Wisconsin Legislature: 25,1185

49.665 (2) (a) 1. The department of health and family services shall request a waiver from the secretary of the federal department of health and human services to permit the department of health and family services to implement, beginning not later than July 1, 1998, or the effective date of the waiver, whichever is later, a health care program under this section. If a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m. and (ap) and provisions related to sub. (4) (ap), is granted and in effect, the department of health and family services shall implement the program under this section, subject to subd. 2. The department of health and family services may not implement the program under this section unless a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m. and (ap) and provisions related to sub. (4) (ap), is granted and in effect.

25,1177 Section 1177. 49.665 (2) (a) 2. of the statutes is created to read:

49.665 (2) (a) 2. The department may not implement sub. (4) (ap) or provisions related to the coverage under sub. (4) (ap) unless a state plan amendment authorizing the coverage under sub. (4) (ap) is approved by the federal department of health and human services.

25,1178 Section 1178. 49.665 (3) of the statutes is amended to read:

49.665 (3) Administration. The Subject to sub. (2) (a) 2., the department shall administer a program to provide the health services and benefits described in s. 49.46 (2) to 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 of a member of a an eligible child's household, or family or individual coverage offered by the employer of an eligible unborn child's mother or her spouse, under circumstances in which the department determines that purchasing that coverage would not be more costly than providing the coverage under this section.

25,1179 Section 1179. 49.665 (4) (ap) of the statutes is created to read:

49.665 (4) (ap) An unborn child whose mother is not eligible for health care coverage under par. (a) or (am) or for medical assistance under s. 49.46 or 49.47, except that she may be eligible for benefits under s. 49.45 (27), is eligible for health care coverage under this section, which shall be limited to coverage for prenatal care, if all of the following requirements are met:

1. The income of the unborn child's mother, mother and her spouse, or mother and her family, whichever is applicable, does not exceed 185 percent of the poverty line, except as provided in par. (at) and except that, if an unborn child is already receiving health care coverage under this section, the applicable specified person or persons may have an income that does not exceed 200 percent of the poverty line. The department shall establish by rule the criteria to be used to determine income.

2. Each of the following applicable persons who is employed provides verification from his or her employer, in the manner specified by the department, of his or her earnings:

a. The unborn child's mother.

b. The spouse of the unborn child's mother.

c. Members of the unborn child's mother's family.

3. The unborn child's mother provides medical verification of her pregnancy, in the manner specified by the department.

4. The unborn child and the mother of the unborn child meet all other requirements established by the department by rule except for any of the following:

a. The mother is not a U.S. citizen or an alien qualifying for medicaid under 8 USC 1612.

b. The mother is an inmate of a public institution.

c. The mother does not provide a social security number, but only if subd. 4. a. applies.

25,1180 Section 1180. 49.665 (4) (at) 3. of the statutes is amended to read:

49.665 (4) (at) 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 or for applicable persons specified in par. (ap) 1. with respect to an unborn child already receiving health care coverage under this section.

25,1181 Section 1181. 49.665 (4) (c) of the statutes is amended to read:

49.665 (4) (c) No person may be denied health care coverage under this section solely because of a health condition of that person or, of any family member of that person, or of the mother of an unborn child.

25,1182 Section 1182. 49.665 (4) (d) of the statutes is created to read:

49.665 (4) (d) An unborn child's eligibility for coverage under par. (ap) shall not begin before the first day of the month in which the unborn child's mother provides the medical verification required under par. (ap) 3.

25,1183 Section 1183. 49.665 (5) (ag) of the statutes is amended to read:

49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or a child who does not reside with his or her parent, or the mother of an unborn child, who receives health care coverage under this section shall pay a percentage of the cost of that coverage in accordance with a schedule established by the department by rule. The department may not establish or implement a schedule that requires a family or child to contribute contribution, including the amounts required under par. (am), of more than 5% of the family's or child's income of the family, child, or applicable persons specified in sub. (4) (ap) 1. towards the cost of the health care coverage provided under this section.

25,1184 Section 1184. 49.665 (5) (am) (intro.) of the statutes is amended to read:

49.665 (5) (am) (intro.) Except as provided in pars. (b) and (bm), a child or, a family member , or the mother of an unborn child, who receives health care coverage under this section shall pay the following cost-sharing amounts:

25,1184c Section 1184c. 49.665 (5) (am) 1. of the statutes is amended to read:

49.665 (5) (am) 1. A copayment of $1 $3 for each prescription of a drug that bears only a generic name, as defined in s. 450.12 (1) (b).

25,1185 Section 1185. 49.665 (5) (b) of the statutes is amended to read:

49.665 (5) (b) The department may not require a family, or child who does not reside with his or her parent, or applicable persons specified in sub. (4) (ap) 1., with an income below 150% of the poverty line, to contribute to the cost of health care coverage provided under this section.

25,1186 Section 1186. 49.665 (5) (c) of the statutes is amended to read:

49.665 (5) (c) The department may establish by rule requirements for wage withholding as a means of collecting the a family's or an unborn child's mother's share of the cost of the health care coverage under this section.

25,1186bc Section 1186bc. 49.665 (7) of the statutes is created to read:

49.665 (7) Employer verification forms; forfeiture and penalty assessment. (a) 1. Notwithstanding sub. (4) (a) 3m., the department shall mail information verification forms to the employers of the individuals required to provide the verifications under sub. (4) (a) 3m. to obtain the information specified.

2. An employer that receives a verification form shall complete the form and return it to the department, by mail, with a postmark that is not more than 30 working days after the date on which the department mailed the form to the employer.

3. As an alternative to the method under subd. 2., an employer may, within 30 working days after the date on which the department mailed the form to the employer, return the completed form to the department by any electronic means approved by the department. The department must be able to determine, or the employer must be able to verify, the date on which the form was sent to the department electronically.

(b) 1. Subject to subd. 3., an employer that does not comply with the requirements under par. (a) 2. or 3. shall be required to pay a forfeiture of $50 for each verification form not returned in compliance with par. (a) 2. or 3.

2. Subject to subd. 3., whenever the department imposes a forfeiture under subd. 1., the department shall also levy a penalty assessment of $50.

3. An employer with fewer than 250 employees may not be required to pay more than $1,000 in forfeitures and penalty assessments under this paragraph in any 6-month period. An employer with 250 or more employees may not be required to pay more than $15,000 in forfeitures and penalty assessments under this paragraph in any 6-month period.

4. All penalty assessments collected under subd. 2. shall be credited to the appropriation account under s. 20.435 (4) (jz) and all forfeitures collected under subd. 1. shall be credited to the common school fund.

(c) An employer may contest an assessment of forfeiture or penalty assessment under par. (b) by sending a written request for hearing to the division of hearings and appeals in the department of administration. Proceedings before the division are governed by ch. 227.

25,1186c Section 1186c. 49.665 (7) (a) 1. of the statutes, as created by 2005 Wisconsin Act .... (this act), is amended to read:

49.665 (7) (a) 1. Notwithstanding sub. (4) (a) 3m. and (ap) 2., the department shall mail information verification forms to the employers of the individuals required to provide the verifications under sub. (4) (a) 3m. and (ap) 2. to obtain the information specified.

25,1188 Section 1188. 49.77 (6) of the statutes is created to read:

49.77 (6) Authority to administer; rules. The department shall administer this section and s. 49.775, and may promulgate rules to guide the administration of eligibility determinations and benefits payments.

25,1188d Section 1188d. 49.77 (7) of the statutes is created to read:

49.77 (7) Joint finance supplemental funding. The department may request the joint committee on finance to provide supplemental funding under s. 13.101 (3) for the appropriation under s. 20.435 (7) (ed) if the department determines that the amounts appropriated under s. 20.435 (7) (ed) are insufficient to fully support benefit costs under this section. Notwithstanding s. 13.101 (3) (a) 1., the committee may provide supplemental funding under this subsection without finding that an emergency exists.

25,1188p Section 1188p. 49.775 (2) (bm) of the statutes is amended to read:

49.775 (2) (bm) The custodial parent assigns to the state any right of the custodial parent or of the dependent child to support from any other person. No amount of support that begins to accrue after the individual ceases to receive payments under this section may be considered assigned to the state. Any money that is received by the department of workforce development under an assignment to the state under this paragraph and that is not the federal share of support shall be paid to the custodial parent. The department of workforce development shall pay the federal share of support assigned under this paragraph as required under federal law or waiver.

25,1189 Section 1189. 49.78 (8) (a) of the statutes is amended to read:

49.78 (8) (a) From the appropriation accounts under s. 20.435 (4) (bn) and, (nn), and (y) and subject to par. (b), the department shall reimburse each county and tribal governing body that contracts with the department under sub. (2) for reasonable costs of administering the income maintenance programs. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.435 (4) (bn) and , (nn), and (y) by contract under sub. (2). The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county or tribal governing body for fraud and error reduction under s. 49.197 (1m) and (4) or 49.845.

25,1189m Section 1189m. 49.78 (8) (a) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

49.78 (8) (a) From the appropriation accounts under s. 20.435 (4) (bn), and (nn), and (y) and subject to par. (b), the department shall reimburse each county and tribal governing body that contracts with the department under sub. (2) for reasonable costs of administering the income maintenance programs. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.435 (4) (bn), and (nn), and (y) by contract under sub. (2). The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county or tribal governing body for fraud and error reduction under s. 49.197 or 49.845.

25,1190 Section 1190. 49.78 (11) of the statutes is created to read:

49.78 (11) Requirement to provide information. (a) 1. The department, a county department under s. 46.215, 46.22, or 46.23, or a tribal governing body may request from any person in this state information it determines appropriate and necessary for determining or verifying eligibility or benefits for a recipient under any income maintenance program. Unless access to the information is prohibited or restricted by law, or unless the person has good cause, as determined by the department in accordance with federal law and regulations, for refusing to cooperate, the person shall make a good faith effort to provide the information within 7 days after receiving a request under this paragraph. The department, county department, or tribal governing body, or employees of any of them, may not disclose information obtained under this subdivision for any purpose not connected with the administration of the income maintenance program for which the information was requested.

2. In conjunction with any request for information under subd. 1., including a request made by subpoena under par. (b), the department, county department, or tribal governing body shall advise the person of the time by which the information must be provided.

(b) The department, a county department, or a tribal governing body may issue a subpoena, in substantially the form authorized under s. 885.02, to compel the production of financial information or other documentary evidence for determining or verifying eligibility or benefits for a recipient under any income maintenance program.

1. Allowing access to financial or other records by the department, a county department, or a tribal governing body in response to a request under par. (a) or a subpoena described in par. (b).

2. Disclosing information from financial or other records to the department, a county department, or a tribal governing body in response to a request under par. (a) or a subpoena described in par. (b).

3. Any other action taken in good faith to comply with this subsection or a subpoena described in par. (b) or to comply with a request for information or access to records from the department, a county department, or a tribal governing body for determining or verifying eligibility or benefits for a recipient under any income maintenance program.

25,1191 Section 1191. 49.785 (2) of the statutes is amended to read:

49.785 (2) From the appropriation under s. 20.435 (4) (bn), the department shall reimburse a county or applicable tribal governing body or organization for any amount that the county or applicable tribal governing body or organization is required to pay under sub. (1) if the county or applicable tribal governing body or organization complies with sub. (3). From the appropriation under s. 20.435 (4) (bn), the department shall reimburse a county or applicable tribal governing body or organization for cemetery expenses or for funeral and burial expenses for persons a person described under sub. (1) that the county or applicable tribal governing body or organization is not required to pay under subs. (1) and (1m) only if the department approves the reimbursement due to unusual circumstances and if the county or applicable tribal governing body or organization complies with sub. (3).

25,1191c Section 1191c. 49.785 (3) of the statutes is created to read:

49.785 (3) As a condition for reimbursement under sub. (2) for amounts paid on behalf of a deceased recipient, a county or applicable tribal governing body or organization shall provide to the department all of the following information with respect to the deceased recipient:

(a) The total cemetery expenses.

(b) The total funeral and burial expenses.

(c) The total amount of each of the expenses under pars. (a) and (b) that the county or tribal governing body or organization paid on behalf of the deceased recipient.

25,1192 Section 1192. 49.79 (9) of the statutes is repealed.

25,1193 Section 1193. 49.82 (2) of the statutes is amended to read:

49.82 (2) Eligibility verification. Proof shall be provided for each person included in an application for public assistance under this chapter, except for a child who is eligible for medical assistance under s. 49.46 or 49.47 because of 42 USC 1396a (e) (4) or an unborn child who is eligible for coverage under the Badger Care health care program under s. 49.665 (4) (ap), of his or her social security number or that an application for a social security number has been made.

25,1194 Section 1194. 49.83 of the statutes is amended to read:

49.83 Limitation on giving information. Except as provided under s. 49.32 (9), (10), and (10m), no person may use or disclose information concerning applicants and recipients of relief funded by a relief block grant, aid to families with dependent children, Wisconsin works Works under ss. 49.141 to 49.161, social services, child and spousal support and establishment of paternity and medical support liability services under s. 49.22, or supplemental payments under s. 49.77 for any purpose not connected with the administration of the programs, except that the department of workforce development may disclose such information to the department of revenue for the sole purpose of administering state taxes. Any person violating this section may be fined not less than $25 nor more than $500 or imprisoned in the county jail not less than 10 days nor more than one year or both.

25,1195 Section 1195. 49.845 of the statutes is created to read:

49.845 Fraud investigation and error reduction. (1) Fraud investigation. From the appropriations under s. 20.435 (4) (bn), (kz), (L), and (nn), the department of health and family services shall establish a program to investigate suspected fraudulent activity on the part of recipients of medical assistance under subch. IV, food stamp benefits under the food stamp program under 7 USC 2011 to 2036, supplemental security income payments under s. 49.77, payments for the support of children of supplemental security income recipients under s. 49.775, and health care benefits under the Badger Care health care program under s. 49.665 and, if the department of workforce development contracts with the department of health and family services under sub. (4), on the part of recipients of aid to families with dependent children under s. 49.19 and participants in the Wisconsin Works program under ss. 49.141 to 49.161. The activities of the department of health and family services under this subsection may include comparisons of information provided to the department by an applicant and information provided by the applicant to other federal, state, and local agencies, development of an advisory welfare investigation prosecution standard, and provision of funds to county departments under ss. 46.215, 46.22, and 46.23 and to Wisconsin Works agencies to encourage activities to detect fraud. The department of health and family services shall cooperate with district attorneys regarding fraud prosecutions.

(2) State error reduction activities. The department of health and family services shall conduct activities to reduce payment errors in the Medical Assistance program under subch. IV, the food stamp program under 7 USC 2011 to 2036, the supplemental security income payments program under s. 49.77, the program providing payments for the support of children of supplemental security income recipients under s. 49.775, and the Badger Care health care program under s. 49.665 and, if the department of workforce development contracts with the department of health and family services under sub. (4), in Wisconsin Works under ss. 49.141 to 49.161.

(3) Wisconsin Works agency error reduction. If the department of workforce development contracts with the department of health and family services under sub. (4), the department of health and family services shall provide funds from the appropriation under s. 20.435 (4) (kz) to Wisconsin Works agencies to offset the administrative costs of reducing payment errors in Wisconsin Works under ss. 49.141 to 49.161.

(4) Contract for Wisconsin Works. Notwithstanding s. 49.197 (1m) and (3), the department of workforce development may contract with the department of health and family services to investigate suspected fraudulent activity on the part of recipients of aid to families with dependent children under s. 49.19 and participants in Wisconsin Works under ss. 49.141 to 49.161 and to conduct activities to reduce payment errors in Wisconsin Works under ss. 49.141 to 49.161, as provided in this section.

25,1196 Section 1196. 49.847 of the statutes is created to read:

49.847 Recovery of incorrect payments under certain public assistance programs. (1) Subject to ss. 49.497 (1) and 49.793 (1), the department of health and family services, or a county or elected governing body of a federally recognized American Indian tribe or band acting on behalf of the department, may recover benefits incorrectly paid under any of the programs administered by the department under this chapter.

(2) The department, county, or elected governing body may recover an overpayment from a family or individual who continues to receive benefits under any program administered by the department under this chapter by reducing the family's or individual's benefit amount. Subject to s. 49.793 (1), the department may by rule specify other methods for recovering incorrectly paid benefits.

(3) Subject to ss. 49.497 (2) and 49.793 (2), a county or elected governing body may retain a portion of an amount recovered under this section due to the efforts of an employee or officer of the county, tribe, or band, as provided by the department by rule.

25,1197 Section 1197. 49.85 (1) of the statutes is amended to read:

49.85 (1) Department notification requirement. If a county department under s. 46.215, 46.22, or 46.23 or a governing body of a federally recognized American Indian tribe or band determines that the department of health and family services may recover an amount under s. 49.497, 49.793, or 49.847, or that the department of workforce development may recover an amount under s. 49.161, or 49.195 (3), or 49.793, or collect an amount under s. 49.147 (6) (cm), the county department or governing body shall notify the affected department of the determination. If a Wisconsin works Works agency determines that the department of workforce development may recover an amount under s. 49.161 or 49.195 (3), or collect an amount under s. 49.147 (6) (cm), the Wisconsin works Works agency shall notify the department of workforce development of the determination.

25,1198 Section 1198. 49.85 (2) (a) of the statutes is renumbered 49.85 (2) (a) (intro.) and amended to read:

49.85 (2) (a) (intro.) At least annually, the department of health and family services shall certify to the department of revenue the amounts that, based on the notifications received under sub. (1) and on other information received by the department of health and family services, the department of health and family services has determined that it may recover under s. 49.45 (2) (a) 10. or , 49.497, 49.793, or 49.847, except that the department of health and family services may not certify an amount under this subsection unless it all of the following apply:

1. The department has met the notice requirements under sub. (3) and unless its.