Amendment ASA1-AB591

AB591-ASA1,61,16 (b) The department may review a decision of a Wisconsin works agency under par. (a).

AB591-ASA1, s. 91 Section 91. 49.153 of the statutes is created to read:

AB591-ASA1,61,18 49.153 Wisconsin works health plan. (1) Definitions. In this section:

AB591-ASA1,61,22 (a) "Employer-subsidized health care coverage" means health care coverage offered by the employer for which the employer pays at least 50% of the cost of coverage for the employe, including dependent coverage, or a higher percentage as determined by the department by rule.

AB591-ASA1,61,25 (b) "Unsubsidized employer-offered health care coverage" means health care coverage offered by the employer for which the employer pays less than 50% of the cost of coverage for the employe including dependent coverage.

AB591-ASA1,62,5 (2) Administration. The department of health and family services shall provide health services and benefits under sub. (4) to individuals who have been determined by a Wisconsin works agency to be eligible under sub. (3) for such services and benefits. The Wisconsin works agency shall provide the department of health and family services with a list of eligible individuals.

AB591-ASA1,62,17 (3) Eligibility. (a) General provisions. 1. A Wisconsin works agency shall determine eligibility for benefits and services under this section, in accordance with rules promulgated by the department of health and family services in consultation with the department of industry, labor and job development. An individual who applies for and receives benefits and services under this section is considered to have assigned to the state any rights to medical support or other payment of medical expenses from any other person, including rights to unpaid amounts accrued at the time of application for benefits and services under this section and any rights to support accruing during the time for which benefits and services under this section are provided. Eligibility for benefits and services under this section begins on the day on which the department of health and family services or the provider issues a health plan membership card.

AB591-ASA1,62,21 2. Except as provided in subd. 3. and pars. (em) and (f), an individual who is eligible for the health care coverage under this section remains eligible under this section for 12 consecutive months or until the individual has access to unsubsidized employer-offered health care coverage, whichever is later.

AB591-ASA1,62,24 3. A Wisconsin works agency shall periodically review an individual's eligibility. The individual remains eligible for benefits and services under this section until any of the following applies:

AB591-ASA1,63,3 a. The assets of the individual or, if the individual is a member of a Wisconsin works group, the assets of the Wisconsin works group of which the individual is a member, exceed the asset limits for at least 2 months.

AB591-ASA1,63,6 b. The income of the individual, or, if the individual is a member of a Wisconsin works group, the income of the Wisconsin works group of which the individual is a member is expected to exceed the income limits for at least 2 consecutive months.

AB591-ASA1,63,9 (b) Wisconsin works groups. Except as provided in pars. (d) and (e), an individual who is a member of a Wisconsin works group is eligible for benefits and services under this section if all of the following conditions apply:

AB591-ASA1,63,11 1. The individual meets the criteria under s. 49.145 (2) (c), (f), (g), (i), (L) and (m) and resides in this state.

AB591-ASA1,63,12 2. The Wisconsin works group meets the asset limitation under s. 49.145 (3) (a).

AB591-ASA1,63,17 3. The gross income of the Wisconsin works group is at or below 165% of the poverty line, or, for a Wisconsin works group that is already receiving health care coverage under this section, the gross income is at or below 200% of the poverty line. In calculating the gross income of the Wisconsin works group, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA1,63,20 (c) Pregnant women. Except as provided in par. (e), a pregnant woman whose pregnancy has been medically verified and who has no dependent children is eligible for benefits and services under this section if she meets the following conditions:

AB591-ASA1,63,22 1. The woman meets the criteria under s. 49.145 (2) (c), (g), (i), (L) and (m) and resides in this state.

AB591-ASA1,63,23 2. The woman meets the asset limitation under s. 49.145 (3) (a).

AB591-ASA1,64,3 3. The gross income of the woman is at or below 165% of the poverty line. In calculating gross income under this subdivision, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. and 3.

AB591-ASA1,64,7 (d) Minor parents. An individual who is a custodial parent and who is under the age of 18, and any dependent children with respect to whom the individual is a custodial parent, are eligible for benefits and services under this section only if the individual meets any of the following conditions:

AB591-ASA1,64,12 1. The individual resides with his or her custodial parent and the gross income of the Wisconsin works group of which the individual is a member does not exceed 165% of the poverty line. In calculating the gross income of the Wisconsin works group, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA1,64,16 2. The individual is in an independent living arrangement supervised by an adult and the gross income of the individual does not exceed 165% of the poverty line. In calculating the gross income of the individual, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA1,64,21 (e) Access to employer-subsidized health care coverage. An individual is eligible for health care coverage under this section only if the individual has not had access to employer-subsidized health care coverage for the 18 months immediately preceding application for health care coverage under this section. This paragraph does not apply to any of the following:

AB591-ASA1,65,2 1. An individual who has lost access to employer-subsidized health care coverage within the 18 months immediately preceding application for health care coverage under this subsection because of the termination by the employer of the employment relationship for a reason other than misconduct on the part of the employe and who has not had access to employer-subsidized health care coverage since the termination.

AB591-ASA1,65,6 2. An individual who has lost access to employer-subsidized health care coverage within the 18 months immediately preceding application for health care coverage under this subsection because of the termination by the employe of the employment relationship for just cause.

AB591-ASA1,65,8 3. A dependent child who has lost eligibility for employer-subsidized health care coverage for any reason.

AB591-ASA1,65,9 4. A participant in a Wisconsin works employment position.

AB591-ASA1,65,16 (em) Continuous coverage requirement. An individual who withdraws from health care coverage under this section while the individual is still eligible for health care coverage under this section is ineligible for health care coverage under this section for a period of 6 months following the withdrawal. Failure to pay in a timely manner, as defined by the department of industry, labor and job development by rule, the premium established under sub. (4) (d) constitutes withdrawal for purposes of this paragraph.

AB591-ASA1,65,19 (f) Ineligibility. No individual is eligible for health care coverage under this section in a month in which that individual is eligible for employer-subsidized health care coverage.

AB591-ASA1,66,2 (4) Wisconsin works health plan. (a) Health maintenance organization contract. The department of health and family services shall contract with one or more health maintenance organizations or other health care providers to provide health care services under this subsection. Each contract for the provision of health care services entered into by the department of health and family services under this subsection shall be awarded on the basis of a competitive process in accordance with procedures established by the department of health and family services.

AB591-ASA1,66,5 (b) Health care services provided. 1. Except as provided in subd. 2., the Wisconsin works health plan shall cover the care and services specified under s. 49.46 (2).

AB591-ASA1,66,8 2. Except as otherwise required under a federal waiver received under 42 USC 1315, the Wisconsin works health plan shall not cover the following goods and services:

AB591-ASA1,66,10 a. Home care, as defined in s. 632.895 (1) (b), in excess of the minimum required under s. 632.895 (2).

AB591-ASA1,66,11 b. Skilled nursing care in excess of the minimum required under s. 632.895 (3).

AB591-ASA1,66,12 c. Over-the-counter drugs.

AB591-ASA1,66,14 d. Treatment of nervous or mental disorders and alcoholism or other drug abuse problems in excess of the minimum coverage required under s. 632.89 (2).

AB591-ASA1,66,15 e. Services described under 42 USC 1396d (r) (5).

AB591-ASA1,66,20 (c) Distribution of payments. From the appropriations under s. 20.435 (1) (b) and (o), the department of health and family services shall make payments to a health maintenance organization or other health care provider with which the department of health and family services has contracted under par. (a) in accordance with a payment schedule established by contract.

AB591-ASA1,67,8 (d) Premiums. Except as otherwise provided in this paragraph, an individual who receives the Wisconsin works health plan shall pay to the Wisconsin works agency a monthly premium in accordance with criteria based on income and family size and established by the department of health and family services in consultation with the department of industry, labor and job development. The department of industry, labor and job development or the Wisconsin works agency shall deduct the established premium from a trial job participant's wages. The Wisconsin works agency shall deduct the established premium from the monthly grant payment of a participant in a community service job and from the monthly grant of a participant in a transitional placement. The Wisconsin works agency shall remit to the department of industry, labor and job development in the manner prescribed by the department of industry, labor and job development all premium payments that the Wisconsin works agency receives under this paragraph.

AB591-ASA1, s. 92 Section 92. 49.155 of the statutes is created to read:

AB591-ASA1,67,11 49.155 Wisconsin works; child care subsidy. (1) Definitions. In this section:

AB591-ASA1,67,13 (a) "Level I day care provider" means a day care provider certified under s. 48.651 (1) (a).

AB591-ASA1,67,15 (b) "Level II day care provider" means a day care provider certified under s. 48.651 (1) (b).

AB591-ASA1,67,19 (1m) Eligibility. A Wisconsin works agency shall determine eligibility for a child care subsidy under this section. Under this section, an individual may receive a subsidy for child care for a child who has not attained the age of 10 if the individual meets all of the following conditions:

AB591-ASA1,68,2 (a) The individual is a custodial parent of a child who is under the age of 10, or is a person who, under s. 48.57 (3m), is providing care and maintenance for a child who is under the age of 10, and child care services for that child are needed in order for the individual to meet the school attendance requirement under s. 49.26 (1) (ge) or to work in an unsubsidized job or a Wisconsin works employment position or participate in any of the following activities approved by the Wisconsin works agency:

AB591-ASA1,68,3 1. Training provided by an employer during the regular hours of employment.

AB591-ASA1,68,5 2. Other employment skills training, as defined by the department by rule, if the individual meets any of the following conditions:

AB591-ASA1,68,7 a. The individual has been employed in unsubsidized employment for 9 consecutive months and continues to be so employed.

AB591-ASA1,68,8 b. The individual is a participant in a Wisconsin works employment position.

AB591-ASA1,68,12 (b) The individual meets the eligibility conditions under s. 49.145 (2) (c) to (g) and (3) (a), except that an individual may be eligible for a child care subsidy under this section regardless of the number of days the individual has resided in this state prior to applying for the child care subsidy.

AB591-ASA1,68,16 (c) The gross income of the individuals's family is at or below 165% of the poverty line for a family the size of the individual's family. In calculating the gross income of the family, the department shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA1,68,18 (d) The individual satisfies other eligibility criteria established by the department by rule.

AB591-ASA1,68,21 (2) Distribution of child care funds. From the appropriation under s. 20.445 (3 (dz), the department shall distribute funds allocated for child care services under this section.

AB591-ASA1,68,24 (3) County administration. (a) A Wisconsin works agency shall refer an individual who has been determined eligible under sub. (1m) to a county department under s. 46.215, 46.22 or 46.23 for child care assistance.

AB591-ASA1,69,4 (b) The county department under s. 46.215, 46.22 or 46.23 shall administer child care assistance under this section. In administering child care assistance under this section, the county department under s. 46.215, 46.22 or 46.23 shall do all of the following:

AB591-ASA1,69,5 1. Determine an individual's liability under sub. (5).

AB591-ASA1,69,7 2. Provide a voucher to an eligible individual for the payment of child care services provided by a child care provider.

AB591-ASA1,69,8 3. Set maximum reimbursement rates as provided under sub. (6) (b).

AB591-ASA1,69,9 4. Reimburse child care providers.

AB591-ASA1,69,10 5. Certify child care providers under s. 48.651.

AB591-ASA1,69,13 6. Assist individuals who are eligible for child care subsidies under this section to identify available child care providers and select appropriate child care arrangements.

AB591-ASA1,69,17 (4) Choice of provider. An eligible individual shall choose whether the child care will be provided by a day care center licensed under s. 48.65, a Level I day care provider, a Level II day care provider or a day care program provided or contracted for by a school board under s. 120.13 (14).

AB591-ASA1,69,21 (5) Liability for payment. An individual who receives aid under this section is liable for a percentage of the cost of child care received, payable in accordance with a sliding scale formula established by the department that is based on the individual's ability to pay and the cost of the child care.

AB591-ASA1,70,2 (6) Child care rates and quality standards. (a) The department shall establish the maximum rate that a county department under s. 46.215, 46.22 or 46.23 may pay for child care services provided under this section. The department shall set the rate so that at least 75% of the number of places for children within the licensed capacity of all child care providers in each county or in a multicounty area determined by the department can be purchased at or below that maximum rate.

AB591-ASA1,70,6 (b) The department shall set a maximum rate that a county department under s. 46.215, 46.22 or 46.23 may pay for Level I day care providers for services provided to eligible individuals. The maximum rate set under this paragraph may not exceed 75% of the rate established under par. (a).

AB591-ASA1,70,10 (c) The department shall set a maximum rate that a county department under s. 46.215, 46.22 or 46.23 may pay for Level II day care providers for services provided to eligible individuals. The maximum rate set under this paragraph may not exceed 50% of the rate established under par. (a).

AB591-ASA1,70,13 (d) The department may establish a system of rates for child care programs that exceed the quality of care standards required for licensure under s. 48.65 or for certification under s. 48.651 (1) (a).

AB591-ASA1,70,17 (7) Refusal to pay child care providers. The department or the county department under s. 46.215, 46.22 or 46.23 may refuse to pay a child care provider for child care provided under this section if any of the following applies to the child care provider, employe or person living on the premises where child care is provided:

AB591-ASA1,70,20 (a) The person has been convicted of a felony or misdemeanor that the department or county department determines substantially relates to the care of children.

AB591-ASA1,70,22 (b) The person is the subject of a pending criminal charge that the department or county department determines substantially relates to the care of children.

AB591-ASA1,70,24 (c) The person has been determined under s. 48.981 to have abused or neglected a child.

AB591-ASA1, s. 93 Section 93. 49.157 of the statutes is created to read:

AB591-ASA1,71,3 49.157 Wisconsin works; transportation costs. (1) Assistance. In accordance with rules promulgated by the department, a Wisconsin works agency may grant financial assistance to a participant for transportation costs.

AB591-ASA1,71,6 (2) Distribution of funds. The department shall distribute to the Wisconsin works agencies the funds allocated under s. 49.181 (1) (h) for transportation assistance provided under sub. (1).

AB591-ASA1, s. 94 Section 94. 49.159 of the statutes is created to read:

AB591-ASA1,71,15 49.159 Wisconsin works; noncustodial and minor and other custodial parents. (1) Noncustodial parents. An individual who would be eligible under s. 49.145 except that the individual is the noncustodial parent of a dependent child, is eligible for services under this subsection if the dependent child's custodial parent is a participant and if the individual pays child support pursuant to a court order. The Wisconsin works agency may provide job search assistance and case management designed to enable eligible noncustodial parents to obtain and retain employment.

AB591-ASA1,71,23 (2) Minor custodial parents; financial and employment counseling. A custodial parent who is under the age of 18 is eligible, regardless of that individual's or that individual's parent's income or assets, to meet with a financial and employment planner. The financial and employment planner may provide the individual with information regarding Wisconsin works eligibility, available child care services, employment and financial planning, family planning services, community resources, eligibility for food stamps and other food and nutrition programs.

AB591-ASA1,72,2 (3) Other custodial parents. A custodial parent in a Wisconsin works group in which the other custodial parent is a participant in a Wisconsin works employment position is eligible for employment training and job search assistance services provided by the Wisconsin works agency.

AB591-ASA1, s. 95 Section 95. 49.161 of the statutes is created to read:

AB591-ASA1,72,11 49.161 Wisconsin works; overpayments. (1) Trial jobs overpayments. Notwithstanding s. 49.96, the department shall recover an overpayment of benefits paid under s. 49.148 (1) (a) from an individual who receives or has received benefits paid under s. 49.148 (1) (a). The value of the benefit liable for recovery under this subsection may include the value of work performed by the individual in a trial job if the person was ineligible to receive the benefit at the time it was paid. The department shall promulgate rules establishing policies and procedures for administrating this subsection.

AB591-ASA1,72,15 (2) Community service jobs and transitional placements overpayments. The department shall recover an overpayment of benefits paid under s. 49.148 (1) (b) and (c) from an individual who continues to receive benefits under s. 49.148 (1) (b) and (c) by reducing the amount of the individual's benefit payment by no more than 10%.

AB591-ASA1, s. 96 Section 96. 49.181 of the statutes is created to read:

AB591-ASA1,72,23 49.181 Public assistance and local assistance funding. (1) Funds distribution. Except as provided in subs. (2) and (3), within the limits of the appropriation under s. 20.435 (4) (dz), the department shall allocate amounts under this subsection. In this subsection, references to "1993 stats." are as affected by the acts of 1995 that are enacted prior to the effective date of this subsection .... [revisor inserts date]. The department shall allocate the following amounts for the following purposes:

AB591-ASA1,73,5 (a) Child care for recipients and former recipients of aid to families with dependent children. For child care services under s. 49.50 (6g) and for child care services and related transportation costs under s. 49.50 (6e) and (6k) (b), the department shall allocate $4,713,000 in fiscal year 1995-96, less any amounts expended or encumbered in fiscal year 1995-96 from the appropriations under s. 20.435 (4) (cn), 1993 stats., and s. 20.435 (4) (df), 1993 stats., for the purposes specified under this paragraph, and $5,687,400 in fiscal year 1996-97.

AB591-ASA1,73,10 (b) Low-income and at-risk child care. For low-income and at-risk child care services under s. 46.98 (2m) to (4), the department shall allocate $5,576,100 in fiscal year 1995-96, less any amount expended or encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (7) (b) for the purposes specified under this paragraph, and $5,576,100 in fiscal year 1996-97.

AB591-ASA1,73,18 (c) Income maintenance payments to individuals. For income maintenance payments to individuals under s. 49.52 and for foster care and treatment foster care provided by nonlegally responsible relatives under state or county administered programs, if the relatives are licensed to operate foster homes or treatment foster homes under s. 48.62, the department shall allocate $141,277,600 in fiscal year 1995-96, less any amount expended or encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (4) (d), 1993 stats., for the purposes specified under this paragraph, and $122,684,200 in fiscal year 1996-97.

AB591-ASA1,73,25 (cm) Foster, treatment foster and kinship care. For foster care and treatment foster care provided by nonlegally responsible relatives under state or county administered programs, if the relatives are licensed to operate foster homes or treatment foster homes under s. 48.62, and for kinship care under s. 48.57 (3m), including assessments under s. 48.57 (3m) (a) 3. and background investigations under s. 48.57 (3m) (a) 4., the department shall allocate $10,284,500 in fiscal year 1996-97.

AB591-ASA1,74,9 (d) Public assistance administration and medical assistance eligibility determination. For payment distribution under s. 49.52 (1) for county administration of public assistance benefits and medical assistance eligibility determination, for payments to American Indian tribes for administration of public assistance benefits, and for fraud investigation and error reduction under s. 49.197 (1m) and (4), the department shall allocate $28,189,100 in fiscal year 1995-96, less any amount encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (4) (de), 1993 stats., for the purposes specified under this paragraph, and $28,864,400 in fiscal year 1996-97.

AB591-ASA1,74,14 (e) Emergency assistance for families with needy children. For emergency assistance for families with needy children under s. 49.19 (11) (b), the department shall allocate $1,659,700 in fiscal year 1995-96, less any amount encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (4) (dc), 1993 stats., for the purpose specified under this paragraph, and $1,659,700 in fiscal year 1996-97.