AB 365

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 the MA state plan and waivers of federal Medicaid law 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 that would add to or change current law regarding the MA

program. Before implementing a policy that conflicts with a state statute, DHS must

submit the proposed change to the Joint Committee on Finance (JCF). If the

proposed change is not rejected by JCF, DHS must submit to the federal Department

of Health and Human Services (federal DHHS) the amendment or waiver request,

to the extent necessary to implement its policy. If the federal DHHS does not allow

the amendment or does not grant the waiver, DHS may not implement the policy.

Currently, DHS has proposed changes that, having not been rejected by JCF, have

been submitted to the federal DHHS for approval. Some of these changes pertain to

BC+ and BC+ Core and may have been implemented following approval by the

federal DHHS. Some of these changes have not yet received approval by the federal

DHHS, and these proposed changes are incorporated into the statutes in

2013

Wisconsin Act 20

, pending federal approval. This bill eliminates some of those

changes.

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.