SB40-CSA1,737,168 49.468 (1) (c) For an elderly or disabled individual who is only entitled to
9coverage under part A of medicare and who does not meet the eligibility criteria for
10medical assistance under s. 49.46 (1), 49.465 or, 49.47 (4), or 49.471 but meets the
11limitations on income and resources under par. (d), medical assistance shall pay the
12deductible and coinsurance portions of medicare services under 42 USC 1395 to
131395i which are not paid under 42 USC 1395 to 1395i, including those medicare
14services that are not included in the approved state plan for services under 42 USC
151396
; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late
16enrollment penalty for premiums under part A of medicare, if applicable.
SB40-CSA1, s. 1594 17Section 1594. 49.468 (1m) (a) of the statutes is amended to read:
SB40-CSA1,737,2318 49.468 (1m) (a) Beginning on January 1, 1993, for an elderly or disabled
19individual who is entitled to coverage under part A of medicare and is entitled to
20coverage under part B of medicare, does not meet the eligibility criteria for medical
21assistance under s. 49.46 (1), 49.465 or, 49.47 (4), or 49.471 but meets the limitations
22on income and resources under par. (b), medical assistance shall pay the monthly
23premiums under 42 USC 1395r.
SB40-CSA1, s. 1595 24Section 1595. 49.468 (2) (a) of the statutes is amended to read:
SB40-CSA1,738,6
149.468 (2) (a) Beginning on January 1, 1991, for a disabled working individual
2who is entitled under P.L. 101-239, section 6012 (a), to coverage under part A of
3medicare and who does not meet the eligibility criteria for medical assistance under
4s. 49.46 (1), 49.465 or, 49.47 (4), or 49.471 but meets the limitations on income and
5resources under par. (b), medical assistance shall pay the monthly premiums for the
6coverage under part A of medicare, including late enrollment fees, if applicable.
SB40-CSA1, s. 1596 7Section 1596. 49.47 (4) (a) (intro.) of the statutes is amended to read:
SB40-CSA1,738,108 49.47 (4) (a) (intro.) Any individual who meets the limitations on income and
9resources under pars. (b) and to (c) and who complies with par. pars. (cm) and (cr)
10shall be eligible for medical assistance under this section if such individual is:
SB40-CSA1, s. 1597 11Section 1597. 49.47 (4) (as) 1. of the statutes is amended to read:
SB40-CSA1,738,1612 49.47 (4) (as) 1. The person would meet the financial and other eligibility
13requirements for home or community-based services under s. 46.27 (11), 46.277, or
1446.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c)
15(1d) but for the fact that the person engages in substantial gainful activity under 42
16USC 1382c
(a) (3).
SB40-CSA1, s. 1598 17Section 1598. 49.47 (4) (as) 3. of the statutes is amended to read:
SB40-CSA1,738,2018 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11), 46.277,
19or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1)
20(c)
(1d).
SB40-CSA1, s. 1598r 21Section 1598r. 49.47 (4) (b) (intro.) of the statutes is amended to read:
SB40-CSA1,738,2422 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the
23exclusion of any amounts under the Long-Term Care Partnership Program
24established under s. 49.45 (31),
does not exceed the following:
SB40-CSA1, s. 1599 25Section 1599. 49.47 (4) (b) 1. of the statutes is amended to read:
SB40-CSA1,739,3
149.47 (4) (b) 1. A Subject to par. (bc), a home and the land used and operated
2in connection therewith or in lieu thereof a mobile home if the home or mobile home
3is used as the person's or his or her family's place of abode.
SB40-CSA1, s. 1600 4Section 1600. 49.47 (4) (bc) of the statutes is created to read:
SB40-CSA1,739,95 49.47 (4) (bc) 1. Subject to subd. 2., a person shall be ineligible under this
6section for medical assistance for nursing facility services or other long-term care
7services described in s. 49. 453 (2) if the equity in his or her home and the land used
8and operated in connection with the home exceeds $750,000. This subdivision does
9not apply if any of the following persons lawfully resides in the home:
SB40-CSA1,739,1010 a. The person's spouse.
SB40-CSA1,739,1211 b. The person's child who is under age 21 or who is disabled, as defined in s.
1249.468 (1) (a) 1.
SB40-CSA1,739,1313 2. Subdivision 1. applies to all of the following:
SB40-CSA1,739,1614 a. At the time of application, to a person who applies for medical assistance for
15nursing facility services or other long-term care services described in s. 49.453 (2)
16after the effective date of this subd. 2. a. .... [revisor inserts date].
SB40-CSA1,739,2217 b. At the time of the person's first recertification after the effective date of this
18subd. 2. b. .... [revisor inserts date], to a person not specified in subd. 2. a. who applied
19for medical assistance for nursing facility services or other long-term care services
20described in s. 49.453 (2) on or after January 1, 2006, and who was eligible for medical
21assistance for those services on the effective date of this subd. 2. b. .... [revisor inserts
22date].
SB40-CSA1, s. 1601 23Section 1601. 49.47 (4) (bm) of the statutes is created to read:
SB40-CSA1,740,324 49.47 (4) (bm) For purposes of determining eligibility or benefits amount for
25a person described in par. (a) 3. or 4. who resides in a continuing care retirement

1community or a life care community, any entrance fee paid on admission to the
2community shall be considered a resource available to the person to the extent that
3all of the following apply:
SB40-CSA1,740,64 1. The person has the ability to use the entrance fee, or the contract provides
5that the entrance fee may be used, to pay for care if the person's other resources or
6income are insufficient to pay for the care.
SB40-CSA1,740,97 2. The person is eligible for a refund of any remaining entrance fee when the
8person dies or terminates the continuing care retirement community or life care
9community contract and leaves the community.
SB40-CSA1,740,1110 3. The entrance fee does not confer an ownership interest in the continuing care
11retirement community or life care community.
SB40-CSA1, s. 1602 12Section 1602. 49.47 (4) (cr) of the statutes is created to read:
SB40-CSA1,740,2313 49.47 (4) (cr) 1. As a condition of receiving medical assistance for long-term
14care services described in s. 49.453 (2) (a), an applicant for or recipient of the
15long-term care services shall disclose on the application or recertification form a
16description of any interest the individual or his or her community spouse, as defined
17in s. 49.453 (1) (ar), has in an annuity, regardless of whether the annuity is
18irrevocable or is treated as an asset. The application or recertification form shall
19include a statement that the state becomes a remainder beneficiary under any
20annuity in which the individual or his or her spouse has an interest by virtue of the
21provision of the medical assistance. The applicant or recipient shall, no later than
2230 days after the department receives the application or recertification form, take
23any action required by the annuity issuer to make the state a remainder beneficiary.
SB40-CSA1,741,224 2. The department shall notify the issuer of an annuity disclosed under subd.
251. of the state's right as a remainder beneficiary and shall request that the issuer

1notify the department of any changes to or payments made under the annuity
2contract.
SB40-CSA1,741,33 3. This paragraph applies to all of the following:
SB40-CSA1,741,44 a. Annuities purchased on or after February 8, 2006.
SB40-CSA1,741,65 b. Annuities purchased before February 8, 2006, for which a transaction, as
6defined in s. 49.453 (4) (ac), has occurred on or after February 8, 2006.
SB40-CSA1, s. 1603 7Section 1603. 49.47 (6) (a) 1. of the statutes is amended to read:
SB40-CSA1,741,98 49.47 (6) (a) 1. Except as provided in subds. 6. to 7., all beneficiaries, for all
9services under s. 49.46 (2) (a) and (b), subject to s. 49.46 (2) (dc).
SB40-CSA1, s. 1604 10Section 1604. 49.47 (9m) of the statutes is repealed.
SB40-CSA1, s. 1605 11Section 1605. 49.471 of the statutes is created to read:
SB40-CSA1,741,13 1249.471 BadgerCare Plus. (1) Definitions. In this section, unless the context
13requires otherwise:
SB40-CSA1,741,1514 (a) "BadgerCare Plus" means the Medical Assistance program described in this
15section.
SB40-CSA1,741,1916 (b) "Caretaker relative" means an individual who is maintaining a residence
17as a child's home, who exercises primary responsibility for the child's care and
18control, including making plans for the child, and who is any of the following with
19respect to the child:
SB40-CSA1,741,2220 1. A blood relative, including those of half-blood, and including first cousins,
21nephews, nieces, and individuals of preceding generations as denoted by prefixes of
22grand, great, or great-great.
SB40-CSA1,741,2323 2. A stepfather, stepmother, stepbrother, or stepsister.
SB40-CSA1,741,2524 3. An individual who is the adoptive parent of the child's parent, a natural or
25legally adopted child of such individual, or a relative of an adoptive parent.
SB40-CSA1,742,2
14. A spouse of any individual named in this paragraph even if the marriage is
2terminated by death or divorce.
SB40-CSA1,742,43 (c) "Child" means an individual who is under the age of 19 years. "Child"
4includes an unborn child.
SB40-CSA1,742,55 (d) "Essential person" means an individual who satisfies all of the following:
SB40-CSA1,742,66 1. Is related to an individual receiving benefits under this section.
SB40-CSA1,742,87 2. Is otherwise nonfinancially eligible, except that the individual need not have
8a minor child under his or her care.
SB40-CSA1,742,109 3. Provides at least one of the following to an individual receiving benefits
10under this section:
SB40-CSA1,742,1511 a. Child care that enables a caretaker to work outside the home for at least 30
12hours per week for pay, to receive training for at least 30 hours per week, or to attend,
13on a full-time basis as defined by the school, high school or a course of study meeting
14the standards established by the state superintendent of public instruction for the
15granting of a declaration of equivalency of high school graduation under s. 115.29 (4).
SB40-CSA1,742,1616 b. Care for anyone who is incapacitated.
SB40-CSA1,742,1917 (e) "Family" means all children for whom assistance is requested, their minor
18siblings, including half brothers, half sisters, stepbrothers, and stepsisters, and any
19parents of these minors and their spouses.
SB40-CSA1,742,2120 (f) "Family income" means the total gross earned and unearned income
21received by all members of a family.
SB40-CSA1,742,2222 (g) "Group health plan" has the meaning given in 42 USC 300gg-91 (a) (1).
SB40-CSA1,742,2523 (h) "Health insurance coverage" has the meaning given in 42 USC 300gg-91
24(b) (1), and also includes any arrangement under which a 3rd party agrees to pay for
25the health care costs of the individual.
SB40-CSA1,743,1
1(i) "Parent" has the meaning given in s. 49.141 (1) (j).
SB40-CSA1,743,22 (j) "Recipient" means an individual receiving benefits under this section.
SB40-CSA1,743,43 (k) "Unborn child" means an individual from conception until he or she is born
4alive for whom all of the following requirements are met:
SB40-CSA1,743,65 1. The unborn child's mother is not eligible for medical assistance under this
6subchapter, except that she may be eligible for benefits under s. 49.45 (27).
SB40-CSA1,743,97 2. The income of the unborn child's mother, mother and her spouse, or mother
8and her family, whichever is applicable, does not exceed 300 percent of the poverty
9line.
SB40-CSA1,743,1210 3. Each of the following applicable persons who is employed provides
11verification from his or her employer, in the manner specified by the department, of
12his or her earnings:
SB40-CSA1,743,1313 a. The unborn child's mother.
SB40-CSA1,743,1414 b. The spouse of the unborn child's mother.
SB40-CSA1,743,1515 c. Members of the unborn child's mother's family.
SB40-CSA1,743,1916 4. The unborn child's mother provides medical verification of her pregnancy,
17in the manner specified by the department. An unborn child's eligibility for coverage
18under this section does not begin before the first day of the month in which the
19unborn child's mother provides the medical verification.
SB40-CSA1,743,2220 5. The unborn child and the mother of the unborn child meet all other
21applicable eligibility requirements under this chapter or established by the
22department by rule except for any of the following:
SB40-CSA1,743,2423 a. The mother is not a U.S. citizen or an alien qualifying for Medicaid under
248 USC 1612.
SB40-CSA1,743,2525 b. The mother is an inmate of a public institution.
SB40-CSA1,744,2
1c. The mother does not provide a social security number, but only if subd. 5. a.
2applies.
SB40-CSA1,744,15 3(2) Waiver. The department shall request a waiver from, and submit
4amendments to the state Medical Assistance plan to, the secretary of the federal
5department of health and human services to implement BadgerCare Plus. If the
6state plan amendments are approved and a waiver that is substantially consistent
7with the provisions of this section, excluding sub. (2m), is granted and in effect, the
8department shall implement BadgerCare Plus beginning on January 1, 2008, the
9effective date of the state plan amendments, or the effective date of the waiver,
10whichever is latest. If the state plan amendments are not approved or if a waiver that
11is substantially consistent with the provisions of this section, excluding sub. (2m),
12is not granted, BadgerCare Plus may not be implemented. If the state plan
13amendments are approved but approval is not continued or if a waiver that is
14substantially consistent with the provisions of this section, excluding sub. (2m), is
15granted but not continued in effect, BadgerCare Plus shall be discontinued.
SB40-CSA1,745,2 16(2m) Approval to qualify as a health coverage tax credit plan. The
17department shall seek any necessary federal approvals to ensure that BadgerCare
18Plus is qualified health insurance under 26 USC 35 (e). Notwithstanding subs. (4)
19and (5), if BadgerCare Plus is determined to be qualified health insurance under 26
20USC 35
(e), the department shall expand eligibility under BadgerCare Plus to
21include individuals who are eligible individuals under 26 USC 35 (c).
22Notwithstanding sub. (10) (a) and (b) 1. to 4., individuals who are eligible for coverage
23under BadgerCare Plus under this subsection shall pay premiums that are equal to
24the capitation payments that the department would make on behalf of similar

1individuals with coverage under BadgerCare Plus, or the full per member per month
2cost of coverage, whichever is appropriate.
SB40-CSA1,745,10 3(3) Ineligibility for other Medical Assistance benefits. (a) 1.
4Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4), if the amendments
5to the state plan under sub. (2) are approved and a waiver under sub. (2) that is
6consistent with all of the provisions of this section, excluding sub. (2m), is granted
7and in effect, an individual described in sub. (4) (a) or (b) or (5) is not eligible under
8s. 49.46, 49.465, 49.47, or 49.665 for Medical Assistance or BadgerCare health
9program benefits. The eligibility of an individual described in sub. (4) (a) or (b) or
10(5) for Medical Assistance benefits shall be determined under this section.
SB40-CSA1,745,1211 2. Notwithstanding subd. 1., an individual who is eligible for medical
12assistance under s. 49.46 (1) (a) 3. or 4. may not receive benefits under this section.
SB40-CSA1,745,1613 3. Notwithstanding subd. 1., an individual described in sub. (4) (a) or (b) or (5)
14who is eligible for medical assistance under s. 49.46 (1) (a) 5., 6m., 14., 14m., or 15.
15or (d) or 49.47 (4) (a) or (as) may receive medical assistance benefits under this
16section or under s. 49.46 or 49.47.
SB40-CSA1,745,2317 (b) 1. If an individual over 18 years of age who is eligible for and receiving
18Medical Assistance benefits under s. 49.46, 49.47, or 49.665 in the month before
19BadgerCare Plus is implemented loses that eligibility solely due to the
20implementation of BadgerCare Plus and, because of his or her income, is not eligible
21for BadgerCare Plus, the individual shall continue receiving for 18 consecutive
22months the medical assistance he or she was receiving before the implementation of
23BadgerCare Plus if all of the following are satisfied:
SB40-CSA1,746,3
1a. The individual's eligibility for the Medical Assistance benefits in the month
2before the implementation of BadgerCare Plus was based on an application filed
3before the implementation of BadgerCare Plus.
SB40-CSA1,746,64 b. The individual continues to pay any premium that he or she was required
5to pay for the Medical Assistance coverage in the same amount as the amount that
6was due in the month before the implementation of BadgerCare Plus.
SB40-CSA1,746,97 c. The individual continues to meet all nonfinancial eligibility requirements for
8the coverage that he or she had in the month before the implementation of
9BadgerCare Plus.
SB40-CSA1,746,1110 d. The individual continues to be ineligible for BadgerCare Plus because of his
11or her income.
SB40-CSA1,746,1512 2. Notwithstanding subd. 1., if at any time during an individual's 18-month
13eligibility extension under subd. 1. any criterion under subd. 1. a. to d. is not satisfied,
14the individual's eligibility for the extended coverage is terminated and any time
15remaining in the eligibility period is lost.
SB40-CSA1,746,18 16(4) General eligibility criteria; applicable benefits. (a) Except as otherwise
17provided in this section, all of the following individuals are eligible for the benefits
18described in s. 49.46 (2) (a) and (b), subject to sub. (6) (k):
SB40-CSA1,746,2019 1. A pregnant woman whose family income does not exceed 200 percent of the
20poverty line.
SB40-CSA1,746,2321 2. A child who is under one year of age, whose mother was, on the day the child
22was born, eligible for and receiving medical assistance under subd. 1. or 5. or s. 49.46
23or 49.47, and who lives with his or her mother in this state.
SB40-CSA1,747,3
13. A child whose family income does not exceed 200 percent of the poverty line.
2For a child under this subdivision who is an unborn child, benefits are limited to
3prenatal care.
SB40-CSA1,747,44 3m. A child who obtains eligibility under sub. (7) (b) 2.
SB40-CSA1,747,55 4. An individual who satisfies all of the following criteria:
SB40-CSA1,747,106 a. The individual is a parent or caretaker relative of a child who is living in the
7home with the parent or caretaker relative or who is temporarily absent from the
8home for not more than 6 months or, if the child has been removed from the home for
9more than 6 months, the parent or caretaker relative is working toward unifying the
10family by complying with a permanency plan under s. 48.38.
SB40-CSA1,747,1211 b. Except as provided in subd. 4. c., the individual's family income does not
12exceed 200 percent of the poverty line and does not include self-employment income.
SB40-CSA1,747,1513 c. If the individual's family income includes self-employment income, the
14individual's family income does not exceed 200 percent of the poverty line as
15calculated under sub. (7) (a) 2.
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