SB 538

Currently, the Department of Health Services (DHS) administers the Medical

Assistance (MA) program, which is a joint federal and state program that provides

health services to individuals who have limited resources. Some services are

provided through programs that operate under a waiver of federal Medicaid laws,

including services provided through the BadgerCare Plus (BC+) and BadgerCare

Plus Core (BC+ Core) programs. Current law requires DHS to study potential

changes to MA for certain purposes. If DHS determines that revision of existing

statutes or rules would be necessary to advance any of the purposes for which the

study was conducted, DHS may propose a policy to take certain actions including:

modifying existing benefits and offering different benefits packages to different

groups of MA recipients, restricting or eliminating presumptive eligibility, setting

standards for establishing and verifying eligibility requirements; developing

standards and methodologies to assure accurate eligibility determinations and

redetermine continuing eligibility, and reducing income levels for purposes of

determining eligibility. Before implementing a policy that conflicts with a state

statute, DHS must submit to the Joint Committee on Finance (JCF), under the

committee's passive review process, the proposed amendment to the state MA plan

or proposed waiver of federal Medicaid law. If JCF does not reject the proposed plan

amendment or waiver request, DHS must submit the amendment or waiver request

to the federal government, if necessary, to the extent necessary to implement the

policy. If the federal government does not allow the amendment or does not grant

the waiver, DHS may not implement the policy.

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