SB 363

This bill requires the Department of Health Services to request a waiver or

submit amendments to the state Medical Assistance plan to permit certain

individuals whose income is greater than the income eligibility limit for the

BadgerCare Plus program or the assistance for childless adults demonstration

project to purchase coverage through these programs through a separate purchase

option. The bill also requires DHS to include a request to allow an option for small

businesses to purchase coverage under these programs for their employees.

Currently, DHS administers the Medical Assistance 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 program and the childless adults demonstration project.

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

than 100 percent of the federal poverty line, before a 5 percent income disregard is

applied, are eligible for BadgerCare Plus benefits. Under current law, childless

adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent

of the FPL, before a 5 percent income disregard is applied; and 3) are not otherwise

eligible for Medical Assistance, including BadgerCare Plus, are eligible for benefits

under the assistance for childless adults demonstration project.

This bill requires DHS to request a waiver from or submit amendments to the

state Medical Assistance plan to the secretary of the federal Department of Health

and Human Services that would allow individuals whose income is greater than the

eligibility limit for the BadgerCare Plus or the childless adults demonstration

project, but who otherwise meet the eligibility requirements, to purchase coverage

through a separate purchase option program that meets criteria specified in the bill.

The bill also requires DHS to include a request for any federal waiver or state plan

amendments necessary to allow an option for small businesses to purchase coverage

for their employees as part of the Small Business Health Options Program through

an exchange established under federal law. Under the bill, DHS must submit a

report providing information on the status on the progress of receiving a federal

waiver and the results from actuarial and economic analyses that are necessary for

a waiver proposal. If any necessary waiver or state plan amendments are approved,

DHS must implement the program.

Under the bill, DHS must also seek any federal waiver and state Medical

Assistance plan amendments necessary to allow qualified individuals who choose to

purchase the BadgerCare Plus option or the childless adults demonstration project

option to use advanced tax credits and cost-sharing credits, if eligible, to purchase

one of these options. If DHS is authorized to implement the program, and if 1) any

waiver or state plan amendment is necessary and is approved or 2) DHS determines

neither a waiver nor state plan amendment is necessary, DHS shall allow the use of