LRB-5052/1
PJK & TAY:jlg:km
1997 - 1998 LEGISLATURE
March 5, 1998 - Introduced by Representatives Musser, Porter, Owens,
Ziegelbauer, Brandemuehl, Hasenohrl and Jensen. Referred to Committee
on Insurance, Securities and Corporate Policy.
AB888,1,2
1An Act to create 49.45 (24t) of the statutes;
relating to: medical assistance
2accounts.
Analysis by the Legislative Reference Bureau
Under current law, the department of health and family services (DHFS)
administers the medical assistance (MA) program under which certain low-income
persons are entitled to health care coverage. Currently, health services under MA
are delivered either on a fee for service basis or through a health maintenance
organization with which DHFS contracts.
This bill requires DHFS to submit to the cochairpersons of the joint committee
on finance (committee) a plan for a medical assistance account. If the committee
approves the plan, DHFS is required to seek a waiver from the secretary of the
federal department of health and human services to permit DHFS to establish a
medical assistance account pilot project. The bill sets out certain features that must
be included in the pilot project.
Participants in the pilot project must be eligible for MA. DHFS must contract
with at least 2 insurers to provide a high-deductible, catastrophic health insurance
policy to each participating individual or family. DHFS must pay the premiums and
annual deductible under a policy, and must establish a medical assistance account
for each participant. A participant may use moneys in the account to pay for health
care services. At the end of each year, a participant may leave any remaining moneys
in the account to be carried over to the next year or may receive a voucher for 50%
of any remaining moneys to be used for education, job training or child care.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB888, s. 1
1Section
1. 49.45 (24t) of the statutes is created to read:
AB888,2,172
49.45
(24t) Medical assistance account pilot. (a) Not later than November
31, 1998, the department shall submit to the joint committee on finance a plan for a
4medical assistance account pilot project that meets the requirements under par. (b).
5If the cochairpersons of the committee do not, within 14 working days after the date
6of the department's submittal, notify the department that the committee has
7scheduled a meeting for the purpose of reviewing the proposed plan, the department
8shall request a waiver from the secretary of the federal department of health and
9human services to implement the plan and, if a federal waiver is granted and in
10effect, the department of health and family services shall implement the plan. If
11within 14 working days after the date of the department's submittal the
12cochairpersons of the committee notify the department that the committee has
13scheduled a meeting for the purpose of reviewing the proposed plan, the department
14shall, after the review, request a waiver from the secretary of the federal department
15of health and human services to implement the plan as modified, if at all, by the
16committee. If a waiver is granted and in effect, the department of health and family
17services shall implement the plan.
AB888,2,1918
(b) To the extent permitted by federal law or waiver, the medical assistance
19account pilot project shall include at least all of the following elements:
AB888,3,3
11. The department shall determine eligibility for participation in the pilot
2project from among individuals and families eligible for medical assistance.
3Participation by eligible individuals and families shall be on a voluntary basis.
AB888,3,64
2. A participant shall receive health care through coverage under a
5high-deductible, catastrophic health insurance policy, in conjunction with a medical
6assistance account.
AB888,3,107
3. The department shall contract with at least 2 insurers authorized to do
8business in this state in one or more lines of insurance, including health insurance,
9to provide the high-deductible, catastrophic health insurance policies to
10participants.
AB888,3,1311
4. On behalf of a participant, the department shall pay the policy premiums and
12the annual deductibles. The premiums shall be paid directly to the insurers and the
13annual deductibles shall be paid directly to health care providers.
AB888,3,1714
5. The department shall determine the benefits and the deductibles under the
15health insurance policies. Annual deductibles may not be less than $500 nor more
16than $1,000 for a participating individual, and may not be less than $1,000 nor more
17than $2,500 for a participating family.
AB888,3,2118
6. On behalf of a participant, the department shall establish a medical
19assistance account, which may be used by the participant to pay for health care
20services. The department may consolidate all medical assistance accounts into one
21account for investment purposes.
AB888,3,2522
7. The department shall determine the amount that will be allocated to a
23medical assistance account, the purposes for which moneys in the account may be
24used by a participant and the methods by which moneys will be deducted from an
25account when health care services are purchased by a participant.
AB888,4,6
18. At the end of each year, a participant shall have the option of leaving any
2moneys remaining in the account for carrying over to the next year or receiving a
3voucher for 50% of any moneys remaining in the account for use by the participant
4for education, job training or child care purposes. The department shall set a time
5limit for use of a voucher such that the voucher is forfeited if not used within the time
6set.
AB888,4,127
9. The department shall specify the circumstances under which a medical
8assistance account is terminated, including the death of a participating individual
9or ineligibility of a participating individual or family, and the disposition of any
10moneys remaining in the account. Any participant that voluntarily terminates
11participation in the pilot project and that receives a refund of any moneys in the
12participant's account shall be prohibited from participation for at least one year.
