AB100-ASA1,500,138 49.46 (1) (a) 14. Any person who would meet the financial and other eligibility
9requirements for home or community-based services under s. 46.27 (11) or, 46.277,
10or 46.2785
but for the fact that the person engages in substantial gainful activity
11under 42 USC 1382c (a) (3), if a waiver under s. 49.45 (38) is in effect or federal law
12permits federal financial participation for medical assistance coverage of the person
13and if funding is available for the person under s. 46.27 (11) or, 46.277, or 46.2785.
AB100-ASA1, s. 1154 14Section 1154. 49.46 (1) (a) 15. of the statutes is amended to read:
AB100-ASA1,500,1715 49.46 (1) (a) 15. Any individual who is infected with tuberculosis and meets the
16income and resource eligibility requirements for the federal supplemental security
17Supplemental Security Income program under 42 USC 1381 to 1383d.
AB100-ASA1, s. 1157 18Section 1157. 49.46 (2) (b) 8. of the statutes is amended to read:
AB100-ASA1,500,2219 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27
20(11), 46.275, 46.277 or, 46.278, or 46.2785, under the family care benefit if a waiver
21is in effect under s. 46.281 (1) (c), or under a waiver requested under 2001 Wisconsin
22Act 16
, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).
AB100-ASA1, s. 1157j 23Section 1157j. 49.46 (2) (f) of the statutes is amended to read:
AB100-ASA1,501,324 49.46 (2) (f) Benefits under this subsection or s. 49.45 (27) may not include
25payment for gastric bypass surgery or gastric stapling surgery unless it is performed

1because of a medical emergency
the procedure is required to be covered under federal
2medicaid law, as interpreted by the federal centers for medicare and medicaid
3services
.
AB100-ASA1, s. 1158 4Section 1158. 49.47 (4) (as) 1. of the statutes is amended to read:
AB100-ASA1,501,95 49.47 (4) (as) 1. The person would meet the financial and other eligibility
6requirements for home or community-based services under s. 46.27 (11) or, 46.277,
7or 46.2785
or under the family care benefit if a waiver is in effect under s. 46.281 (1)
8(c) but for the fact that the person engages in substantial gainful activity under 42
9USC 1382c
(a) (3).
AB100-ASA1, s. 1159 10Section 1159. 49.47 (4) (as) 3. of the statutes is amended to read:
AB100-ASA1,501,1311 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or,
1246.277, or 46.2785 or under the family care benefit if a waiver is in effect under s.
1346.281 (1) (c).
AB100-ASA1, s. 1167 14Section 1167. 49.497 (title) of the statutes is amended to read:
AB100-ASA1,501,16 1549.497 (title) Recovery of incorrect medical assistance Medical
16Assistance or Badger Care
payments.
AB100-ASA1, s. 1168 17Section 1168. 49.497 (1) of the statutes is renumbered 49.497 (1) (a) (intro.)
18and amended to read:
AB100-ASA1,501,2119 49.497 (1) (a) (intro.) The department may recover any payment made
20incorrectly for benefits specified under s. 49.46, 49.468 or 49.47 provided under this
21subchapter or s. 49.665
if the incorrect payment results from any of the following:
AB100-ASA1,501,23 221. A misstatement or omission of fact by a person supplying information in an
23application for benefits under s. 49.46, 49.468 or 49.47 this subchapter or s. 49.665.
AB100-ASA1,502,2 242. The department may also recover if a medical assistance failure of a Medical
25Assistance or Badger Care
recipient or any other person responsible for giving

1information on the recipient's behalf fails to report the receipt of income or assets in
2an amount that would have affected the recipient's eligibility for benefits.
AB100-ASA1,502,9 3(b) The department's right of recovery is against any medical assistance
4Medical Assistance or Badger Care recipient to whom or on whose behalf the
5incorrect payment was made. The extent of recovery is limited to the amount of the
6benefits incorrectly granted. The county department under s. 46.215 or 46.22 or the
7governing body of a federally recognized American Indian tribe administering
8medical assistance Medical Assistance or Badger Care shall begin recovery actions
9on behalf of the department according to rules promulgated by the department.
AB100-ASA1, s. 1169 10Section 1169. 49.497 (1) (a) 3. of the statutes is created to read:
AB100-ASA1,502,1511 49.497 (1) (a) 3. The failure of a Medical Assistance or Badger Care recipient
12or any other person responsible for giving information on the recipient's behalf to
13report any change in the recipient's financial or nonfinancial situation or eligibility
14characteristics that would have affected the recipient's eligibility for benefits or the
15recipient's cost-sharing requirements.
AB100-ASA1, s. 1170 16Section 1170. 49.497 (1m) of the statutes is created to read:
AB100-ASA1,503,217 49.497 (1m) (a) If, after notice that an incorrect payment was made, a recipient,
18or parent of a minor recipient, who is liable for repayment of an incorrect payment
19fails to repay the incorrect payment or enter into, or comply with, an agreement for
20repayment, the department may bring an action to enforce the liability or may issue
21an order to compel payment of the liability. Any person aggrieved by an order issued
22by the department under this paragraph may appeal the order as a contested case
23under ch. 227 by filing with the department a request for a hearing within 30 days
24after the date of the order. The only issue at hearing shall be the determination by

1the department that the person has not repaid the incorrect payment or entered into,
2or complied with, an agreement for repayment.
AB100-ASA1,503,123 (b) If any recipient, or parent of a minor recipient, named in an order to compel
4payment issued under par. (a) fails to pay the department any amount due under the
5terms of the order and no contested case to review the order is pending and the time
6for filing for a contested case review has expired, the department may present a
7certified copy of the order to the circuit court for any county. The sworn statement
8of the secretary shall be evidence of the incorrect payment. The circuit court shall,
9without notice, render judgment in accordance with the order. A judgment rendered
10under this paragraph shall have the same effect and shall be entered in the judgment
11and lien docket and may be enforced in the same manner as if the judgment had been
12rendered in an action tried and determined by the circuit court.
AB100-ASA1,503,1413 (c) The recovery procedure under this subsection is in addition to any other
14recovery procedure authorized by law.
AB100-ASA1, s. 1171 15Section 1171. 49.497 (2) of the statutes is amended to read:
AB100-ASA1,503,1916 49.497 (2) A county or governing body of a federally recognized American
17Indian tribe may retain 15% of benefits distributed under s. 49.46, 49.468 or 49.47
18provided under this subchapter or s. 49.665 that are recovered under sub. (1) this
19section
due to the efforts of an employee or officer of the county or tribe.
AB100-ASA1, s. 1172 20Section 1172. 49.497 (4) of the statutes is created to read:
AB100-ASA1,503,2421 49.497 (4) The department may appear for the state in any and all collection
22matters under this section, and may commence suit in the name of the department
23to recover an incorrect payment from the recipient to whom or on whose behalf it was
24made.
AB100-ASA1, s. 1173 25Section 1173. 49.497 (5) of the statutes is created to read:
AB100-ASA1,504,3
149.497 (5) The department may make an agreement with a recipient, or parent
2of a minor recipient, who is liable under sub. (1), providing for repayment of an
3incorrect payment at a specified rate or amount.
AB100-ASA1, s. 1174 4Section 1174. 49.665 (1) (b) of the statutes is amended to read:
AB100-ASA1,504,65 49.665 (1) (b) "Child" means a person who is born and who is under the age of
619.
AB100-ASA1, s. 1175 7Section 1175. 49.665 (1) (g) of the statutes is created to read:
AB100-ASA1,504,98 49.665 (1) (g) "Unborn child" means a person from the time of conception until
9it is born alive.
AB100-ASA1, s. 1176 10Section 1176. 49.665 (2) (a) of the statutes is renumbered 49.665 (2) (a) 1. and
11amended to read:
AB100-ASA1,504,2212 49.665 (2) (a) 1. The department of health and family services shall request a
13waiver from the secretary of the federal department of health and human services
14to permit the department of health and family services to implement, beginning not
15later than July 1, 1998, or the effective date of the waiver, whichever is later, a health
16care program under this section. If a waiver that is consistent with all of the
17provisions of this section, excluding sub. (4) (a) 3m. and (ap) and provisions related
18to sub. (4) (ap)
, is granted and in effect, the department of health and family services
19shall implement the program under this section, subject to subd. 2. The department
20of health and family services may not implement the program under this section
21unless a waiver that is consistent with all of the provisions of this section, excluding
22sub. (4) (a) 3m. and (ap) and provisions related to sub. (4) (ap), is granted and in effect.
AB100-ASA1, s. 1177 23Section 1177. 49.665 (2) (a) 2. of the statutes is created to read:
AB100-ASA1,505,224 49.665 (2) (a) 2. The department may not implement sub. (4) (ap) or provisions
25related to the coverage under sub. (4) (ap) unless a state plan amendment

1authorizing the coverage under sub. (4) (ap) is approved by the federal department
2of health and human services.
AB100-ASA1, s. 1178 3Section 1178. 49.665 (3) of the statutes is amended to read:
AB100-ASA1,505,164 49.665 (3) Administration. The Subject to sub. (2) (a) 2., the department shall
5administer a program to provide the health services and benefits described in s. 49.46
6(2) to persons that meet the eligibility requirements specified in sub. (4). The
7department shall promulgate rules setting forth the application procedures and
8appeal and grievance procedures. The department may promulgate rules limiting
9access to the program under this section to defined enrollment periods. The
10department may also promulgate rules establishing a method by which the
11department may purchase family coverage offered by the employer of a member of
12an eligible family or by of a member of a an eligible child's household , or family or
13individual coverage offered by the employer of an eligible unborn child's mother or
14her spouse,
under circumstances in which the department determines that
15purchasing that coverage would not be more costly than providing the coverage
16under this section.
AB100-ASA1, s. 1179 17Section 1179. 49.665 (4) (ap) of the statutes is created to read:
AB100-ASA1,505,2218 49.665 (4) (ap) An unborn child whose mother is not eligible for health care
19coverage under par. (a) or (am) or for medical assistance under s. 49.46 or 49.47,
20except that she may be eligible for benefits under s. 49.45 (27), is eligible for health
21care coverage under this section, which shall be limited to coverage for prenatal care,
22if all of the following requirements are met:
AB100-ASA1,506,323 1. The income of the unborn child's mother, mother and her spouse, or mother
24and her family, whichever is applicable, does not exceed 185 percent of the poverty
25line, except as provided in par. (at) and except that, if an unborn child is already

1receiving health care coverage under this section, the applicable specified person or
2persons may have an income that does not exceed 200 percent of the poverty line.
3The department shall establish by rule the criteria to be used to determine income.
AB100-ASA1,506,64 2. Each of the following applicable persons who is employed provides
5verification from his or her employer, in the manner specified by the department, of
6his or her earnings:
AB100-ASA1,506,77 a. The unborn child's mother.
AB100-ASA1,506,88 b. The spouse of the unborn child's mother.
AB100-ASA1,506,99 c. Members of the unborn child's mother's family.
AB100-ASA1,506,1110 3. The unborn child's mother provides medical verification of her pregnancy,
11in the manner specified by the department.
AB100-ASA1,506,1312 4. The unborn child and the mother of the unborn child meet all other
13requirements established by the department by rule except for any of the following:
AB100-ASA1,506,1514a. The mother is not a U.S. citizen or an alien qualifying for medicaid under 8
15USC 1612
.
AB100-ASA1,506,1616 b. The mother is an inmate of a public institution.
AB100-ASA1,506,1817 c. The mother does not provide a social security number, but only if subd. 4. a.
18applies.
AB100-ASA1, s. 1180 19Section 1180. 49.665 (4) (at) 3. of the statutes is amended to read:
AB100-ASA1,506,2320 49.665 (4) (at) 3. The department may not adjust the maximum income level
21of 200% of the poverty line for persons already receiving health care coverage under
22this section or for applicable persons specified in par. (ap) 1. with respect to an unborn
23child already receiving health care coverage under this section
.
AB100-ASA1, s. 1181 24Section 1181. 49.665 (4) (c) of the statutes is amended to read:
AB100-ASA1,507,3
149.665 (4) (c) No person may be denied health care coverage under this section
2solely because of a health condition of that person or , of any family member of that
3person, or of the mother of an unborn child.
AB100-ASA1, s. 1182 4Section 1182. 49.665 (4) (d) of the statutes is created to read:
AB100-ASA1,507,75 49.665 (4) (d) An unborn child's eligibility for coverage under par. (ap) shall not
6begin before the first day of the month in which the unborn child's mother provides
7the medical verification required under par. (ap) 3.
AB100-ASA1, s. 1183 8Section 1183. 49.665 (5) (ag) of the statutes is amended to read:
AB100-ASA1,507,179 49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or a
10child who does not reside with his or her parent, or the mother of an unborn child,
11who receives health care coverage under this section shall pay a percentage of the
12cost of that coverage in accordance with a schedule established by the department
13by rule. The department may not establish or implement a schedule that requires
14a family or child to contribute contribution, including the amounts required under
15par. (am), of more than 5% of the family's or child's income of the family, child, or
16applicable persons specified in sub. (4) (ap) 1.
towards the cost of the health care
17coverage provided under this section.
AB100-ASA1, s. 1184 18Section 1184. 49.665 (5) (am) (intro.) of the statutes is amended to read:
AB100-ASA1,507,2119 49.665 (5) (am) (intro.) Except as provided in pars. (b) and (bm), a child or, a
20family member, or the mother of an unborn child, who receives health care coverage
21under this section shall pay the following cost-sharing amounts:
AB100-ASA1, s. 1184c 22Section 1184c. 49.665 (5) (am) 1. of the statutes is amended to read:
AB100-ASA1,507,2423 49.665 (5) (am) 1. A copayment of $1 $3 for each prescription of a drug that
24bears only a generic name, as defined in s. 450.12 (1) (b).
AB100-ASA1, s. 1185 25Section 1185. 49.665 (5) (b) of the statutes is amended to read:
AB100-ASA1,508,4
149.665 (5) (b) The department may not require a family, or child who does not
2reside with his or her parent, or applicable persons specified in sub. (4) (ap) 1., with
3an income below 150% of the poverty line, to contribute to the cost of health care
4coverage provided under this section.
AB100-ASA1, s. 1186 5Section 1186. 49.665 (5) (c) of the statutes is amended to read:
AB100-ASA1,508,86 49.665 (5) (c) The department may establish by rule requirements for wage
7withholding as a means of collecting the a family's or an unborn child's mother's
8share of the cost of the health care coverage under this section.
AB100-ASA1, s. 1186bc 9Section 1186bc. 49.665 (7) of the statutes is created to read:
AB100-ASA1,508,1310 49.665 (7) Employer verification forms; forfeiture and penalty assessment.
11(a) 1. Notwithstanding sub. (4) (a) 3m., the department shall mail information
12verification forms to the employers of the individuals required to provide the
13verifications under sub. (4) (a) 3m. to obtain the information specified.
AB100-ASA1,508,1714 2. An employer that receives a verification form shall complete the form and
15return it to the department, by mail, with a postmark that is not more than 30
16working days after the date on which the department mailed the form to the
17employer.
AB100-ASA1,508,2318 3. As an alternative to the method under subd. 2., an employer may, within 30
19working days after the date on which the department mailed the form to the
20employer, return the completed form to the department by any electronic means
21approved by the department. The department must be able to determine, or the
22employer must be able to verify, the date on which the form was sent to the
23department electronically.
AB100-ASA1,509,3
1(b) 1. Subject to subd. 3., an employer that does not comply with the
2requirements under par. (a) 2. or 3. shall be required to pay a forfeiture of $50 for each
3verification form not returned in compliance with par. (a) 2. or 3.
AB100-ASA1,509,54 2. Subject to subd. 3., whenever the department imposes a forfeiture under
5subd. 1., the department shall also levy a penalty assessment of $50.
AB100-ASA1,509,106 3. An employer with fewer than 250 employees may not be required to pay more
7than $1,000 in forfeitures and penalty assessments under this paragraph in any
86-month period. An employer with 250 or more employees may not be required to
9pay more than $15,000 in forfeitures and penalty assessments under this paragraph
10in any 6-month period.
AB100-ASA1,509,1311 4. All penalty assessments collected under subd. 2. shall be credited to the
12appropriation account under s. 20.435 (4) (jz) and all forfeitures collected under subd.
131. shall be credited to the common school fund.
AB100-ASA1,509,1714 (c) An employer may contest an assessment of forfeiture or penalty assessment
15under par. (b) by sending a written request for hearing to the division of hearings and
16appeals in the department of administration. Proceedings before the division are
17governed by ch. 227.
AB100-ASA1, s. 1186c 18Section 1186c. 49.665 (7) (a) 1. of the statutes, as created by 2005 Wisconsin
19Act .... (this act), is amended to read:
AB100-ASA1,509,2320 49.665 (7) (a) 1. Notwithstanding sub. (4) (a) 3m. and (ap) 2., the department
21shall mail information verification forms to the employers of the individuals required
22to provide the verifications under sub. (4) (a) 3m. and (ap) 2. to obtain the information
23specified.
AB100-ASA1, s. 1188 24Section 1188. 49.77 (6) of the statutes is created to read:
AB100-ASA1,510,3
149.77 (6) Authority to administer; rules. The department shall administer
2this section and s. 49.775, and may promulgate rules to guide the administration of
3eligibility determinations and benefits payments.
AB100-ASA1, s. 1188d 4Section 1188d. 49.77 (7) of the statutes is created to read:
AB100-ASA1,510,115 49.77 (7) Joint finance supplemental funding. The department may request
6the joint committee on finance to provide supplemental funding under s. 13.101 (3)
7for the appropriation under s. 20.435 (7) (ed) if the department determines that the
8amounts appropriated under s. 20.435 (7) (ed) are insufficient to fully support benefit
9costs under this section. Notwithstanding s. 13.101 (3) (a) 1., the committee may
10provide supplemental funding under this subsection without finding that an
11emergency exists.
AB100-ASA1, s. 1188p 12Section 1188p. 49.775 (2) (bm) of the statutes is amended to read:
AB100-ASA1,510,2113 49.775 (2) (bm) The custodial parent assigns to the state any right of the
14custodial parent or of the dependent child to support from any other person. No
15amount of support that begins to accrue after the individual ceases to receive
16payments under this section may be considered assigned to the state. Any money
17that is received by the department of workforce development under an assignment
18to the state under this paragraph and that is not the federal share of support shall
19be paid to the custodial parent. The department of workforce development shall pay
20the federal share of support assigned under this paragraph as required under federal
21law or waiver.
AB100-ASA1, s. 1189 22Section 1189. 49.78 (8) (a) of the statutes is amended to read:
AB100-ASA1,511,723 49.78 (8) (a) From the appropriation accounts under s. 20.435 (4) (bn) and, (nn),
24and (y)
and subject to par. (b), the department shall reimburse each county and tribal
25governing body that contracts with the department under sub. (2) for reasonable

1costs of administering the income maintenance programs. The amount of each
2reimbursement paid under this paragraph shall be calculated using a formula based
3on workload within the limits of available state and federal funds under s. 20.435 (4)
4(bn) and, (nn), and (y) by contract under sub. (2). The amount of reimbursement
5calculated under this paragraph and par. (b) is in addition to any reimbursement
6provided to a county or tribal governing body for fraud and error reduction under s.
749.197 (1m) and (4) or 49.845.
AB100-ASA1, s. 1189m 8Section 1189m. 49.78 (8) (a) of the statutes, as affected by 2005 Wisconsin Act
9.... (this act), is amended to read:
AB100-ASA1,511,1910 49.78 (8) (a) From the appropriation accounts under s. 20.435 (4) (bn), and (nn),
11and (y)
and subject to par. (b), the department shall reimburse each county and tribal
12governing body that contracts with the department under sub. (2) for reasonable
13costs of administering the income maintenance programs. The amount of each
14reimbursement paid under this paragraph shall be calculated using a formula based
15on workload within the limits of available state and federal funds under s. 20.435 (4)
16(bn), and (nn), and (y) by contract under sub. (2). The amount of reimbursement
17calculated under this paragraph and par. (b) is in addition to any reimbursement
18provided to a county or tribal governing body for fraud and error reduction under s.
1949.197 or 49.845.
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