SB 68

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 MA

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. Certain parents and caretaker

relatives and certain childless adults with incomes of not more than 100 percent of

the federal poverty line (FPL), before a 5 percent income disregard is applied, are

currently eligible for BC + or BC+ Core benefits.

The federal Patient Protection and Affordable Care Act (ACA) creates

American health benefit exchanges through which individuals purchase coverage

under a qualified health plan, which is health insurance that meets certain criteria

under the ACA. Generally, under the ACA, individuals with household incomes

between 100 and 400 percent of the FPL who purchase certain qualified health plans

through the American health benefit exchanges (exchanges) qualify for income tax

credits to subsidize some of the cost of purchasing the qualified health plan.

Qualified health plans may require cost-sharing, such as deductibles or copayments,

and the ACA provides certain individuals who purchase specific plans through an

exchange with reductions in cost-sharing. The ACA also provides financial

assistance through an enhanced federal medical assistance percentage (FMAP) to

states that expand their Medicaid programs. The enhanced FMAP under the ACA

applies to certain newly eligible individuals whose family income level is up to 133

percent of the FPL.

This bill requires DHS to create a premium assistance program to pay

premiums and any cost-sharing amounts to assist eligible parents or caretaker

relatives and eligible childless adults in purchasing coverage through a qualified

health plan offered through an American health benefit exchange. Eligible parents

or caretaker relatives and eligible childless adults are those who would otherwise be

eligible for BC+ or BC+ Core except that their family income exceeds the eligibility

requirements for BC+ or BC+ Core but does not exceed 133 percent of the FPL. The

bill also requires that DHS ensure that individuals who become eligible for BC+ or

BC+ Core while having coverage under a qualified health plan that is offered by an

insurer that also offers a managed care plan for the MA program are allowed to

transition from the qualified health plan to the managed care plan. DHS must also

ensure that eligible parents, caretaker relatives, and childless adults are allowed to

enroll in qualified health plans throughout the year and not solely during open

enrollment periods determined by the federal government.

DHS is required to submit a request for any necessary approval to the federal

government to implement the premium assistance program and to qualify for the

highest available enhanced FMAP for eligible childless adults, parents, and