SB 38

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. Under current law, BC+ provides health and

medical services to eligible recipients and has a standard plan with a larger set of

benefits and a Benchmark plan with fewer benefits. Recipients of standard BC+

benefits may be required to pay certain copayments for services and, with some

exceptions, to pay premiums. Recipients of BC+ under the Benchmark plan have

increased copayments and coinsurance for certain services, and certain recipients

under the Benchmark plan may be charged higher premiums compared to certain

recipients under the standard plan.

Under current law, unless DHS has a policy that conflicts with current state law

eligibility requirements, the following individuals, among others, are eligible for

benefits under the BC+ standard plan: a pregnant women whose family income does

not exceed 200 percent of the federal poverty line (FPL); a child meeting certain

criteria whose family income does not exceed 200 percent of the FPL; a child meeting

certain criteria whose family income exceeds 150 percent of the FPL but the

difference between the actual family income and 150 percent of the FPL is expended

on behalf of a member of the child's family or the child for certain medical or health

reasons; a parent or caretaker relative of a child whose family income does not exceed

200 percent of the FPL; and an individual who qualifies for a transitional extension

of MA benefits even though his or her income increases above the poverty line. The

following individuals, among others, are eligible for benefits under the BC+

Benchmark plan, under current law: a pregnant woman whose family income

exceeds 200 percent, but does not exceed 300 percent, of the FPL; a pregnant woman

and everyone in her family if her family income exceeds 300 percent of the FPL but

the difference between her actual family income and 300 percent of the FPL is

expended for any family member's or her medical or health care; a child whose family

income exceeds 200 percent, but does not exceed 300 percent, of the FPL; and a

parent or caretaker of a child whose income includes self-employment income but

does not exceed 200 percent of the FPL after depreciation is deducted.

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,