Medical Assistance for certain adults who are not currently eligible for traditional Medicaid or BadgerCare Plus. (FE)

Under current law, DHS also administers BC+ Core, which provides basic primary and preventive care to eligible individuals. Adults who are under age 65, who have family incomes that do not exceed 200 percent of the FPL, and who are not otherwise eligible for MA, including BC+, are eligible for benefits under BC+ Core, unless DHS has a policy that conflicts with current state law eligibility requirements.

DHS also currently administers the BadgerCare Plus Basic (BC+ Basic) plan, which is not an MA program but is funded by premiums paid by plan participants.

To be eligible for the BC+ Basic plan, an individual must be on the waiting list for BC+ Core. BC+ Basic provides health care benefits that do not exceed those benefits provided by BC+ Core. Under current law, BC+ Basic terminates on January 1, 2014.

Currently, beginning on January 1, 2014, the federal Patient Protection and Affordable Care Act (PPACA) requires states that participate in the Medicaid program to offer medical assistance benefits to adults who are under 65 years of age, are not pregnant, are not entitled to Medicare benefits, are not otherwise eligible for Medicaid, and have an income, as calculated under a specified method, that does not exceed 133 percent of the FPL (expansion population). PPACA requires the state to provide benefits to the expansion population that meet the standards of benchmark coverage as defined in PPACA. The federal Department of Health and Human Services (federal DHHS) pays a matching rate, known as the federal medical assistance percentage or FMAP, to states that participate in the Medicaid program.

PPACA creates enhanced FMAPs, which are rates that are higher than the typical matching rate, for states to cover newly eligible individuals in the expansion population and for states that already covered certain individuals in the expansion population to cover the entire expansion population. The United States Supreme Court decision, in National Federation of Independent Business v. Sebelius , 567 U.S.

___, 132 S. Ct. 2566 (2012), makes coverage of the expansion population by states optional instead of mandatory.

This bill makes adults who are under 65 years of age, who are not pregnant, who are not otherwise eligible for MA under the state's traditional MA program or BC+, and whose income, as determined under federal law, do not exceed 133 percent of the FPL (Wisconsin expansion population) eligible for the BC+ Benchmark plan beginning January 1, 2014. The bill also eliminates BC+ Core and the language regarding BC+ Basic.

The bill requires that, if the benefits under the BC+ Benchmark plan are not sufficient to qualify DHS to obtain an enhanced FMAP, DHS must provide coverage that complies with PPACA in order to qualify for an enhanced FMAP. Additionally, if the federal DHHS prohibits charging a copayment or premium to the Wisconsin expansion population in order to qualify for an enhanced FMAP, DHS may not charge copayments or premiums that disqualify DHS from obtaining an enhanced FMAP.