Assembly Bill 1224 aims to establish a publicly financed health care plan for all residents of Wisconsin, including nonresidents employed in the state. The bill mandates the Department of Health Services (DHS) to seek necessary federal waivers to implement this health plan, which will cover medically necessary health services. It prohibits cost-sharing for covered services, except for room and board in skilled nursing facilities, and allows DHS to assess premiums based on income. The bill also creates the office of the ombudsman for patient advocacy within DHS to assist residents in securing health care services and to handle complaints from enrollees.

Additionally, the bill outlines the creation of a health plan fund, which will consist of various sources of revenue, including federal payments and donations. It establishes a framework for health care providers participating in the plan, including payment rates and claims processing. The bill also includes provisions for ensuring that individuals have access to primary care and care coordination, as well as measures for cost control and quality assurance. Once the health plan is operational, the commercial sale of health benefits for services covered under the plan will be prohibited in Wisconsin.

Statutes affected:
Bill Text: 15.01(6), 15.01