Eliminating certain proposed changes to the Medical Assistance program and BadgerCare Plus that have not been approved by the federal government. (FE)

Under current law, certain children are presumptively eligible for benefits under BC+, meaning that they are eligible for benefits beginning on the day on which a qualified entity determines, based on preliminary information, income eligibility for BC+. Current law allows DHS to refuse to provide presumptive eligibility for those children if the federal DHHS approves. This bill eliminates the ability for DHS to refuse to provide presumptive eligibility.

Under current law, certain individuals are retroactively eligible for BC+ benefits for any of the three months before the month of application for BC+ if the individual met the eligibility criteria in that month. Adults who are not pregnant, not disabled, and not elderly and whose income exceeds 133 of percent of the federal poverty line (FPL) are not eligible retroactively for BC+ under current law. With federal approval, current law allows DHS to eliminate retroactive eligibility for all adults who are not disabled. This bill removes the ability for DHS to eliminate retroactive eligibility for adults other than those whose income exceeds 133 percent of the FPL and who are not pregnant, not disabled, and not elderly.

Certain individuals, under current law, are eligible for transitional MA because of becoming ineligible for another public assistance program. With federal DHHS approval, DHS may charge a premium for certain recipients of transitional MA benefits or eliminates transitional MA benefits. The bill prohibits the charging of a premium for transitional MA benefits and elimination of transitional MA benefits.

Only if the federal DHHS approves, DHS may apply certain calculations to the determination of family income for eligibility for BC+ and BC+ Core. With federal approval, DHS counts, for an individual who is not disabled, the income of all adults residing in the home for at least 60 days excluding the income of certain grandparents. DHS must exclude from a calculation of family size an individual who is only included in the family income calculation, if the federal DHHS approves.

Under the bill, DHS may not perform these special income calculations for BC+ or BC+ Core eligibility determinations.

Under current law, an individual whose family income exceeds 150 percent of the FPL is not eligible for BC+ if, during certain times, the individual has coverage provided by an employer for which the employer pays at least 80 percent of the premium or coverage under the state health plan, or if the individual has access to employer coverage or coverage under the state health plan. Currently, adults who are not disabled and not pregnant and whose family income exceeds 133 percent of the FPL are ineligible for BC+ if, during certain times, the adult has access to individual or family health coverage provided by an employer that does not exceed 9.5 percent of the family's monthly income or access to coverage under the state employer health plan. Current law also adds, if the federal DHHS approves, to the types of individuals for whom access to certain insurance coverage will result in ineligibility all of the following: children who are not disabled and whose family income is at a level set by DHS but no lower than 133 percent of the FPL; adult parents and adult caretaker relatives whose family income is at a level set by DHS but no lower than 100 percent of the FPL; adults, including pregnant women, who are under 26 years of age, who are eligible to be covered under a parent's employers coverage, whose income is at a level determined by DHS but no lower than 100 percent of the FPL, and who meet other qualifications. The bill prohibits DHS from considering ineligible for BC+ due to insurance coverage those type of individuals for whom DHS would need federal DHHS approval to make them ineligible.

Under current law, if the federal DHHS approves, certain individuals are ineligible for BC+ if the insurance coverage to which they have access is private major medical insurance in which the monthly premium does not exceed 9.5 percent of the family's monthly income. The bill eliminates private major medical insurance as a type of insurance coverage for which individuals with access to that coverage are ineligible for BC+.

Under current law, the following individuals who had health insurance coverage but no longer have the coverage are ineligible for BC+ for three months following the month in which the insurance coverage ended without a good cause reason: individuals with a family income that exceeds 150 percent of the FPL; unborn children or mothers of unborn children; certain pregnant women; and adults who are not disabled and not pregnant and whose family income exceeds 133 percent of the FPL. The following individuals are also subject to three months of ineligibility under current law if the federal DHHS approves: individuals who are not disabled and who are children of an individual whose family income is at a level determined by DHS but not lower than 133 percent of the FPL and adult parents or adult caretaker relatives who are not disabled and not pregnant and whose family income is at a level determined by DHS but no lower than 100 percent of the FPL. The bill prohibits DHS from subjecting to a three-month period of ineligibility those individuals for whom imposing eligibility requires approval of the federal DHHS.

Under current law, certain individuals are required to pay premiums for BC+.

If the federal DHHS approves, a child who is not disabled and whose family income is at a level determined by DHS but at least 150 percent of the FPL must pay a premium for BC+. The bill eliminates the ability of DHS to require, with federal approval, a premium for BC+ from children who are not disabled and whose family income is at least 150 percent of the FPL.

Under current law, if an individual who is required to pay a premium does not pay or requests termination of coverage under BC+, the coverage is terminated and the individual is ineligible for BC+ for a specified period. For children, the current ineligibility period is three months, except for any month in which the child's family income does not exceed 150 percent of the FPL. With federal DHHS approval, DHS may apply to children an ineligibility period of up to 12 months. The bill eliminates the ability for DHS to apply to children an ineligibility period longer than three months.

If allowed by the federal DHHS, current law allows DHS to provide to certain adults an alternate benefits package that provides benefits similar to those benefits provided in a commercial, major medical insurance policy. The bill eliminates the ability for DHS to provide such an alternate benefits package.

Current law allows DHS to enroll, with federal DHHS approval, a child who is receiving services though the early intervention program in a special plan. The bill eliminates the special plan in which DHS may enroll children receiving early intervention program services.