AB 311

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 financial 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.

Under current law, certain parents and caretaker relatives with incomes of not

more than 200 percent of the federal poverty line (FPL) are eligible for BC+ benefits.

Beginning on January 1, 2014, the income eligibility level for parents and caretaker

relatives is 100 percent of the FPL before a 5 percent income disregard is applied.

Under current law, adults who are under age 65, who have a family income that does

not exceed 200 percent of the FPL and who are not otherwise eligible for MA,

including BC+, are eligible for benefits under BC+ Core. Beginning January 1, 2014,

only those individuals whose family incomes do not exceed 100 percent of the FPL,

before a 5 percent income disregard is applied, are eligible for BC+ Core. Also,

beginning on January 1, 2014, DHS is not limited to providing only basic primary

and preventive care coverage to recipients of BC+ Core benefits. The biennial

budget,

2013 Wisconsin Act 20

, creates a procedure requiring DHS to maintain

current income eligibility levels for a certain period for parents and caretaker

relatives enrolled in BC+ and for individuals receiving BC+ Core benefits if DHS has

not received certification of an American health benefit exchange, if federal law

requires such certification.

This bill changes the family income eligibility level on January 1, 2014, to up

to 133 percent of the FPL for parents and caretaker relatives under BC+ and for

individuals under BC+ Core. The federal Patient Protection and Affordable Care Act

allows a state to receive an enhanced federal medical assistance percentage (FMAP)

payment for providing benefits to certain individuals through a state's MA program.

The bill requires DHS to comply with all federal requirements and to request any

amendment to the state MA plan, waiver of Medicaid law, or other federal approval

necessary to qualify for the highest available enhanced FMAP for parents and

caretaker relatives and individuals eligible for BC+ Core (collectively nonpregnant,

nonelderly adults). If DHS does not qualify for the enhanced FMAP or if the FMAP

is reduced, DHS is required to submit to the Joint Committee on Finance (JCF) a

fiscal analysis comparing the cost of covering nonpregnant, nonelderly adults under

the MA program at up to 133 percent of the FPL to the cost of reducing income

eligibility to those adults to up to 100 percent of the FPL. DHS may reduce income

eligibility levels for nonpregnant, nonelderly adults to up to 100 percent of the FPL

only if JCF approves.