AB 1153

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 FPL. 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 exchange but uses the federal platform, known as HealthCare.gov, to handle eligibility and enrollment functions. Wisconsin currently uses the federally facilitated exchange. The bill authorizes OCI to enter into any agreement with the federal government necessary to implement the state-based exchange provisions.