group. The bill eliminates this provision.