SB 1

Medical Assistance

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. The 2013-2015 biennial budget

act,

2013 Wisconsin Act 20

(Act 20), makes changes to BC+, BC+ Core, and MA, and

some of those changes are not in effect until January 1, 2014.

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

eligibility requirements, certain individuals are eligible for benefits under the BC+

standard plan. Beginning on January 1, 2014, Act 20 reduces the income eligibility

level for the BC+ standard plan for parents and caretaker relatives from not more

than 200 percent of the federal poverty line (FPL) to not more than 100 percent of

the FPL before a 5 percent income disregard is applied. Act 20 also defines,

beginning on January 1, 2014, for purposes of eligibility of a parent or caretaker

relative, a "dependent child." In addition, Act 20 eliminates the distinction between

self-employment income and other income. This bill delays the effective date of

these changes enacted in Act 20 from January 1, 2014, to April 1, 2014.

Under current law, certain individuals are eligible for benefits under the BC+

Benchmark plan including pregnant women whose family income exceeds 200

percent but does not exceed 300 percent of the FPL and children under one year of

age of those women; certain other pregnant women; children whose family income

exceeds 200 percent but does not exceed 300 percent of the FPL; and parents or

caretaker relatives whose family income includes self-employment income and does

not exceed 200 percent of the FPL under a certain calculation. Act 20, beginning on

January 1, 2014, provides benefits under the standard plan to the pregnant women

and children who are currently eligible for the BC+ Benchmark plan. Under Act 20,

parents and caretaker relatives are covered only under the standard plan. Certain

individuals, under current law, may pay the full member per month cost of coverage

to receive benefits under the Benchmark plan. On January 1, 2014, Act 20

eliminates the ability of children whose family incomes exceed 300 percent of the

FPL to receive Benchmark plan benefits. This bill delays the effective date of these

changes enacted in Act 20 from January 1, 2014, to April 1, 2014.

Under current law, BC+ Core provides basic primary and preventive care to

eligible individuals. Adults who are under age 65, who have family incomes that do