AB591-ASA3,82,10 8(4) Work with the department of commerce to coordinate the provision of
9training to participants in conjunction with employers eligible for the development
10zone program under subch. VI of ch. 560.
AB591-ASA3, s. 91 11Section 91. 49.151 of the statutes is created to read:
AB591-ASA3,82,20 1249.151 Wisconsin works; sanctions. (1) Refusal to participate. A
13participant who refuses to participate 3 times in any Wisconsin works employment
14position component is ineligible to participate in that component. A participant
15whom the Wisconsin works agency has determined is ineligible under this section for
16a particular Wisconsin works employment position component may be eligible to
17participate in any other Wisconsin works employment position component in which
18the participant has not refused to participate 3 times. A participant refuses to
19participate in a Wisconsin works employment position component if the participant
20does any of the following:
AB591-ASA3,82,2221 (a) Expresses verbally or in writing to a Wisconsin works agency that he or she
22refuses to participate.
AB591-ASA3,83,223 (b) Fails to appear for an interview with a prospective employer or, if the
24participant is in a Wisconsin works transitional placement, fails to appear for an

1assigned activity, including an activity under s. 49.147 (5) (b) 1. a. to e., without good
2cause, as determined by the Wisconsin works agency.
AB591-ASA3,83,43 (c) Voluntarily leaves appropriate employment or training without good cause,
4as determined by the Wisconsin works agency.
AB591-ASA3,83,55 (d) Loses employment as a result of being discharged for cause.
AB591-ASA3,83,86 (e) Demonstrates through other behavior or action, as specified by the
7department by rule, that he or she refuses to participate in a Wisconsin works
8employment position.
AB591-ASA3,83,16 9(2) Intentional program violations. If a court finds or it is determined after
10an administrative hearing that an individual who is a member of a Wisconsin works
11group applying for or receiving benefits under ss. 49.141 to 49.161, for the purpose
12of establishing or maintaining eligibility for those benefits or for the purpose of
13increasing the value of those benefits, has intentionally violated, on 3 separate
14occasions, any provision in ss. 49.141 to 49.161 or any rule promulgated under those
15sections, the Wisconsin works agency may permanently deny benefits under ss.
1649.141 to 49.161 to the individual.
AB591-ASA3, s. 92 17Section 92. 49.152 of the statutes is created to read:
AB591-ASA3,83,25 1849.152 Review of agency decisions. (1) Petition for review. Any
19individual whose application for Wisconsin works under s. 49.147 (1) to (5) is not
20acted upon by the Wisconsin works agency with reasonable promptness after the
21filing of the application, as defined by the department by rule, or is denied in whole
22or in part, whose benefit is modified or canceled, or who believes that the benefit was
23calculated incorrectly, may petition the Wisconsin works agency for a review of such
24action. Review is unavailable if the action by the Wisconsin works agency occurred
25more than 45 days prior to submission of the petition for review.
AB591-ASA3,84,6
1(2) Review. (a) Upon a timely petition under sub. (1), the Wisconsin works
2agency shall give the applicant or participant reasonable notice and opportunity for
3a review. The Wisconsin works agency shall render its decision as soon as possible
4after the review and shall send a certified copy of its decision to the applicant or
5participant. The Wisconsin works agency shall deny a petition for a review or shall
6refuse to grant relief if the petitioner does any of the following:
AB591-ASA3,84,77 1. Withdraws the petition in writing.
AB591-ASA3,84,108 2. Abandons the petition. Abandonment occurs if the petitioner fails to appear
9in person or by representative at a scheduled review without good cause, as defined
10by the department by rule.
AB591-ASA3,84,1211 (b) The department may review a decision of a Wisconsin works agency under
12par. (a) if any of the following occurs:
AB591-ASA3,84,1413 1. Within 15 days of receiving the decision of the Wisconsin works agency, the
14applicant or participant petitions the department for a review of that decision.
AB591-ASA3,84,1615 2. The Wisconsin works agency requests the department to review the decision
16of the Wisconsin works agency.
AB591-ASA3,84,1917 (c) The department shall review a Wisconsin works agency's decision to deny
18an application based solely on a determination of financial ineligibility if any of the
19following occurs:
AB591-ASA3,84,2120 1. Within 15 days after receiving the decision of the Wisconsin works agency,
21the applicant petitions the department for a review of the decision.
AB591-ASA3,84,2322 2. The Wisconsin works agency requests the department to review the decision
23of the Wisconsin works agency.
AB591-ASA3,85,424 (cm) If, under par. (c), the department reverses a decision of the Wisconsin
25works agency, the petitioner shall receive, retroactive to the date that the Wisconsin

1works agency made its initial decision to deny the application, the benefit that the
2individual would have received, computed as if the individual had complied with all
3of the requirements of the Wisconsin works employment position into which the
4applicant most likely would have been placed.
AB591-ASA3, s. 93 5Section 93. 49.153 of the statutes is created to read:
AB591-ASA3,85,6 649.153 Wisconsin works health plan. (1) Definitions. In this section:
AB591-ASA3,85,117 (a) "Employer-subsidized health care coverage" means a health care plan,
8which provides coverage of health care costs, offered by the employer for which the
9employer pays at least 50% of the cost of the plan for the employe, including
10dependent coverage and excluding any deductibles or copayments that may be
11required under the plan.
AB591-ASA3,85,1612 (b) "Unsubsidized employer-offered health care coverage" means a health care
13plan, which provides coverage of health care costs, offered by the employer for which
14the employer pays less than 50% of the cost of coverage for the employe, including
15dependent coverage and excluding any deductibles or copayments that may be
16required under the plan.
AB591-ASA3,85,22 17(2) Administration. The department of health and family services shall
18provide health services and benefits under sub. (4) to individuals who have been
19determined by a Wisconsin works agency to be eligible under subs. (3) to (3p) for such
20services and benefits. The Wisconsin works agency shall maintain a list of eligible
21individuals and shall make the list available to the department of health and family
22services upon request.
AB591-ASA3,86,17 23(3) Eligibility. (a) General provisions. 1. A Wisconsin works agency shall
24determine eligibility for benefits and services under this section, in accordance with
25rules promulgated by the department of health and family services in consultation

1with the department of industry, labor and job development. The Wisconsin works
2agency shall make the eligibility determination within 2 working days, as defined
3in s. 227.01 (14), after the date on which the agency receives a completed application
4from the individual for services and benefits under this section and shall
5immediately notify the department of health and family services of that
6determination. An individual who applies for and receives benefits and services
7under this section is considered to have assigned to the state any rights to medical
8support or other payment of medical expenses from any other person, including
9rights to unpaid amounts accrued at the time of application for benefits and services
10under this section and any rights to support accruing during the time for which
11benefits and services under this section are provided. Eligibility for benefits and
12services under this section begins on the day on which the department of health and
13family services or the provider issues a health plan membership card. The
14department of health and family services or the provider shall issue the health plan
15membership card to an individual within 3 working days, as defined in s. 227.01 (14),
16after the date on which the Wisconsin works agency notifies the department of health
17and family services that the individual is eligible.
AB591-ASA3,86,2118 2. a. Except as provided in subd. 3. and pars. (em) and (f), an individual who
19is eligible for the health care coverage under this section remains eligible under this
20section for 12 consecutive months or until the individual has access to unsubsidized
21employer-offered health care coverage, whichever is later.
AB591-ASA3,86,2522 b. Notwithstanding subd. 2. a., an individual who is described under par. (f) 1.
23a., b., c. or d. who is eligible for health care coverage under this section remains
24eligible until the individual no longer meets eligibility criteria, as provided in subd.
253.
AB591-ASA3,87,4
13. A Wisconsin works agency shall, within the period of an individual's
2eligibility, as specified under subd. 2., periodically review an individual's eligibility.
3The individual remains eligible for benefits and services under this section until any
4of the following applies:
AB591-ASA3,87,75 a. The assets of the individual or, if the individual is a member of a Wisconsin
6works group, the assets of the Wisconsin works group of which the individual is a
7member, exceed the asset limits for at least 2 months.
AB591-ASA3,87,108 b. The income of the individual, or, if the individual is a member of a Wisconsin
9works group, the income of the Wisconsin works group of which the individual is a
10member, is expected to exceed the income limits for at least 2 consecutive months.
AB591-ASA3,87,1511 (e) Access to employer-subsidized health care coverage. An individual is eligible
12for health care coverage under this section only if the individual has not had access
13to employer-subsidized health care coverage within the 18 months immediately
14preceding application for health care coverage under this section. This paragraph
15does not apply to any of the following:
AB591-ASA3,87,2116 1. An individual who has lost access to employer-subsidized health care
17coverage within the 18 months immediately preceding application for health care
18coverage under this subsection because of the termination by the employer of the
19employment relationship for a reason other than misconduct on the part of the
20employe and who has not had access to employer-subsidized health care coverage
21since the termination.
AB591-ASA3,87,2522 2. An individual who has lost access to employer-subsidized health care
23coverage within the 18 months immediately preceding application for health care
24coverage under this subsection because of the termination by the employe of the
25employment relationship for just cause.
AB591-ASA3,88,2
13. A dependent child who has lost eligibility for employer-subsidized health
2care coverage for any reason.
AB591-ASA3,88,53 3m. A pregnant woman with an income equal to or less than 165% of the poverty
4line who has lost eligibility for employer-subsidized health care coverage for any
5reason.
AB591-ASA3,88,66 4. A participant in a Wisconsin works employment position.
AB591-ASA3,88,107 (em) Continuous coverage requirement. An individual who withdraws from
8health care coverage under this section while the individual is still eligible for health
9care coverage under this section is ineligible for health care coverage under this
10section for a period of 6 months following the withdrawal.
AB591-ASA3,88,1211 (f) Ineligibility. No individual is eligible for health care coverage under this
12section in a month in which any of the following applies:
AB591-ASA3,88,1413 1. The individual is eligible for employer-subsidized health care coverage. This
14subdivision does not apply to any of the following:
AB591-ASA3,88,1615 a. A pregnant woman in a Wisconsin works group with an income that is equal
16to or less than 165% of the poverty line.
AB591-ASA3,88,1817 b. A child who has not attained the age of 6 in a Wisconsin works group with
18an income equal to or less than 165% of the poverty line.
AB591-ASA3,88,2119 c. A child who has attained the age of 6 and has not attained the age of 12 in
20a Wisconsin works group with an income that is equal to or less than 100% of the
21poverty line.
AB591-ASA3,89,222 d. A child who has attained the age of 6 and has not attained the age of 12 in
23a Wisconsin works group with an income in excess of 100% of the poverty line if the
24total amount obligated or expended for medical care or other type of remedial care
25and for health insurance premiums, when subtracted from the Wisconsin works

1group's income, places the Wisconsin works group at or below 100% of the poverty
2line.
AB591-ASA3,89,43 2. The individual fails to pay the established premium in a timely manner, as
4defined by the department of industry, labor and job development by rule.
AB591-ASA3,89,6 5(3g) Eligible groups. Subject to the requirements under sub. (3), the following
6individuals are eligible for benefits and services under this section:
AB591-ASA3,89,87 (a) Wisconsin works groups. Except as provided in par. (c), an individual who
8is a member of a Wisconsin works group, if all of the following conditions apply:
AB591-ASA3,89,109 1. The individual meets the criteria under s. 49.145 (2) (c), (f), (g), (i), (L) and
10(m) and resides in this state.
AB591-ASA3,89,1411 2. The Wisconsin works group meets the asset limitation under s. 49.145 (3) (a).
12In determining the assets under this subdivision, the Wisconsin works agency shall
13exclude all of the resources specified under 42 USC 1382b (a) if any of the following
14conditions is met:
AB591-ASA3,89,1515 a. The group contains a child who has not attained the age of 6.
AB591-ASA3,89,1816 b. The group contains a child who has attained the age of 6 and has not attained
17the age of 12 and the gross income of the group, as determined under subd. 3., does
18not exceed 100% of the poverty line.
AB591-ASA3,89,2319 3. The gross income of the Wisconsin works group is at or below 165% of the
20poverty line, or, for a Wisconsin works group that is already receiving health care
21coverage under this section, the gross income is at or below 200% of the poverty line.
22In calculating the gross income of the Wisconsin works group, the Wisconsin works
23agency shall include income described under s. 49.145 (3) (b) 1. to 3.
AB591-ASA3,90,3
1(b) Pregnant women. A pregnant woman whose pregnancy has been medically
2verified and who has no dependent children, if she meets all of the following
3conditions:
AB591-ASA3,90,54 1. The woman meets the criteria under s. 49.145 (2) (c), (g), (i), (L) and (m) and
5resides in this state.
AB591-ASA3,90,86 2. The woman meets the asset limitation under s. 49.145 (3) (a). In determining
7the assets of the woman, the Wisconsin works agency shall exclude all of the
8resources specified under 42 USC 1382b (a).
AB591-ASA3,90,119 3. The gross income of the woman is at or below 165% of the poverty line. In
10calculating gross income under this subdivision, the Wisconsin works agency shall
11include income described under s. 49.145 (3) (b) 1. and 3.
AB591-ASA3,90,1412 (c) Minor parents. An individual who is a custodial parent and who is under
13the age of 18, and any dependent children with respect to whom the individual is a
14custodial parent, only if the individual meets one of the following conditions:
AB591-ASA3,90,1915 1. The individual resides with his or her custodial parent and the gross income
16of the Wisconsin works group of which the individual is a member does not exceed
17165% of the poverty line. In calculating the gross income of the Wisconsin works
18group, the Wisconsin works agency shall include income described under s. 49.145
19(3) (b) 1. to 3.
AB591-ASA3,90,2320 2. The individual is in an independent living arrangement supervised by an
21adult and the gross income of the individual does not exceed 165% of the poverty line.
22In calculating the gross income of the individual, the Wisconsin works agency shall
23include income described under s. 49.145 (3) (b) 1. to 3.
AB591-ASA3,91,4 24(3m) Medically needy. (a) An individual who meets all of the requirements
25of sub. (3g) (a) or (c), except that the income calculated for the individual under sub.

1(3g) (a) 3. or (c) 1. or 2. exceeds the applicable income limit under sub. (3g) (a) 3. or
2(c) 1. or 2., is eligible for benefits and services under this section only if all of the
3excess income above the applicable limit has been obligated or expended for medical
4care or other type of remedial care.
AB591-ASA3,91,125 (am) Notwithstanding par. (a) and sub. (3) (a) 2. a., (e) and (f) 1., if the individual
6is a pregnant woman or a child who has not attained the age of 6, and the individual
7meets all of the requirements of sub. (3g) (a), (b) or (c), except that the income
8calculated for the individual under sub. (3g) (a) 3., (b) 3. or (c) 1. or 2. exceeds the
9applicable income limit under sub. (3g) (a) 3., (b) 3. or (c) 1. or 2., the individual is
10eligible for benefits and services under this section if all of the excess income above
11the applicable limit has been obligated or expended for medical care or other type of
12remedial care or for personal health insurance premiums.
AB591-ASA3,91,2013 (as) Notwithstanding par. (a) and sub. (3) (a) 2. a., if the individual is a child
14who has attained the age of 6 and has not attained the age of 12, and the individual
15meets all of the requirements of sub. (3g) (a) except that the income calculated for the
16individual under sub. (3g) (a) 3. exceeds the income level under sub. (3g) (a) 3., the
17individual is eligible for benefits and services under this section if the total amount
18obligated or expended for medical care or other type of remedial care and for health
19insurance premiums, when subtracted from the Wisconsin works group's income,
20places the Wisconsin works group at 100% of the poverty line.
AB591-ASA3,91,2321 (b) In determining the income for an individual under this subsection for
22purposes of determining the premium amount under sub. (4) (d), the Wisconsin
23works agency shall exclude the excess income specified under par. (a), (am) or (as).
AB591-ASA3,92,6 24(3p) Presumptive eligibility for pregnant women. (a) Notwithstanding sub.
25(3g) (a), (b) and (c), a pregnant woman is eligible under this subsection for

1ambulatory prenatal care services under this section during the period beginning on
2the day on which an authorized health care provider under contract under sub. (4)
3(a) determines, on the basis of preliminary information, that the woman's family
4income does not exceed 165% of the poverty line and that the woman's family's assets
5do not exceed the asset limits under s. 49.145 (3) (a). Eligibility under this subsection
6ends as follows:
AB591-ASA3,92,107 1. If the woman applies under sub. (3g) (a), (b) or (c) for benefits and services
8under this section within the time required under par. (c), on the day on which the
9Wisconsin works agency determines whether the woman is eligible for benefits and
10services under sub. (3g) (a), (b) or (c).
AB591-ASA3,92,1411 2. If the woman does not apply under sub. (3g) (a), (b) or (c) for benefits and
12services under this section within the time required under par. (c), on the last day
13of the month following the month in which the health care provider makes the
14determination under this paragraph.
AB591-ASA3,92,1715 (c) A woman who is determined to be eligible under this subsection shall apply
16under sub. (3g) (a), (b) or (c) for benefits and services under this section within 14
17days after the date on which the health care provider makes that determination.
AB591-ASA3,92,2018 (cm) A woman who receives services under this subsection is liable for a
19monthly premium payable in the amount and in the manner prescribed under sub.
20(4) (d) beginning with the first month in which she receives those services.
AB591-ASA3,92,2321 (d) A health care provider under contract under sub. (4) (a) that determines
22that a woman is eligible under this subsection for benefits and services under this
23section shall do all of the following:
AB591-ASA3,92,2524 1. Notify the Wisconsin works agency of that determination within 5 working
25days after the day on which the determination is made.
AB591-ASA3,93,1
12. Notify the woman of the requirements under pars. (c) and (cm).
AB591-ASA3,93,42 (e) The Wisconsin works agency shall provide health care providers under
3contract under sub. (4) (a) with application forms for benefits and services under this
4section and information on how to assist women in completing the forms.
AB591-ASA3,93,65 (f) No provider may make more than one eligibility determination under this
6subsection with respect to an individual.
AB591-ASA3,93,13 7(4) Administration and benefits. (a) Health maintenance organization
8contract.
The department of health and family services shall contract with health
9maintenance organizations or other health care providers, including federally
10qualified health centers, to provide health care services under this subsection. A
11health maintenance organization or other health care provider that contracts under
12this subsection shall meet the certification criteria established by the department of
13health and family services under s. 49.45 (2) (a) 11.
AB591-ASA3,93,1614 (b) Health care services provided. 1. Except as provided in subd. 2., the
15Wisconsin works health plan shall cover the care and services specified under s.
1649.46 (2).
AB591-ASA3,93,1917 1m. The Wisconsin works health plan shall cover in-home psychotherapy for
18individuals who are under the age of 21 if the in-home psychotherapy is prescribed
19pursuant to a physical examination under 42 USC 1396 (r) (1).
AB591-ASA3,93,2120 1s. The Wisconsin works health plan shall cover insulin if it is prescribed by
21a physician.
AB591-ASA3,93,24222. Except as otherwise required under a federal waiver received under 42 USC
231315
, the Wisconsin works health plan shall not cover the following goods and
24services:
AB591-ASA3,94,2
1a. Home care, as defined in s. 632.895 (1) (b), in excess of the minimum required
2under s. 632.895 (2).
AB591-ASA3,94,33 b. Skilled nursing care in excess of the minimum required under s. 632.895 (3).
AB591-ASA3,94,44 c. Over-the-counter drugs.
AB591-ASA3,94,65 d. Treatment of alcoholism or other drug abuse problems in excess of the
6minimum coverage required under s. 632.89 (2).
AB591-ASA3,94,87e. Services described under 42 USC 1396d (r) (5), unless the services are
8otherwise covered under this section.
AB591-ASA3,94,99 (bm) Abortion coverage excluded. 1. In this paragraph:
AB591-ASA3,94,1010 a. "Abortion" means the intentional destruction of the life of an unborn child.
AB591-ASA3,94,1211 b. "Unborn child" means a human being from the time of conception until it is
12born alive.
AB591-ASA3,94,1513 2. Except as provided in subd. 3., each contract that is entered into under par.
14(a) shall explicitly provide that it does not include coverage for the performance of
15an abortion.
AB591-ASA3,94,1616 3. This paragraph does not apply to any of the following:
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