SB 174

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 BadgerCare Plus (BC+) and BadgerCare

Plus Core (BC+ Core) programs.

Under current law, certain parents and caretaker relatives with incomes of not

more than 100 percent of the federal poverty line (FPL), before a 5 percent income

disregard is applied, are eligible for BC+ benefits. Under current law, 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.

This bill changes the family income eligibility level to up to 133 percent of the

FPL for parents and caretaker relatives under BC+ and for childless adults 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

requires DHS to comply with all federal requirements and to request any

amendment to the state MA plan, 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.