(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).
9,1459
Section
1459. 49.496 (3) (c) 2. of the statutes is created to read:
49.496 (3) (c) 2. If the department's claim is not allowable because of par. (b), the estate includes an interest in a home and the personal representative closes the estate by sworn statement under s. 865.16, the personal representative shall stipulate in the statement that the home is assigned subject to a lien in favor of the department for the amount described in par. (a). The personal representative shall record the statement in the same manner as described in s. 863.29, as if the statement were a final judgment.
9,1460
Section
1460. 49.496 (3) (f) of the statutes is created to read:
49.496 (3) (f) The department may contract with or employ an attorney to probate estates to recover under this subsection the costs of care.
9,1460m
Section 1460m. 49.496 (4) of the statutes is amended to read:
49.496 (4) Administration. The department may require a county department under s. 46.215, 46.22 or 46.23 or the governing body of a federally recognized American Indian tribe administering medical assistance to gather and provide the department with information needed to recover medical assistance under this section. The department shall pay to a county department or tribal governing body an amount equal to 5% of the recovery collected by the department relating to a beneficiary for whom the county department or tribal governing body made the last determination of medical assistance eligibility. A county department or tribal governing body may use funds received under this subsection only to pay costs incurred under this subsection and, if any amount remains, to pay for improvements to functions required under s. 49.33 (2) 49.45 (2) (b) 1. The department may withhold payments under this subsection for failure to comply with the department's requirements under this subsection. The department shall treat payments made under this subsection as costs of administration of the medical assistance program.
9,1461
Section
1461. 49.496 (5) of the statutes is amended to read:
49.496 (5) Use of funds. From the appropriation under s. 20.435 (5) (4) (im), the department shall pay the amount of the payments under sub. (4) that is not paid from federal funds, shall pay to the federal government the amount of the funds recovered under this section equal to the amount of federal funds used to pay the benefits recovered under this section and shall spend the remainder of the funds recovered under this section for medical assistance benefits under this subchapter.
9,1463
Section
1463. 49.499 (1) to (3) of the statutes are renumbered 49.499 (1) (a) to (c).
9,1464
Section
1464. 49.499 (2m) of the statutes is created to read:
49.499 (2m) From the appropriation under s. 20.435 (6) (g), the department may distribute funds for innovative projects designed to protect the health and property of a resident in a nursing facility, as defined in s. 49.498 (1) (i).
9,1465
Section
1465. 49.665 (1) (a) of the statutes is renumbered 49.665 (1) (e) and amended to read:
49.665 (1) (e) "Custodial parent
Parent" has the meaning given in s. 49.141 (1) (b) (j).
9,1466
Section
1466. 49.665 (1) (b) of the statutes is repealed and recreated to read:
49.665 (1) (b) "Child" means a person who is under the age of 19.
9,1467
Section
1467. 49.665 (1) (d) of the statutes is amended to read:
49.665 (1) (d) "Family" means a unit that consists of at least one dependent child and his or her custodial parent or parents, all of whom reside in the same household. "Family" includes the spouse of an individual who is a custodial parent if the spouse resides in the same household as the individual.
9,1468
Section
1468. 49.665 (1) (f) of the statutes is created to read:
49.665
(1) (f) "State plan" means the state child health plan under
42 USC 1397aa (b).
9,1469
Section
1469. 49.665 (3) of the statutes is amended to read:
49.665 (3) Administration. The department shall administer a program to provide the health services and benefits described in s. 49.46 (2) to families persons that meet the eligibility requirements specified in sub. (4). The department shall promulgate rules setting forth the application procedures and appeal and grievance procedures. The department may promulgate rules limiting access to the program under this section to defined enrollment periods. The department may also promulgate rules establishing a method by which the department may purchase family coverage offered by the employer of a member of an eligible family or by a member of a child's household under circumstances in which the department determines that purchasing that coverage would not be more costly than providing the coverage under this section.
9,1470
Section
1470. 49.665 (4) (a) 1. of the statutes is amended to read:
49.665 (4) (a) 1. The family's income does not exceed 185% of the poverty line, except as provided in par. (at) and except that a family that is already receiving health care coverage under this section may have an income that does not exceed 200% of the poverty line. The department shall establish by rule the criteria to be used to determine income.
9,1470d
Section 1470d. 49.665 (4) (a) 3. of the statutes is amended to read:
49.665 (4) (a) 3. The family has not had access to employer-subsidized health care coverage within the time period established by the department by rule, but not to exceed 18 months, immediately preceding application for health care coverage under this section. The department may establish exceptions to this subdivision
time period restriction by rule.
9,1471
Section
1471. 49.665 (4) (am) of the statutes is created to read:
49.665 (4) (am) A child who does not reside with his or her parent is eligible for health care coverage under this section if the child meets all of the following requirements:
1. The child's income does not exceed 185% of the poverty line, except as provided in par. (at) and except that a child that is already receiving health care coverage under this section may have an income that does not exceed 200% of the poverty line. The department shall use the criteria established under par. (a) 1. to determine income under this subdivision.
2. The child does not have access to employer-subsidized health care coverage.
3. The child has not had access to employer-subsidized health care coverage within the time period established by the department under par. (a) 3. The department may establish exceptions to this subdivision.
4. The child meets all other requirements established by the department by rule. In establishing other eligibility criteria, the department may not include any health condition requirements.
9,1472
Section
1472. 49.665 (4) (at) of the statutes is created to read:
49.665 (4) (at) 1. a. Except as provided in subd. 1. b., the department shall establish a lower maximum income level for the initial eligibility determination if funding under s. 20.435 (4) (bc), (jz) and (p) is insufficient to accommodate the projected enrollment levels for the health care program under this section. The adjustment may not be greater than necessary to ensure sufficient funding.
b. The department may not lower the maximum income level for initial eligibility unless the department first submits to the joint committee on finance its plans for lowering the maximum income level and the committee approves the plan. If, within 14 days after submitting the plan to the joint committee on finance, the cochairpersons of the committee do not notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the plan, the plan is considered approved by the committee.
2. If, after the department has established a lower maximum income level under subd. 1., projections indicate that funding under s. 20.435 (4) (bc), (jz) and (p) is sufficient to raise the level, the department shall, by state plan amendment, raise the maximum income level for initial eligibility, but not to exceed 185% of the poverty line.
3. The department may not adjust the maximum income level of 200% of the poverty line for persons already receiving health care coverage under this section.
9,1473
Section
1473. 49.665 (4) (b) of the statutes is amended to read:
49.665 (4) (b) Notwithstanding fulfillment of the eligibility requirements under this subsection, a family
no person is not entitled to health care coverage under this section.
