49.46 (1p) Demonstration project for persons with HIV. The department shall request a waiver from the secretary of the federal department of health and human services to allow the department to provide under this section coverage of services specified under sub. (2) for persons who have HIV infection, as defined in s. 252.01 (2). If a waiver is granted and in effect, the department shall provide coverage for the services specified under sub. (2) for persons who qualify under the terms of the waiver.
9,1435
Section
1435. 49.46 (2) (b) 8. of the statutes is amended to read:
49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277 or 46.278 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c).
9,1437
Section
1437. 49.46 (2) (b) 18. of the statutes is created to read:
49.46 (2) (b) 18. Alcohol or other drug abuse residential treatment services of no more than 45 days per treatment episode, under s. 49.45 (46). This subdivision does not apply after July 1, 2003.
9,1437m
Section 1437m. 49.47 (4) (a) 1. of the statutes is amended to read:
49.47 (4) (a) 1. Under 18 At least 19 years of age but under 21 years of age or, if and the person resides in an intermediate care facility, skilled nursing facility or inpatient psychiatric hospital, under 21 years of age.
9,1437n
Section 1437n. 49.47 (4) (a) 2. of the statutes is renumbered 49.47 (4) (ag) 2.
9,1437p
Section 1437p. 49.47 (4) (ag) (intro.) of the statutes is created to read:
49.47 (4) (ag) (intro.) Any individual who meets the limitations on income under par. (c) and who complies with par. (cm) shall be eligible for medical assistance under this section if such individual is:
9,1437q
Section 1437q. 49.47 (4) (ag) 1. of the statutes is created to read:
49.47 (4) (ag) 1. Under the age of 19.
9,1438
Section
1438. 49.47 (4) (as) 1. of the statutes is amended to read:
49.47
(4) (as) 1. The person would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11) or 46.277
or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c) but for the fact that the person engages in substantial gainful activity under
42 USC 1382c (a) (3).
9,1439
Section
1439. 49.47 (4) (as) 3. of the statutes is amended to read:
49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or 46.277 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c).
9,1439g
Section 1439g. 49.47 (4) (b) 2m. a. of the statutes is amended to read:
49.47 (4) (b) 2m. a. For persons who are eligible under par. (a) 1. or 2., one vehicle is exempt from consideration as an asset. A 2nd vehicle is exempt from consideration as an asset only if the department determines that it is necessary for the purpose of employment or to obtain medical care. The equity value of any nonexempt vehicles owned by the applicant is an asset for the purposes of determining eligibility for medical assistance under this section.
9,1439m
Section 1439m. 49.47 (4) (cm) 3. of the statutes is created to read:
49.47 (4) (cm) 3. An individual who is otherwise eligible under this subsection and who has set aside funds in an irrevocable burial trust under s. 445.125 (1) (a) 2. shall, as a condition of eligibility for medical assistance, specify the state as a secondary beneficiary of the trust with respect to all funds in the trust that exceed the burial costs but do not exceed the amount of medical assistance paid on behalf of the individual.
9,1439q
Section 1439q. 49.47 (6) (a) 7. of the statutes is amended to read:
49.47 (6) (a) 7. Beneficiaries eligible under sub. (4) (a) 2. (ag) 2. or (am) 1., for services under s. 49.46 (2) (a) and (b) that are related to pregnancy, including postpartum services and family planning services, as defined in s. 253.07 (1) (b), or related to other conditions which may complicate pregnancy.
9,1440
Section
1440. 49.472 of the statutes is created to read:
49.472 Medical assistance purchase plan. (1) Definitions. In this section:
(a) "Earned income" has the meaning given in
42 USC 1382a (a) (1).
(am) "Family" means an individual, the individual's spouse and any dependent child, as defined in s. 49.141 (1) (c), of the individual.
(b) "Health insurance" means surgical, medical, hospital, major medical or other health service coverage, including a self-insured health plan, but does not include hospital indemnity policies or ancillary coverages such as income continuation, loss of time or accident benefits.
(c) "Independence account" means an account approved by the department that consists solely of savings, and dividends or other gains derived from those savings, from income earned from paid employment after the initial date that an individual began receiving medical assistance under this section.
(d) "Medical assistance purchase plan" means medical assistance, eligibility for which is determined under this section.
(e) "Unearned income" has the meaning given in
42 USC 1382a (a) (2).
(2) Waivers and amendments. The department shall submit to the federal department of health and human services an amendment to the state medical assistance plan, and shall request any necessary waivers from the secretary of the federal department of health and human services, to permit the department to expand medical assistance eligibility as provided in this section. If the state plan amendment and all necessary waivers are approved and in effect, the department shall implement the medical assistance eligibility expansion under this section not later than January 1, 2000, or 3 months after full federal approval, whichever is later.
(3) Eligibility. Except as provided in sub. (6) (a), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:
(a) The individual's family's net income is less than 250% of the poverty line for a family the size of the individual's family. In calculating the net income, the department shall apply all of the exclusions specified under
42 USC 1382a (b).
(b) The individual's assets do not exceed $15,000. In determining assets, the department may not include assets that are excluded from the resource calculation under
42 USC 1382b (a) or assets accumulated in an independence account. The department may exclude, in whole or in part, the value of a vehicle used by the individual for transportation to paid employment.
(c) The individual would be eligible for supplemental security income for purposes of receiving medical assistance but for evidence of work, attainment of the substantial gainful activity level, earned income and unearned income in excess of the limit established under
42 USC 1396d (q) (2) (B) and (D).
(e) The individual is legally able to work in all employment settings without a permit under s. 103.70.
(f) The individual maintains premium payments calculated by the department in accordance with sub. (4), unless the individual is exempted from premium payments under sub. (4) (b) or (5).
(g) The individual is engaged in gainful employment or is participating in a program that is certified by the department to provide health and employment services that are aimed at helping the individual achieve employment goals.
(h) The individual meets all other requirements established by the department by rule.
(4) Premiums. (a) Except as provided in par. (b) and sub. (5), an individual who is eligible for medical assistance under sub. (3) and receives medical assistance shall pay a monthly premium to the department. The department shall establish the monthly premiums by rule in accordance with the following guidelines:
1. The premium for any individual may not exceed the sum of the following:
a. Three and one-half percent of the individual's earned income after the disregards specified in subd. 2m.
b. One hundred percent of the individual's unearned income after the deductions specified in subd. 2.
2. In determining an individual's unearned income under subd. 1., the department shall disregard all of the following:
a. A maintenance allowance established by the department by rule. The maintenance allowance may not be less than the sum of $20, the federal supplemental security income payment level determined under
42 USC 1382 (b) and the state supplemental payment determined under s. 49.77 (2m).
b. Medical and remedial expenses and impairment-related work expenses.
2m. If the disregards under subd. 2. exceed the unearned income against which they are applied, the department shall disregard the remainder in calculating the individual's earned income.
3. The department may reduce the premium by 25% for an individual who is covered by private health insurance.
(b) The department may waive monthly premiums that are calculated to be below $10 per month. The department may not assess a monthly premium for any individual whose income level, after adding the individual's earned income and unearned income, is below 150% of the poverty line.
(5) Community options participants. From the appropriation under s. 20.435 (7) (bd), the department may pay all or a portion of the monthly premium calculated under sub. (4) (a) for an individual who is a participant in the community options program under s. 46.27 (11).
(6) Insured persons. (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s. 20.435 (4) (b), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.
(b) If federal financial participation is available, from the appropriation under s. 20.435 (4) (b), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).
(7) Department duties. The department shall do all of the following:
(a) Determine eligibility, or contract with a county department, as defined in 49.45 (6c) (a) 3., or with a tribal governing body to determine eligibility, of individuals for the medical assistance purchase plan in accordance with sub. (3).
(b) Ensure, to the extent practicable, continuity of care for a medical assistance recipient under this section who is engaged in paid employment, or is enrolled in a home-based or community-based waiver program under section 1915 (c) of the Social Security Act, and who becomes ineligible for medical assistance.
9,1441
Section
1441. 49.475 (5) of the statutes is amended to read:
49.475 (5) Reimbursement of costs. From the appropriations under s. 20.435 (1) (4) (bm) and (p) (pa), the department shall reimburse an insurer that provides information under this section for the insurer's reasonable costs incurred in providing the requested information, including its reasonable costs, if any, to develop and operate automated systems specifically for the disclosure of information under this section.
9,1441g
Section 1441g. 49.48 (1) of the statutes is amended to read:
49.48 (1) The Except as provided in sub. (1m), the department shall require each applicant to provide the department with the applicant's social security number, if the applicant is an individual, as a condition of issuing or renewing a certification under s. 49.45 (2) (a) 11. as an eligible provider of services.
9,1441h
Section 1441h. 49.48 (1m) of the statutes is created to read:
49.48 (1m) If an individual who applies for or to renew a certification under sub. (1) does not have a social security number, the individual, as a condition of obtaining the certification, shall submit a statement made or subscribed under oath or affirmation to the department that the applicant does not have a social security number. The form of the statement shall be prescribed by the department of workforce development. A certification issued or renewed in reliance upon a false statement submitted under this subsection is invalid.
9,1444
Section
1444. 49.496 (2) (title) of the statutes is amended to read:
49.496 (2) (title) Liens on the homes of nursing home residents and inpatients at hospitals.
9,1445
Section
1445. 49.496 (2) (a) of the statutes is amended to read:
49.496 (2) (a) Except as provided in par. (b), the department may obtain a lien on a recipient's home if the recipient resides in a nursing home, or if the recipient resides in a hospital and is required to contribute to the cost of care, and the recipient cannot reasonably be expected to be discharged from the nursing home or hospital and return home. The lien is for the amount of medical assistance paid on behalf of the recipient while the recipient resides in a nursing home that is recoverable under sub. (3) (a).
9,1446
Section
1446. 49.496 (2) (b) 3. of the statutes is amended to read:
49.496 (2) (b) 3. The recipient's sibling who has an ownership interest in the home and who has lived in the home continuously beginning at least 12 months before the recipient was admitted to the nursing home or hospital.
9,1447
Section
1447. 49.496 (2) (c) 1. of the statutes is amended to read:
49.496 (2) (c) 1. Notify the recipient in writing of its determination that the recipient cannot reasonably be expected to be discharged from the nursing home or hospital, its intent to impose a lien on the recipient's home and the recipient's right to a hearing on whether the requirements for the imposition of a lien are satisfied.
9,1448
Section
1448. 49.496 (2) (f) 3. of the statutes is amended to read:
49.496 (2) (f) 3. A child of any age who resides in the home, if that child resided in the home for at least 24 months before the recipient was admitted to the nursing home or hospital and provided care to the recipient that delayed the recipient's admission to the nursing home or hospital.
9,1449
Section
1449. 49.496 (2) (f) 4. of the statutes is amended to read:
49.496 (2) (f) 4. A sibling who resides in the home, if the sibling resided in the home for at least 12 months before the recipient was admitted to the nursing home or hospital.
9,1450
Section
1450. 49.496 (2) (h) of the statutes is amended to read:
49.496 (2) (h) The department shall file a release of a lien imposed under this subsection if the recipient is discharged from the nursing home or hospital and returns to live in the home.
9,1451
Section
1451. 49.496 (3) (a) (intro.) of the statutes is amended to read:
49.496 (3) (a) (intro.) Except as provided in par. (b), the department shall file a claim against the estate of a recipient or against the estate of the surviving spouse of a recipient for all of the following unless already recovered by the department under this section:
9,1452
Section
1452. 49.496 (3) (a) 1. of the statutes is amended to read:
49.496 (3) (a) 1. The amount of medical assistance paid on behalf of the recipient while the recipient resided in a nursing home or while the recipient was an inpatient in a medical institution hospital and was required to contribute to the cost of care.
9,1453
Section
1453. 49.496 (3) (a) 2. a. of the statutes is amended to read:
49.496
(3) (a) 2. a. Home-based or community-based services under
42 USC 1396d (a) (7) and (8) and under any waiver granted under
42 USC 1396n (c) (4) (B) or
42 USC 1396u.
9,1454
Section
1454. 49.496 (3) (a) 2. d. of the statutes is created to read:
49.496 (3) (a) 2. d. Personal care services under s. 49.46 (2) (b) 6. j.
9,1455
Section
1455. 49.496 (3) (am) (intro.) of the statutes is amended to read:
49.496 (3) (am) (intro.) The court shall reduce the amount of a claim under par. (a) by up to $3,000
the amount specified in s. 861.33 (2) if necessary to allow the recipient's heirs or the beneficiaries of the recipient's will to retain the following personal property:
9,1456
Section
1456. 49.496 (3) (am) 3. of the statutes is amended to read:
49.496 (3) (am) 3. Other tangible personal property not used in trade, agriculture or other business, not to exceed $1,000 in value the amount specified in s. 861.33 (1) (a) 4.
9,1458
Section
1458. 49.496 (3) (c) of the statutes is renumbered 49.496 (3) (c) 1. and amended to read:
49.496 (3) (c) 1. If the department's claim is not allowable because of par. (b) and the estate includes an interest in a home, the court exercising probate jurisdiction shall, in the final judgment or summary findings and order, assign the interest in the home subject to a lien in favor of the department for the amount described in par. (a). The personal representative or petitioner for summary settlement or summary assignment of the estate shall record the final judgment as provided in s. 863.29, 867.01 (3) (h) or 867.02 (2) (h).
