AB100, s. 1156 14Section 1156. 49.46 (2) (b) 3. b. of the statutes is created to read:
AB100,562,1815 49.46 (2) (b) 3. b. To obtain nonemergency medical services, except as provided
16in subd. 3. a., appropriate transportation that is provided through an entity with
17which the department has contracted to manage transportation services for the
18Medical Assistance program.
AB100, s. 1157 19Section 1157. 49.46 (2) (b) 8. of the statutes is amended to read:
AB100,562,2320 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27
21(11), 46.275, 46.277 or, 46.278, or 46.2785, under the family care benefit if a waiver
22is in effect under s. 46.281 (1) (c), or under a waiver requested under 2001 Wisconsin
23Act 16
, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).
AB100, s. 1158 24Section 1158. 49.47 (4) (as) 1. of the statutes is amended to read:
AB100,563,5
149.47 (4) (as) 1. The person would meet the financial and other eligibility
2requirements for home or community-based services under s. 46.27 (11) or, 46.277,
3or 46.2785
or under the family care benefit if a waiver is in effect under s. 46.281 (1)
4(c) but for the fact that the person engages in substantial gainful activity under 42
5USC 1382c
(a) (3).
AB100, s. 1159 6Section 1159. 49.47 (4) (as) 3. of the statutes is amended to read:
AB100,563,97 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or,
846.277, or 46.2785 or under the family care benefit if a waiver is in effect under s.
946.281 (1) (c).
AB100, s. 1160 10Section 1160. 49.472 (6) (a) of the statutes is amended to read:
AB100,563,1611 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
12under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department shall, on the part of an
13individual who is eligible for medical assistance under sub. (3), pay premiums for or
14purchase individual coverage offered by the individual's employer if the department
15determines that paying the premiums for or purchasing the coverage will not be more
16costly than providing medical assistance.
AB100, s. 1161 17Section 1161 . 49.472 (6) (a) of the statutes, as affected by 2005 Wisconsin Act
18.... (this act), is amended to read:
AB100,563,2419 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
20under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department shall, on the part of an
21individual who is eligible for medical assistance under sub. (3), pay premiums for or
22purchase individual coverage offered by the individual's employer if the department
23determines that paying the premiums for or purchasing the coverage will not be more
24costly than providing medical assistance.
AB100, s. 1162 25Section 1162. 49.472 (6) (b) of the statutes is amended to read:
AB100,564,4
149.472 (6) (b) If federal financial participation is available, from the
2appropriation account under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department
3may pay medicare Medicare Part A and Part B premiums for individuals who are
4eligible for medicare Medicare and for medical assistance under sub. (3).
AB100, s. 1163 5Section 1163 . 49.472 (6) (b) of the statutes, as affected by 2005 Wisconsin Act
6.... (this act), is amended to read:
AB100,564,107 49.472 (6) (b) If federal financial participation is available, from the
8appropriation account under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department
9may pay Medicare Part A and Part B premiums for individuals who are eligible for
10Medicare and for medical assistance under sub. (3).
AB100, s. 1164 11Section 1164. 49.473 (5) of the statutes is amended to read:
AB100,564,1612 49.473 (5) The department shall audit and pay, from the appropriation
13accounts under s. 20.435 (4) (b), (gp), and (o), (r), and (rg) allowable charges to a
14provider who is certified under s. 49.45 (2) (a) 11. for medical assistance Medical
15Assistance
on behalf of a woman who meets the requirements under sub. (2) for all
16benefits and services specified under s. 49.46 (2).
AB100, s. 1165 17Section 1165 . 49.473 (5) of the statutes, as affected by 2005 Wisconsin Act ....
18(this act), is amended to read:
AB100,564,2319 49.473 (5) The department shall audit and pay, from the appropriation
20accounts under s. 20.435 (4) (b), (gp), (o), and (r), and (rg) allowable charges to a
21provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of
22a woman who meets the requirements under sub. (2) for all benefits and services
23specified under s. 49.46 (2).
AB100, s. 1166 24Section 1166. 49.475 (6) of the statutes is created to read:
AB100,565,10
149.475 (6) Sharing information. The department of health and family services
2shall provide to the department of workforce development, for purposes of the
3medical support liability program under s. 49.22, any information that the
4department of health and family services receives under this section. The
5department of workforce development may allow a county child support agency
6under s. 59.53 (5) or a tribal child support agency access to the information, subject
7to the use and disclosure restrictions under s. 49.83, and shall consult with the
8department of health and family services regarding procedures and methods to
9adequately safeguard the confidentiality of the information provided under this
10subsection.
AB100, s. 1167 11Section 1167. 49.497 (title) of the statutes is amended to read:
AB100,565,13 1249.497 (title) Recovery of incorrect medical assistance Medical
13Assistance or Badger Care
payments.
AB100, s. 1168 14Section 1168. 49.497 (1) of the statutes is renumbered 49.497 (1) (a) (intro.)
15and amended to read:
AB100,565,1816 49.497 (1) (a) (intro.) The department may recover any payment made
17incorrectly for benefits specified under s. 49.46, 49.468 or 49.47 provided under this
18subchapter or s. 49.665
if the incorrect payment results from any of the following:
AB100,565,20 191. A misstatement or omission of fact by a person supplying information in an
20application for benefits under s. 49.46, 49.468 or 49.47 this subchapter or s. 49.665.
AB100,565,24 212. The department may also recover if a medical assistance failure of a Medical
22Assistance or Badger Care
recipient or any other person responsible for giving
23information on the recipient's behalf fails to report the receipt of income or assets in
24an amount that would have affected the recipient's eligibility for benefits.
AB100,566,7
1(b) The department's right of recovery is against any medical assistance
2Medical Assistance or Badger Care recipient to whom or on whose behalf the
3incorrect payment was made. The extent of recovery is limited to the amount of the
4benefits incorrectly granted. The county department under s. 46.215 or 46.22 or the
5governing body of a federally recognized American Indian tribe administering
6medical assistance Medical Assistance or Badger Care shall begin recovery actions
7on behalf of the department according to rules promulgated by the department.
AB100, s. 1169 8Section 1169. 49.497 (1) (a) 3. of the statutes is created to read:
AB100,566,139 49.497 (1) (a) 3. The failure of a Medical Assistance or Badger Care recipient
10or any other person responsible for giving information on the recipient's behalf to
11report any change in the recipient's financial or nonfinancial situation or eligibility
12characteristics that would have affected the recipient's eligibility for benefits or the
13recipient's cost-sharing requirements.
AB100, s. 1170 14Section 1170. 49.497 (1m) of the statutes is created to read:
AB100,566,2415 49.497 (1m) (a) If, after notice that an incorrect payment was made, a recipient,
16or parent of a minor recipient, who is liable for repayment of an incorrect payment
17fails to repay the incorrect payment or enter into, or comply with, an agreement for
18repayment, the department may bring an action to enforce the liability or may issue
19an order to compel payment of the liability. Any person aggrieved by an order issued
20by the department under this paragraph may appeal the order as a contested case
21under ch. 227 by filing with the department a request for a hearing within 30 days
22after the date of the order. The only issue at hearing shall be the determination by
23the department that the person has not repaid the incorrect payment or entered into,
24or complied with, an agreement for repayment.
AB100,567,10
1(b) If any recipient, or parent of a minor recipient, named in an order to compel
2payment issued under par. (a) fails to pay the department any amount due under the
3terms of the order and no contested case to review the order is pending and the time
4for filing for a contested case review has expired, the department may present a
5certified copy of the order to the circuit court for any county. The sworn statement
6of the secretary shall be evidence of the incorrect payment. The circuit court shall,
7without notice, render judgment in accordance with the order. A judgment rendered
8under this paragraph shall have the same effect and shall be entered in the judgment
9and lien docket and may be enforced in the same manner as if the judgment had been
10rendered in an action tried and determined by the circuit court.
AB100,567,1211 (c) The recovery procedure under this subsection is in addition to any other
12recovery procedure authorized by law.
AB100, s. 1171 13Section 1171. 49.497 (2) of the statutes is amended to read:
AB100,567,1714 49.497 (2) A county or governing body of a federally recognized American
15Indian tribe may retain 15% of benefits distributed under s. 49.46, 49.468 or 49.47
16provided under this subchapter or s. 49.665 that are recovered under sub. (1) this
17section
due to the efforts of an employee or officer of the county or tribe.
AB100, s. 1172 18Section 1172. 49.497 (4) of the statutes is created to read:
AB100,567,2219 49.497 (4) The department may appear for the state in any and all collection
20matters under this section, and may commence suit in the name of the department
21to recover an incorrect payment from the recipient to whom or on whose behalf it was
22made.
AB100, s. 1173 23Section 1173. 49.497 (5) of the statutes is created to read:
AB100,568,3
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, s. 1174 4Section 1174. 49.665 (1) (b) of the statutes is amended to read:
AB100,568,65 49.665 (1) (b) "Child" means a person who is born and who is under the age of
619.
AB100, s. 1175 7Section 1175. 49.665 (1) (g) of the statutes is created to read:
AB100,568,98 49.665 (1) (g) "Unborn child" means a person from the time of conception until
9it is born alive.
AB100, s. 1176 10Section 1176. 49.665 (2) (a) of the statutes is renumbered 49.665 (2) (a) 1. and
11amended to read:
AB100,568,2212 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, s. 1177 23Section 1177. 49.665 (2) (a) 2. of the statutes is created to read:
AB100,569,224 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, s. 1178 3Section 1178. 49.665 (3) of the statutes is amended to read:
AB100,569,164 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, s. 1179 17Section 1179. 49.665 (4) (ap) of the statutes is created to read:
AB100,569,2218 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:
AB100,570,323 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.
AB100,570,64 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:
AB100,570,77 a. The unborn child's mother.
AB100,570,88 b. The spouse of the unborn child's mother.
AB100,570,99 c. Members of the unborn child's mother's family.
AB100,570,1110 3. The unborn child's mother provides medical verification of her pregnancy,
11in the manner specified by the department.
AB100,570,1312 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:
AB100,570,1514a. The mother is not a U.S. citizen or an alien qualifying for medicaid under 8
15USC 1612
.
AB100,570,1616 b. The mother is an inmate of a public institution.
AB100,570,1817 c. The mother does not provide a social security number, but only if subd. 4. a.
18applies.
AB100, s. 1180 19Section 1180. 49.665 (4) (at) 3. of the statutes is amended to read:
AB100,570,2320 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, s. 1181 24Section 1181. 49.665 (4) (c) of the statutes is amended to read:
AB100,571,3
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, s. 1182 4Section 1182. 49.665 (4) (d) of the statutes is created to read:
AB100,571,75 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, s. 1183 8Section 1183. 49.665 (5) (ag) of the statutes is amended to read:
AB100,571,179 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, s. 1184 18Section 1184. 49.665 (5) (am) (intro.) of the statutes is amended to read:
AB100,571,2119 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, s. 1185 22Section 1185. 49.665 (5) (b) of the statutes is amended to read:
AB100,572,223 49.665 (5) (b) The department may not require a family, or child who does not
24reside with his or her parent, or applicable persons specified in sub. (4) (ap) 1., with

1an income below 150% of the poverty line, to contribute to the cost of health care
2coverage provided under this section.
AB100, s. 1186 3Section 1186. 49.665 (5) (c) of the statutes is amended to read:
AB100,572,64 49.665 (5) (c) The department may establish by rule requirements for wage
5withholding as a means of collecting the a family's or an unborn child's mother's
6share of the cost of the health care coverage under this section.
AB100, s. 1187 7Section 1187. 49.688 (1) (e) of the statutes is amended to read:
AB100,572,118 49.688 (1) (e) "Program payment rate" means the rate of payment made for the
9identical drug specified under s. 49.46 (2) (b) 6. h., plus 5%, plus a dispensing fee that
10is equal to the dispensing fee permitted to be charged for prescription drugs for which
11coverage is provided under s. 49.46 (2) (b) 6. h.
AB100, s. 1188 12Section 1188. 49.77 (6) of the statutes is created to read:
AB100,572,1513 49.77 (6) Authority to administer; rules. The department shall administer
14this section and s. 49.775, and may promulgate rules to guide the administration of
15eligibility determinations and benefits payments.
AB100, s. 1189 16Section 1189. 49.78 (8) (a) of the statutes is amended to read:
AB100,573,217 49.78 (8) (a) From the appropriation accounts under s. 20.435 (4) (bn) and (nn)
18and subject to par. (b), the department shall reimburse each county and tribal
19governing body that contracts with the department under sub. (2) for reasonable
20costs of administering the income maintenance programs. The amount of each
21reimbursement paid under this paragraph shall be calculated using a formula based
22on workload within the limits of available state and federal funds under s. 20.435 (4)
23(bn) and (nn) by contract under sub. (2). The amount of reimbursement calculated
24under this paragraph and par. (b) is in addition to any reimbursement provided to

1a county or tribal governing body for fraud and error reduction under s. 49.197 (1m)
2and (4)
or 49.845.
AB100, s. 1190 3Section 1190. 49.78 (11) of the statutes is created to read:
AB100,573,164 49.78 (11) Requirement to provide information. (a) 1. The department, a
5county department under s. 46.215, 46.22, or 46.23, or a tribal governing body may
6request from any person in this state information it determines appropriate and
7necessary for determining or verifying eligibility or benefits for a recipient under any
8income maintenance program. Unless access to the information is prohibited or
9restricted by law, or unless the person has good cause, as determined by the
10department in accordance with federal law and regulations, for refusing to
11cooperate, the person shall make a good faith effort to provide the information within
127 days after receiving a request under this paragraph. The department, county
13department, or tribal governing body, or employees of any of them, may not disclose
14information obtained under this subdivision for any purpose not connected with the
15administration of the income maintenance program for which the information was
16requested.
AB100,573,2017 2. In conjunction with any request for information under subd. 1., including a
18request made by subpoena under par. (b), the department, county department, or
19tribal governing body shall advise the person of the time by which the information
20must be provided.
AB100,573,2521 (b) The department, a county department, or a tribal governing body may issue
22a subpoena, in substantially the form authorized under s. 885.02, to compel the
23production of financial information or other documentary evidence for determining
24or verifying eligibility or benefits for a recipient under any income maintenance
25program.
AB100,574,1
1(c) A person is not liable to any person for any of the following:
AB100,574,42 1. Allowing access to financial or other records by the department, a county
3department, or a tribal governing body in response to a request under par. (a) or a
4subpoena described in par. (b).
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