Health and human services
Medical Assistance
Under current law, DHFS administers the Medical Assistance (MA) program, under which eligible individuals, generally low-income, elderly, or disabled, receive health care benefits. Some individuals who are eligible for MA are also eligible for Medicare Part D, which is the portion of the federal health insurance program for individuals who are, generally, 65 years of age or older or disabled that provides prescription drug coverage. Enrollment in Medicare Part D is voluntary. Not all Part D plans in which individuals may enroll cover all of the prescription drugs that may be covered under Medicare Part D.
This bill provides that, for an individual who is eligible for both MA and Medicare Part D, benefits under MA do not include payment for any prescription drug for which there may be coverage under Medicare Part D, regardless of whether the individual is enrolled in Medicare Part D and, if he or she is enrolled, regardless of whether the individual's Part D plan covers the drug. Thus, to have coverage for a prescription drug for which Medicare Part D may provide coverage, an individual who is eligible for both MA and Medicare Part D must enroll in Medicare Part D in a Part D plan that covers the drug; MA will not cover it.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.46 (2) (b) (intro.) of the statutes is amended to read:

49.46 (2) (b) (intro.) Except as provided in par. pars. (be) and (dc), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following services:

SECTION 2. 49.46 (2) (dc) of the statutes is created to read:

49.46 (2) (dc) For an individual who is eligible for medical assistance and who is eligible for coverage under Part D of Medicare under 42 USC 1395w-101 et seq., benefits under par. (b) 6. h. do not include payment for any Part D drug, as defined in 42 CFR 423.100, regardless of whether the individual is enrolled in Part D of Medicare or whether, if the individual is enrolled, his or her Part D plan, as defined in 42 CFR 423.4, covers the Part D drug.

SECTION 3. 49.47 (6) (a) 1. of the statutes is amended to read:

49.47 (6) (a) 1. Except as provided in subds. 6. to 7., all beneficiaries, for all services under s. 49.46 (2) (a) and (b), subject to s. 49.46 (2) (dc).
(End)
LRB-0264LRB-0264/1
PJK:kjf:sh
2007 - 2008 LEGISLATURE

DOA:......Jablonsky, BB0017 - Tribal relief block grant
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL

AN ACT ...; relating to: tribal relief block grant use.
Analysis by the Legislative Reference Bureau
Health and human services
Public assistance
Under current law, DHFS provides relief block grant moneys to counties and tribal governing bodies for providing assistance in the form of health care services to persons who meet the criteria for dependency. Health care services are defined as reasonable and necessary emergency and nonemergency medical, surgical, dental, hospital, nursing, and optometric services. Tribal governing bodies are also authorized to provide treatment for alcohol and other drug abuse with relief block grant moneys. This bill adds mental health services to the types of health care services that tribal governing bodies may provide with relief block grant moneys.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.029 (3) of the statutes is amended to read:

49.029 (3) USE OF RELIEF BLOCK GRANT FUNDS. A tribal governing body may use moneys received as a relief block grant only for the purpose of providing health care services to dependent persons. Notwithstanding s. 49.01 (2g), health care services may include treatment services for alcohol and other drug abuse and mental health services.
(End)
LRB-0265LRB-0265/3
PJK:jld:rs
2007 - 2008 LEGISLATURE

DOA:......Pink, BB0011 - Citizenship and identity documentation
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL

AN ACT ...; relating to: requiring documentary evidence of U.S. citizenship or nationality for Medical Assistance eligibility.
Analysis by the Legislative Reference Bureau
Health and human services
Public assistance
Under current law, as a condition of eligibility for Wisconsin Works, Medical Assistance (MA), or the food stamp program, a person who applies for any of those programs must provide a declaration of citizenship or satisfactory immigration status and may be required to provide additional verification of citizenship or satisfactory immigration status. Wisconsin Works, MA, and the food stamp program are public assistance programs that provide cash benefits and job assistance, medical care, or assistance with food purchases to low-income persons who satisfy other eligibility criteria generally relating to age, pregnancy, or disability.
Federal law now provides that no federal financial participation will be provided to a state for MA expenditures made on behalf of a person who declares that he or she is a citizen or national of the United States unless the person presents satisfactory documentary evidence of citizenship or nationality. Federal law specifies the documentary evidence that is satisfactory and certain exemptions to the requirement based on the basis of the person's eligibility for MA.
This bill provides that, with some exceptions, as a condition of eligibility for MA, Badger Care, or Senior Care an applicant or recipient who declares himself or herself to be a United States citizen or national must provide satisfactory documentary evidence that he or she is a citizen or national. An applicant must provide the documentation at the time of application and a recipient who was not required to provide documentation when he or she applied must provide the documentation at his or her first eligibility review after the bill is enacted. The bill provides that satisfactory documentation consists of those documents and other forms of evidence specified under federal law.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.84 (6) of the statutes is created to read:

49.84 (6) (a) In this subsection, "department" means the department of health and family services.

(b) 1. Notwithstanding any other eligibility requirements for the programs specified in par. (c), unless excepted by par. (c) an applicant for or recipient under any of those programs who declares himself or herself to be a citizen or national of the United States shall provide, as a further condition of eligibility, satisfactory documentary evidence, as provided in par. (d), that he or she is a citizen or national of the United States.

2. An applicant shall provide the documentation at the time of application. If a recipient was not required to provide documentation at the time he or she applied, the recipient shall provide the documentation the first time his or her eligibility is reviewed or redetermined after the effective date of this subdivision .... [revisor inserts date]. An applicant or recipient shall be granted a reasonable time, as determined by the department, to submit the documentation before his or her eligibility is denied or terminated.

(c) The requirement to provide satisfactory documentary evidence under par. (b) applies to applicants for and recipients under all of the following:

1. The Medical Assistance program under subch. IV, except for any of the following:

a. An applicant or recipient who is entitled to benefits under or enrolled in any part of Medicare under 42 USC 1395 et seq., as amended.

b. An applicant or recipient who is receiving supplemental security income under 42 USC 1381 to 1383c.

c. A person who is eligible for medical assistance under s. 49.45 (27).

d. A child who is receiving medical assistance under s. 49.46 (1) (a) 13. or 49.47 (4) (am) 3.

e. A pregnant woman who is receiving medical assistance under s. 49.465.

2. The Badger Care health care program under s. 49.665, except for an unborn child under s. 49.665 (4) (ap).

3. The part of the prescription drug assistance for elderly persons program under s. 49.688 that is supported by a Medical Assistance waiver under 42 USC 1315 (a), as authorized under s. 49.688 (11).

(d) Satisfactory documentary evidence that an applicant or a recipient is a citizen or national of the United States consists of the documents or other forms of evidence specified in 42 CFR 435.407.
(End)
LRB-0266LRB-0266/3
PJK:kjf&wlj:pg
2007 - 2008 LEGISLATURE

DOA:......Milioto, Steve, BB0026 - Medicaid asset transfers
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL

AN ACT ...; relating to: changes in asset transfer rules for Medical Assistance eligibility.
Analysis by the Legislative Reference Bureau
Health and human services
Medical Assistance
Under current law, DHFS administers the Medical Assistance (MA) program, which provides federal and state moneys to pay for health care and long-term care services, including care in a nursing home, provided to MA recipients, who are, generally, low-income, elderly, or disabled persons who meet other specific eligibility requirements. To be eligible for MA for long-term care services, an individual must meet certain very low income and resource requirements, and may have to "spend down" his or her income and resources by paying for his or her own long-term care until the eligibility requirements are met.
Current law provides rules, based on federal law, concerning divestment, which refers to the transferring of one's assets for less than fair market value for the purpose of reducing one's income and resources to become eligible for MA for long-term care services. If a person divests assets on or after the person's look-back date (generally, the date that is three years before the person applies for MA for long-term care services), the person may be ineligible for MA for a specific time period (penalty period). The federal Deficit Reduction Act, which became effective on February 8, 2006, made a number of changes in the divestment rules. To conform Wisconsin law to the federal law, this bill makes a number of changes with respect to divestment, including, among other things:
1. Changes the look-back date to five years for transfers that occur on or after February 8, 2006.
2. Changes the beginning date for the penalty period from the date on which assets were transferred to the later of the date on which assets were transferred or the date on which the person applies and is eligible for MA for long-term care services.
3. Provides that the purchase of a loan, promissory note, mortgage, or life estate after February 8, 2006, is a divestment and specifies the requirements for when such a purchase is not to be considered a divestment.
4. Provides that as a condition of receiving MA for long-term care services an applicant (when applying) or recipient (when being recertified) must disclose any interest he or she or his or her spouse has in an annuity that was purchased on or after February 8, 2006, or with respect to which a transaction occurred on or after February 8, 2006. A transaction is defined as any action that changes the course of payments to be made or the treatment of income or principal.
5. Specifies the conditions under which the purchase of an annuity on or after February 8, 2006, is not to be considered a divestment, including designating DHFS as a remainder beneficiary under the annuity in the first position.
6. Requires DHFS to establish a hardship waiver process, with certain criteria, under which the divestment rules would not apply to a person because it would result in undue hardship for the person and allows DHFS to pay the full nursing facility payment rate for up to 30 days to hold a bed in the facility for a person involved in a pending undue hardship determination.
7. Provides, generally, that a person is ineligible for MA for long-term care services if the equity in their home exceeds $750,000 unless their spouse or minor or disabled child is living in the home. Under current law, a person's home, regardless of the value, is not counted when the person's income and resources for MA eligibility are determined.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.45 (6m) (m) of the statutes is created to read:

49.45 (6m) (m) To hold a bed in a facility, the department may pay the full payment rate under this subsection for up to 30 days for services provided to a person during the pendency of an undue hardship determination, as provided in s. 49.453 (8) (b) 3.

SECTION 2. 49.453 (1) (a) of the statutes is amended to read:

49.453 (1) (a) "Assets" has the meaning given in 42 USC 1396p (e) (h) (1).

SECTION 3. 49.453 (1) (ar) of the statutes is created to read:

49.453 (1) (ar) "Community spouse" means the spouse of either the institutionalized person or the noninstitutionalized person.

SECTION 4. 49.453 (1) (d) of the statutes is amended to read:

49.453 (1) (d) "Income" has the meaning given in 42 USC 1396p (e) (h) (2).

SECTION 5. 49.453 (1) (e) of the statutes is amended to read:

49.453 (1) (e) "Institutionalized individual" has the meaning given in 42 USC 1396p (e) (h) (3).

SECTION 6. 49.453 (1) (f) (intro.) of the statutes is amended to read:

49.453 (1) (f) (intro.) "Look-back date" means for a covered individual, either of the following:

1m. For transfers made before February 8, 2006, the date that is 36 months before, or with respect to payments from a trust or portions of a trust that are treated as assets transferred by the covered individual under s. 49.454 (2) (c) or (3) (b) the date that is 60 months before:

SECTION 7. 49.453 (1) (f) 1. of the statutes is renumbered 49.453 (1) (f) 1m. a.

SECTION 8. 49.453 (1) (f) 2. of the statutes is renumbered 49.453 (1) (f) 1m. b.

SECTION 9. 49.453 (1) (f) 2m. of the statutes is created to read:

Loading...
Loading...