The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss. 49.471, 49.665, and 49.67 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.

At present some recipients of coverage under BadgerCare Plus receive coverage through a benchmark plan under the authority of section 1937 of the Social Security Act. Section 1937 provides authority for States to provide for medical assistance to one or more groups of Medicaid-eligible individuals, specified by the State in an approved state plan amendment, through enrollment in coverage that provides benchmark or benchmark-equivalent health care benefit coverage. Wisconsin first established a benchmark plan effective February 1, 2008.

The populations who are subject to mandatory alternative coverage are (1) Pregnant women and infants with incomes between 200 and 300% of the federal poverty line (FPL), and (2) newborns who are deemed eligible under s. 1902 (e)(4) of the Social Security Act and were born to women with family incomes of 200 to 300% of the FPL, whose eligibility was determined under s. 1902(a)(10)(A)(ii) or s. 1902(a)(10)(C) of the Social Security Act. With this change, individuals who meet those descriptions will instead receive coverage under the Medicaid standard plan, which offers a more generous package of benefits.

Wisconsin is currently working to implement the new federal health care law, the Patient Protection and Affordable Care Act (PPACA). As part of that implementation, the benchmark plan described above will be terminated.

The proposed change is to terminate the benchmark plan described above through which certain individuals receive benefits through the Wisconsin Medicaid program.

The change will be effective January 1, 2014, and will apply to claims with dates of service on or after that date. The change is projected to result in an annual cost of $10.8 million all funds, composed of $4.3 million general purpose revenue (GPR) and $6.5 million federal match (FED).

Copies of documents relating to the proposed change may be obtained free of charge by calling or writing as follows:

Regular Mail:

Al Matano

Bureau of Fiscal Management

Division of Health Care Access and Accountability

P.O. Box 309

Madison, WI 53701-0309

Fax:

(608) 266-1096

Attention: Al Matano

Telephone:

Al Matano

Bureau of Fiscal Management

(608) 267-7939

E-Mail:

alfred.matano@dhs.wisconsin.gov

Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.

Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The e-mail address is alfred.matano@dhs.wisconsin.gov. Regular mail can be sent to the above address. All written comments will be reviewed and considered.

The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.