Medicaid expansion, eligibility, and other changes to BadgerCare Plus, and making appropriations. (FE)

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.

Under current law, certain individuals are eligible for transitional MA benefits.

Current law allows DHS to charge a premium to a recipient of continued transitional MA benefits whose income exceeds 100 percent of the FPL if the federal Department of Health and Human Services (federal DHHS) allows. This bill eliminates the ability for DHS to charge a premium to individuals receiving continued transitional MA benefits.

Before the effective date of 2013 Wisconsin Act 20 , a child whose premium for BC+ is unpaid is not eligible for BC+ for six months except for any month the child's family income does not exceed 150 percent of the FPL. Under current law, under 2013 Wisconsin Act 20 , the ineligibility period for a child for nonpayment of a BC+ premium is three months, or up to 12 months if the federal DHHS approves, except for any month in which the child's family income does not exceed 150 percent of the FPL. That ineligibility period does not apply to a child who has paid the outstanding premiums. This bill returns the ineligibility period for nonpayment of BC+ premiums for a child to six months, except for any month in which the child's family income does not exceed 150 percent of the FPL. Under the bill, DHS is no longer allowed to apply an ineligibility period of longer than six months with federal DHHS approval.