Fraud in parental choice programs, Medicaid expansion, eligibility for BadgerCare Plus and BadgerCare Plus Core, and providing a criminal penalty

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 financial resources. Some services are provided through programs that operate under a waiver of federal Medicaid laws, including services provided through the BC+ and BC+ Core programs. Certain parents and caretaker relatives with incomes of not more than 100 percent of the FPL, before a 5 percent income disregard is applied, are eligible for BC+ benefits.

Adults who are under age 65, who have family incomes that do not exceed 100 percent of the FPL, before a 5 percent income disregard is applied, and who are not otherwise eligible for MA, including BC+ (childless adults), are eligible for benefits under BC+ Core.

The federal Patient Protection and Affordable Care Act allows a state to receive an enhanced federal medical assistance percentage (FMAP) payment for providing benefits to certain individuals through a state's MA program. The bill expands the income eligibility level for parents and caretaker relatives under BC+ and for childless adults under BC+ Core. The bill requires DHS to comply with all federal requirements and to submit any amendment to the state MA plan, request for a waiver of Medicaid law, or other federal approval necessary to qualify for the highest available enhanced FMAP for parents and caretaker relatives and childless adults eligible for BC+ Core (collectively nonpregnant, nonelderly adults). If DHS does not qualify for the enhanced FMAP or if the FMAP is reduced, DHS is required to submit to the Joint Committee on Finance (JCF) a fiscal analysis comparing the cost of covering nonpregnant, nonelderly adults under the MA program at up to 133 percent of the FPL to the cost of limiting income eligibility to those adults to up to 100 percent of the FPL. DHS may reduce income eligibility levels for nonpregnant, nonelderly adults to up to 100 percent of the FPL only if JCF approves.