BadgerCare Plus (BC+) is a Medical Assistance (MA) program that was
approved in the biennial budget act. BC+, which will be administered by the
Department of Health and Family Services (DHFS), provides health care benefits
under two different plans, depending on the basis for a recipient's eligibility, to
recipients who satisfy financial and nonfinancial eligibility criteria. The first plan

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provides the same benefits that are provided under regular MA. Individuals eligible
for BC+ benefits under that plan (regular MA plan) include: a pregnant woman
whose family income does not exceed 200 percent of the poverty level (poverty); a
child under one year of age whose mother, on the day on which the child was born,
was eligible for and receiving benefits under MA or BC+ under the regular MA plan;
any child whose family income does not exceed 200 percent of poverty; an individual
whose family income does not exceed 200 percent of poverty and who is the parent
or caretaker relative of a child who is, generally, living in the home of the parent or
caretaker relative; certain migrant workers and their dependents; and an individual
between 18 and 21 years of age who was in foster care on his or her 18th birthday.

The second plan, called the Benchmark Plan, provides specified benefits,
including, but not limited to, coverage for prescription drugs; physicians' services;
inpatient and outpatient hospital services; home health services; physical,
occupational, and speech therapy; treatment for nervous and mental disorders and
alcoholism and other drug abuse problems; durable medical equipment; and
transportation to obtain emergency medical care. Individuals eligible for BC+
benefits under the Benchmark Plan include: a pregnant woman whose family income
exceeds 200 percent, but does not exceed 300 percent, of poverty; a child under one
year of age whose mother, on the day on which the child was born, was eligible for
and receiving BC+ benefits under the Benchmark Plan; any child whose family
income exceeds 200 percent, but does not exceed 300 percent, of poverty; and an
individual whose family income exceeds 200 percent, but does not exceed 300
percent, of poverty and who is the parent or caretaker relative of a child who is,
generally, living in the home of the parent or caretaker relative. In addition, any
child whose family income exceeds 300 percent of poverty may purchase coverage
under the Benchmark Plan at the full per member per month cost of the coverage.

This bill makes a number of changes to BC+, including the following:

1) Specifies that DHFS will provide prenatal care services under the regular
MA plan for a pregnant woman with presumptive eligibility (has not applied for
benefits but satisfies the eligibility criteria) whose income is not greater than 200
percent of the poverty level (poverty) and will provide prenatal care services under
the Benchmark Plan for a pregnant woman with presumptive eligibility whose
income is greater than 200 percent but not greater than 300 percent of poverty.

2) Specifies that any pregnant woman is eligible for benefits for any of the three
months before applying for benefits if she met the eligibility criteria during that
month. Under current law, only a pregnant woman whose income is less than 150
percent of poverty is eligible for benefits for any of the three months before she
applied for benefits.

3) Specifies that only a pregnant woman with income greater than 300 percent
of poverty may obtain eligibility for BC+ benefits if medical expenses reduce her
income to the applicable limit for eligibility. Current law provides that any pregnant
woman or unborn child may obtain eligibility if medical expenses reduce income.

4) Provides that for determining financial eligibility, a person's income will be
reduced by the amount of a court-ordered obligation, up to amount of the person's
income. Current law reduces income by the amount the person pays in child support.

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5) Provides that a person who loses eligibility for six months for failure to pay
a premium retains eligibility in any month during that six-month period when their
family income is not more than 150 percent of poverty.

6) Extends eligibility for MA coverage for 12, rather than 18, months for a
person over 18 years of age who was receiving MA when BC+ was implemented, who
lost eligibility for MA solely because of the implementation of BC+, and who does not
meet the income eligibility criteria of BC+.

7) Clarifies that a parent or caretaker relative of a child may be eligible for BC+
if the child is absent from the home but the parent or caretaker relative is complying
with a permanency plan prepared under the juvenile justice code provisions of the
statutes, as well as under the children's code provisions of the statutes.

8) Provides that certain persons who are eligible for an extension of MA benefits
when their household incomes increase above poverty are eligible for BC+ benefits
under the regular MA plan, are not required to pay a premium for the extension of
benefits, and do not lose eligibility due to having access to employer-sponsored
health insurance.

9) Clarifies that a child whose family income exceeds 150 percent of poverty and
who may obtain eligibility if the difference between his or her family income and 150
percent of poverty is obligated or expended for medical care or health insurance
premiums is one who is ineligible solely for reasons related to having certain types
of access to certain types of health insurance coverage.

10) Provides that, if approval of the state plan amendments do not allow for
federal funding for benefits for any part or all of one or more of the eligibility groups,
DHFS may in its discretion pay for benefits for any part of any group for which
federal funding is denied with moneys from a specified general purpose revenue
appropriation.