SB1,727,1917 (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.
SB1,727,2120 (f) "Family income" means the total gross earned and unearned income
21received by all members of a family.
SB1,727,2222 (g) "Group health plan" has the meaning given in 42 USC 300gg-91 (a) (1).
SB1,727,2523 (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.
SB1,728,1
1(i) "Parent" has the meaning given in s. 49.141 (1) (j).
SB1,728,22 (j) "Recipient" means an individual receiving benefits under this section.
SB1,728,43 (k) "Unborn child" means an individual from conception until he or she is born
4alive for whom all of the following requirements are met:
SB1,728,65 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).
SB1,728,97 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.
SB1,728,1210 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:
SB1,728,1313 a. The unborn child's mother.
SB1,728,1414 b. The spouse of the unborn child's mother.
SB1,728,1515 c. Members of the unborn child's mother's family.
SB1,728,1916 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.
SB1,728,2220 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:
SB1,728,2423 a. The mother is not a U.S. citizen or an alien qualifying for Medicaid under
248 USC 1612.
SB1,728,2525 b. The mother is an inmate of a public institution.
SB1,729,2
1c. The mother does not provide a social security number, but only if subd. 5. a.
2applies.
SB1,729,15 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.
SB1,730,2 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.
SB1,730,10 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.
SB1,730,1211 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.
SB1,730,1613 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.
SB1,730,2317 (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:
SB1,731,3
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.
SB1,731,64 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.
SB1,731,97 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.
SB1,731,1110 d. The individual continues to be ineligible for BadgerCare Plus because of his
11or her income.
SB1,731,1512 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.
SB1,731,18 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):
SB1,731,2019 1. A pregnant woman whose family income does not exceed 200 percent of the
20poverty line.
SB1,731,2321 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.
SB1,732,3
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.
SB1,732,44 3m. A child who obtains eligibility under sub. (7) (b) 2.
SB1,732,55 4. An individual who satisfies all of the following criteria:
SB1,732,106 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.
SB1,732,1211 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.
SB1,732,1513 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.
SB1,732,2116 5. An individual who, regardless of family income, was born on or after January
171, 1990, and who, on his or her 18th birthday, was in a foster care or treatment foster
18care placement under the responsibility of a state, as determined by the department.
19The coverage for an individual under this subdivision ends on the last day of the
20month in which the individual becomes 21 years of age, unless he or she otherwise
21loses eligibility sooner.
SB1,732,2322 6. Migrant workers and their dependents who are determined eligible under
23sub. (6) (f).
SB1,732,2524 (b) Except as otherwise provided in this section, all of the following individuals
25are eligible for the benefits described in sub. (11):
SB1,733,2
11. A pregnant woman whose family income exceeds 200 percent but does not
2exceed 300 percent of the poverty line.
SB1,733,43 1m. A pregnant woman or unborn child who obtains eligibility under sub. (7)
4(b) 1.
SB1,733,65 2. A child who is under one year of age, whose mother was determined to be
6eligible under subd. 1., and who lives with his or her mother in this state.
SB1,733,97 3. A child whose family income exceeds 200 percent but does not exceed 300
8percent of the poverty line. For a child under this subdivision who is an unborn child,
9benefits are limited to prenatal care.
SB1,733,1010 4. An individual who satisfies all of the following criteria:
SB1,733,1511 a. The individual is a parent or caretaker relative of a child who is living in the
12home with the parent or caretaker relative or who is temporarily absent from the
13home for not more than 6 months or, if the child has been removed from the home for
14more than 6 months, the parent or caretaker relative is working toward unifying the
15family by complying with a permanency plan under s. 48.38.
SB1,733,1716 b. The individual's family income includes self-employment income and does
17not exceed 200 percent of the poverty line as calculated under sub. (7) (a) 3.
SB1,733,2118 (c) Except as otherwise provided in this section, a child who is not an unborn
19child and whose family income exceeds 300 percent of the poverty line is eligible to
20purchase coverage of the benefits described in sub. (11), at the full per member per
21month cost of the coverage.
SB1,733,22 22(5) Presumptive eligibility. (a) In this subsection:
SB1,733,2423 1. "Qualified entity" means an entity that satisfies the requirements under 42
24USC 1396r-1a
(b) (3) (A), as determined by the department.
SB1,734,2
12. "Qualified provider" means a provider that satisfies the requirements under
242 USC 1396r-1 (b) (2), as determined by the department.
SB1,734,73 (b) 1. Except as provided in sub. (6) (a), a pregnant woman is eligible for the
4benefits specified in par. (c) during the period beginning on the day on which a
5qualified provider determines, on the basis of preliminary information, that the
6woman's family income does not exceed 300 percent of the poverty line and ending
7on the applicable day specified in subd. 3.
SB1,734,128 2. Except as provided in sub. (6) (a), a child who is not an unborn child is eligible
9for the benefits described in s. 49.46 (2) (a) and (b) during the period beginning on
10the day on which a qualified entity determines, on the basis of preliminary
11information, that the child's family income does not exceed 150 percent of the poverty
12line and ending on the applicable day specified in subd. 3.
SB1,734,1713 3. a. If the woman or child applies for benefits under sub. (4) within the time
14required under par. (d), the benefits specified in subd. 1. or 2., whichever is
15applicable, end on the day on which the department or the county department under
16s. 46.215, 46.22, or 46.23 determines whether the woman or child is eligible for
17benefits under sub. (4).
SB1,734,2118 b. If the woman or child does not apply for benefits under sub. (4) within the
19time required under par. (d), the benefits specified in subd. 1. or 2., whichever is
20applicable, end on the last day of the month following the month in which the
21provider or entity makes the determination under this paragraph.
SB1,734,2422 (c) On behalf of a woman under par. (b) 1., the department shall audit and pay
23allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory
24prenatal care services under the benefits under sub. (11).
SB1,735,3
1(d) A woman or child who is determined to be eligible under par. (b) shall apply
2for benefits under sub. (4) on or before the last day of the month following the month
3in which the qualified provider or entity makes the eligibility determination.
SB1,735,54 (e) A qualified provider or entity that determines that a woman or child is
5eligible under par. (b) shall do all of the following:
SB1,735,76 1. Notify the department of that determination within 5 working days after the
7day on which the determination is made.
SB1,735,98 2. Notify the woman or child of the requirement under par. (d) at the time of
9the determination.
SB1,735,1210 (f) The department shall provide qualified providers and qualified entities with
11application forms for the benefits under sub. (4) and information on how to assist
12women and children in completing the forms.
SB1,735,19 13(6) Miscellaneous eligibility and benefit provisions. (a) Any pregnant
14woman, including a pregnant woman under sub (5) (b) 1., child who is not an unborn
15child, including a child under sub. (5) (b) 2., parent, or caretaker relative whose
16family income is less than 150 percent of the poverty line is eligible for medical
17assistance under this section for any of the 3 months prior to the month of application
18if the individual met the eligibility criteria under this section and had a family
19income of less than 150 percent of the poverty line in that month.
SB1,735,2320 (b) A pregnant woman who is determined to be eligible for benefits under sub.
21(4) remains eligible for benefits under sub. (4) for the balance of the pregnancy and
22to the last day of the month in which the 60th day after the last day of the pregnancy
23falls without regard to any change in the woman's family income.
SB1,736,324 (c) If a child who is eligible for benefits under sub. (4) is receiving inpatient
25services covered under sub. (4) on the day before his or her 19th birthday and, but

1for attaining 19 years of age, the child would remain eligible for benefits under sub.
2(4), the child remains eligible for benefits until the end of the stay for which the
3inpatient services are being furnished.
SB1,736,64 (d) If an application under this section shows that an individual is an essential
5person, the individual shall be provided the benefits specified under sub. (4) (a) or
6(b).
SB1,736,97 (e) The medical assistance eligibility extensions under s. 49.46 (1) (c), (cg), and
8(co) for individuals who lose eligibility due to increased income do not apply to
9BadgerCare Plus.
SB1,736,1110 (f) The medical assistance eligibility provisions for migrant workers and their
11dependents under s. 49.47 (4) (av) apply to BadgerCare Plus.
SB1,736,1412 (g) 1. Except as provided in subd. 2., as a condition of eligibility for coverage
13under this section, an individual with income shall provide verification, as
14determined by the department, of that income.
SB1,736,1615 2. Subdivision 1. does not apply to an individual under sub. (4) (a) 5. or a child
16under the age of 18.
SB1,736,2017 (h) Within 10 days after the change occurs, a recipient shall report to the
18department any change that might affect his or her eligibility or any change that
19might require premium payment by a recipient who was not required to pay
20premiums before the change.
SB1,736,2321 (i) For purposes of determining eligibility and family income, the department
22shall include a family member who is temporarily absent from the home for not more
23than 6 months, as determined by the department.
SB1,736,2524 (j) All of the following apply to BadgerCare Plus in the same respect as they
25apply under s. 49.46:
SB1,737,2
11. Section 49.46 (2) (c) and (cm), relating to benefits for individuals who are
2eligible for Medicare.
SB1,737,53 2. Section 49.46 (2) (d), relating to prohibiting payments for any part of any
4service payable through 3rd-party liability or any governmental or private benefit
5system.
SB1,737,76 3. Section 49.46 (2) (dm), relating to prohibiting payment for services to
7residents of institutions for mental diseases.
SB1,737,98 4. Section 49.46 (2) (f), relating to prohibiting payment for gastric bypass or
9stapling surgery.
SB1,737,1510 (k) For an individual who is eligible for medical assistance under this section
11and who is eligible for coverage under Part D of Medicare under 42 USC 1395w-101
12et seq., benefits under sub. (11) (a) or s. 49.46 (2) (b) 6. h. do not include payment for
13any Part D drug, as defined in 42 CFR 423.100, regardless of whether the individual
14is enrolled in Part D of Medicare or whether, if the individual is enrolled, his or her
15Part D plan, as defined in 42 CFR 423.4, covers the Part D drug.
SB1,737,20 16(7) Special income provisions. (a) 1. In the calculation of family income, if an
17adult member of the family has self-employment income, the department shall count
18the net self-employment earnings. Net self-employment earnings shall be
19determined by subtracting from gross self-employment income all self-employment
20expenses that are allowed under federal and state tax law, except for depreciation.
SB1,737,2321 2. If a parent's or caretaker relative's family income includes self-employment
22income and, without deducting depreciation, does not exceed 200 percent of the
23poverty line, the parent or caretaker relative is eligible under sub. (4) (a) 4.
SB1,738,224 3. If a parent's or caretaker relative's family income includes self-employment
25income and, without deducting depreciation, exceeds 200 percent of the poverty line,

1the parent or caretaker relative is eligible under sub. (4) (b) 4. if his or her family
2income does not exceed 200 percent of the poverty line after depreciation is deducted.
SB1,738,143 (b) 1. A pregnant woman, or an unborn child, whose family income exceeds 300
4percent of the poverty line may become eligible for coverage under this section if the
5difference between the pregnant woman's or unborn child's family income and the
6applicable income limit under sub. (4) (b) is obligated or expended for any member
7of the pregnant woman's or unborn child's family for medical care or any other type
8of remedial care recognized under state law or for personal health insurance
9premiums or for both. Eligibility obtained under this subdivision continues without
10regard to any change in family income for the balance of the pregnancy and, for a
11pregnant woman but not for an unborn child, to the last day of the month in which
12the 60th day after the last day of the woman's pregnancy falls. Eligibility obtained
13by a pregnant woman under this subdivision extends to all pregnant women in the
14pregnant woman's family.
SB1,738,2215 2. A child who is not an unborn child and whose family income exceeds 150
16percent of the poverty line may obtain eligibility under this section if the difference
17between the child's family income and 150 percent of the poverty line is obligated or
18expended on behalf of the child or any member of the child's family for medical care
19or any other type of remedial care recognized under state law or for personal health
20insurance premiums or for both. Eligibility obtained under this subdivision during
21any 6-month period, as determined by the department, continues for the remainder
22of the 6-month period and extends to all children in the family.
SB1,739,523 3. For a pregnant woman or an unborn child to obtain eligibility under subd.
241., the amount that must be obligated or expended in any 6-month period is equal
25to the sum of the differences in each of those 6 months between the pregnant woman's

1or unborn child's monthly family income and the monthly family income that is 300
2percent of the poverty line. For a child to obtain eligibility under subd. 2., the amount
3that must be obligated or expended in any 6-month period is equal to the sum of the
4differences in each of those 6 months between the child's monthly family income and
5the monthly family income that is 150 percent of the poverty line.
SB1,739,76 (c) When calculating an individual's family income, the department shall do all
7of the following:
SB1,739,98 1. Deduct from family income any payments made by the individual for
9court-ordered child or family support or maintenance.
SB1,739,1010 2. Disregard earnings of children under 18 years of age.
SB1,739,1211 3. Determine separately the family incomes of caretaker relatives and the
12children for whom they are caring and not legally responsible.
SB1,739,1413 4. Not include in the calculation any income of an individual receiving benefits
14under s. 49.77 or federal Title XVI.
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