SB 717

This bill requires the Department of Health Services to request federal

approval to permit certain individuals whose income is greater than the income

eligibility limit for the BadgerCare program, but who otherwise meet the eligibility

requirements, to purchase coverage through BadgerCare through a separate

purchase option that meets criteria specified in the bill, including having a premium

rate similar to the average rate paid by the state to managed care plan contractors

and a minimum actuarial value of 87 percent. The bill also requires DHS to include

an option for small groups of 50 employees or fewer to purchase coverage for group

members under the purchase program under the bill. The bill requires DHS to

submit a report providing information on the status 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. The bill also requires DHS to seek any federal waiver

and state Medical Assistance plan amendments necessary to allow qualified

individuals who choose to purchase the BadgerCare option to use advanced tax

credits and cost-sharing credits, if eligible, to purchase one of these options.

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 program. 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 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 are eligible, under a

demonstration project, for BadgerCare benefits.

The bill requires DHS to develop a plan and request federal approval to create

a basic health plan that complies with the federal Patient Protection and Affordable

Care Act. The basic health plan must cover individuals whose household income

does not exceed 200 percent of the federal poverty line. The ACA allows states to

create such a basic health program.

This bill directs the Office of the Commissioner of Insurance to establish and

operate a state-based health insurance exchange, which must also include access to

the ability to enroll in the purchase option for BadgerCare. Under current law, the

ACA requires that an exchange be established in each state to facilitate the purchase

of qualified health insurance coverage by individuals and small employers. Under

the ACA, a state must operate its own state-based exchange, use the federally

facilitated exchange operated by the U.S. Department of Health and Human

Services, or adopt a hybrid approach under which the state operates a state-based