AB40,1106 4Section 1106. 49.471 (4) (c) of the statutes is repealed.
AB40,1107 5Section 1107. 49.471 (4) (e) of the statutes is created to read:
AB40,572,146 49.471 (4) (e) If the department obtains approval from the federal department
7of health and human services to provide an alternate benchmark plan under sub.
8(11r), to the extent the federal department of health and human services approves,
9the department may enroll in the alternate benchmark plan under sub. (11r) any
10individual whose family income exceeds 100 percent of the poverty line, who is either
11an adult who is not pregnant or a child, and who applies and is otherwise eligible to
12receive benefits under this section, except that the department shall enroll a child
13who has a parent who is enrolled in a plan under this section in the same plan as his
14or her parent.
AB40,1108 15Section 1108. 49.471 (5) (b) 1. of the statutes is amended to read:
AB40,572,2016 49.471 (5) (b) 1. Except as provided in sub. (6) (a) 1., a pregnant woman is
17eligible for the benefits specified in par. (c) during the period beginning on the day
18on which a qualified provider determines, on the basis of preliminary information,
19that the woman's family income does not exceed 300 133 percent of the poverty line
20and ending on the applicable day specified in subd. 3.
AB40,1109 21Section 1109. 49.471 (5) (b) 2. of the statutes is renumbered 49.471 (5) (b) 2.
22(intro.) and amended to read:
AB40,573,523 49.471 (5) (b) 2. (intro.) Except as provided in sub. (6) (a) 2., a child who is not
24an unborn child is eligible for the benefits described in s. 49.46 (2) (a) and (b) during
25the period beginning on the day on which a qualified entity determines, on the basis

1of preliminary information, that the child's family income does not exceed 150
2percent of the poverty line
any of the following and ending on the applicable day
3specified in subd. 3., unless the federal department of health and human services
4approves the department's request to not extend eligibility to children during this
5period:
AB40,1110 6Section 1110. 49.471 (5) (b) 2. a. to c. of the statutes are created to read:
AB40,573,87 49.471 (5) (b) 2. a. 150 percent of the poverty line for a child who is 6 years of
8age or older but has not yet attained the age of 19.
AB40,573,109 b. 185 percent of the poverty line for a child who is one year of age or older but
10has not yet attained the age of 6.
AB40,573,1111 c. 300 percent of the poverty line for a child who is under one year of age.
AB40,1111 12Section 1111. 49.471 (5) (b) 3. a. of the statutes is amended to read:
AB40,573,2013 49.471 (5) (b) 3. a. If the woman or child applies for benefits under sub. (4)
14within the time required under par. (d), the benefits specified in subd. 1. or 2.,
15whichever is applicable, end on the day on which the department or the county
16department under s. 46.215, 46.22, or 46.23 determines whether the woman or child
17is eligible for benefits under sub. (4), except that a child who is not an unborn child
18is not eligible for benefits described in s. 49.46 (2) (a) and (b) during that time if the
19federal department of health and human services approves the department's request
20not to provide those benefits during that time
.
AB40,1112 21Section 1112. 49.471 (5) (c) 1. of the statutes is renumbered 49.471 (5) (c) and
22amended to read:
AB40,574,223 49.471 (5) (c) On behalf of a woman under par. (b) 1. whose family income does
24not exceed 200 percent of the poverty line
, the department shall audit and pay

1allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory
2prenatal care services under the benefits described in s. 49.46 (2) (a) and (b).
AB40,1113 3Section 1113. 49.471 (5) (c) 2. of the statutes is repealed.
AB40,1114 4Section 1114. 49.471 (6) (a) 1. of the statutes is amended to read:
AB40,574,85 49.471 (6) (a) 1. Any Except as provided in subd. 4., any pregnant woman,
6including a pregnant woman under sub. (5) (b) 1., is eligible for medical assistance
7under this section for any of the 3 months prior to the month of application if she met
8the eligibility criteria under this section in that month.
AB40,1115 9Section 1115. 49.471 (6) (a) 2. of the statutes is amended to read:
AB40,574,1510 49.471 (6) (a) 2. Any Except as provided in subd. 3. or 4., any child who is not
11an unborn child, including a child under sub. (5) (b) 2., parent, or caretaker relative
12whose family income is less than 150 percent of the poverty line is eligible for medical
13assistance under this section for any of the 3 months prior to the month of application
14if the individual met the eligibility criteria under this section and had a family
15income of less than 150 percent of the poverty line in that month.
AB40,1116 16Section 1116. 49.471 (6) (a) 3. of the statutes is created to read:
AB40,574,2117 49.471 (6) (a) 3. Any individual described in subd. 2. who is not disabled, not
18elderly, and not pregnant, who is an adult, and whose family income exceeds 133
19percent of the federal poverty level is not eligible for medical assistance under this
20section for any of the 3 months before the month of application for medical assistance
21benefits.
AB40,1117 22Section 1117. 49.471 (6) (a) 4. of the statutes is created to read:
AB40,575,223 49.471 (6) (a) 4. To the extent allowed by the federal department of health and
24human services, any individual described in subd. 1. or 2. who is not disabled is not

1eligible for medical assistance under this section for any of the 3 months before the
2month of application for medical assistance benefits.
AB40,1118 3Section 1118. 49.471 (7) (a) of the statutes is repealed.
AB40,1119 4Section 1119. 49.471 (7) (b) 1. of the statutes is amended to read:
AB40,575,165 49.471 (7) (b) 1. A Eligibility for a pregnant woman whose family income
6exceeds 300 133 percent of the poverty line may become eligible for coverage under
7this section if the difference between the pregnant woman's family income and the
8applicable income limit under sub. (4) (b) is obligated or expended for any member
9of the pregnant woman's family for medical care or any other type of remedial care
10recognized under state law or for personal health insurance premiums or for both.
11Eligibility obtained under this subdivision continues without regard to any change
12in family income for the balance of the pregnancy and to the last day of the month
13in which the 60th day after the last day of the woman's pregnancy falls. Eligibility
14obtained by a pregnant woman under this subdivision extends to all pregnant
15women in the pregnant woman's family
is determined under the method described
16in s. 49.47 (4) (c)
.
AB40,1120 17Section 1120. 49.471 (7) (b) 2. of the statutes is amended to read:
AB40,576,218 49.471 (7) (b) 2. A child who is not an unborn child, whose family income
19exceeds 150 percent of the poverty line, and who is ineligible under this section solely
20because of sub. (8) (b), or whose family income exceeds 300 percent of the poverty line,
21may obtain eligibility under this section if the difference between the child's family
22income and 150 percent of the poverty line is obligated or expended on behalf of the
23child or any member of the child's family for medical care or any other type of
24remedial care recognized under state law or for personal health insurance premiums
25or for both. Eligibility obtained under this subdivision during any 6-month period,

1as determined by the department, continues for the remainder of the 6-month period
2and extends to all children in the family.
AB40,1121 3Section 1121. 49.471 (7) (b) 3. of the statutes is amended to read:
AB40,576,114 49.471 (7) (b) 3. For a pregnant woman to obtain eligibility under subd. 1., the
5amount that must be obligated or expended in any 6-month period is equal to the
6sum of the differences in each of those 6 months between the pregnant woman's
7monthly family income and the monthly family income that is 300 percent of the
8poverty line.
For a child to obtain eligibility under subd. 2., the amount that must
9be obligated or expended in any 6-month period is equal to the sum of the differences
10in each of those 6 months between the child's monthly family income and the monthly
11family income that is 150 percent of the poverty line.
AB40,1122 12Section 1122. 49.471 (7) (c) (intro.) of the statutes is amended to read:
AB40,576,1413 49.471 (7) (c) (intro.) When calculating an individual's family income, the
14department shall do all of the following, subject to par. (d):
AB40,1123 15Section 1123. 49.471 (7) (c) of the statutes, as affected by 2013 Wisconsin Act
16.... (this act), is repealed.
AB40,1124 17Section 1124. 49.471 (7) (d) of the statutes is created to read:
AB40,576,1918 49.471 (7) (d) In addition to applying other income counting requirements the
19department shall do all of the following:
AB40,576,2420 1. When calculating the family income of a member of a household who is not
21disabled, include the income of all adults residing in the home for at least 60
22consecutive days but exclude the income of a grandparent in a household containing
233 generations, unless the grandparent applies for or receives benefits as a parent or
24caretaker relative under this section.
AB40,577,3
12. When determining the size of a family for purposes of determining income
2eligibility, exclude from family size an adult whose income is included in a calculation
3of family income solely under subd. 1.
AB40,577,64 3. Apply this paragraph only to the extent the federal department of health and
5human services approves the income eligibility calculation methods, if approval is
6required.
AB40,1125 7Section 1125. 49.471 (7) (e) of the statutes is created to read:
AB40,577,118 49.471 (7) (e) For the purpose of determining family income, the department
9shall apply the regulations defining a household under 42 CFR 435.603 (f). To
10determine the family size for a pregnant woman, the department shall include the
11pregnant woman and the number of babies she is expecting.
AB40,1126 12Section 1126. 49.471 (8) (b) (intro.) of the statutes is amended to read:
AB40,577,1513 49.471 (8) (b) (intro.) Except as provided in pars. (c), (cg), (cr), (ct), and (d), an
14individual whose family income exceeds 150 percent of the poverty line is not eligible
15for BadgerCare Plus if any of the following applies:
AB40,1127 16Section 1127. 49.471 (8) (cg) of the statutes is created to read:
AB40,577,1917 49.471 (8) (cg) An individual who is not disabled and not pregnant, who is over
1818 years of age, and whose family income exceeds 133 percent of the poverty line is
19not eligible for BadgerCare Plus if all of the following apply:
AB40,577,2020 1. The individual has any of the following:
AB40,577,2321 a. Access to individual or family health coverage provided by an employer in
22which the monthly premium that an employee would pay for an employee-only
23policy does not exceed 9.5 percent of the family's monthly income.
AB40,577,2524 b. Access to individual or family health coverage under the state employee
25health plan.
AB40,578,2
12. The individual has access to any coverage described in subd. 1. during any
2of the following times:
AB40,578,43 a. The 12 months before the first day of the month in which an individual
4applies for and the month in which an individual applies for BadgerCare Plus.
AB40,578,65 b. The 3 months after the last day of the month in which the individual applies
6for BadgerCare Plus.
AB40,578,87 c. The month including the date of the annual determination of the individual's
8eligibility for Medical Assistance.
AB40,578,109 3. The individual does not have as a reason for not obtaining health insurance
10any of the good cause reasons under par. (d) 2. a. to e.
AB40,1128 11Section 1128. 49.471 (8) (cr) of the statutes is created to read:
AB40,578,1412 49.471 (8) (cr) 1. Subject to subd. 4., an individual who is any of the following
13is not eligible for BadgerCare Plus if the criteria under par. (cg) 1. and 2. apply to that
14individual:
AB40,578,1715 a. An individual who is not disabled and who is a child, or unborn child, of an
16individual whose family income is at a level determined by the department but no
17lower than 133 percent of the poverty line.
AB40,578,2018 b. A parent or caretaker relative who is not disabled, not pregnant, and an adult
19and whose family income is at a level determined by the department but no lower
20than 100 percent of the poverty line.
AB40,578,2421 c. An adult, including a pregnant individual, who is not disabled, who is under
2226 years of age; who is eligible to be covered under coverage a parent receives from
23an employer; and whose family income is at a level determined by the department
24but no lower than 100 percent of the poverty line.
AB40,579,3
12. An individual under subd. 1. is not ineligible if any of the good cause reasons
2described in par. (d) 2. a. to e. is the reason that the individual did not obtain health
3insurance coverage.
AB40,579,54 3. An individual under subd. 1. c. is not ineligible if any of the following good
5cause reasons is the reason the individual did not obtain health insurance coverage:
AB40,579,86 a. The parent of the individual is no longer employed by the employer through
7which the parent was eligible for coverage, and the parent does not have current
8coverage.
AB40,579,109 b. The employer of the parent of the individual discontinued providing health
10benefits to all employees.
AB40,579,1311 4. The department may apply this paragraph to eligibility determinations for
12BadgerCare Plus only if the federal department of health and human services
13approves of the conditions to make that individual ineligible, if approval is required.
AB40,1129 14Section 1129. 49.471 (8) (ct) of the statutes is created to read:
AB40,579,2115 49.471 (8) (ct) 1. If the federal department of health and human services
16approves the department's request to add private major medical insurance as a type
17of coverage which causes ineligibility, an individual who is not disabled and not
18pregnant, who is over 18 years of age, whose family income exceeds 133 percent of
19the poverty line, and who has coverage provided by private major medical insurance
20in which the monthly premium does not exceed 9.5 percent of the family's monthly
21income is not eligible for BadgerCare Plus.
AB40,579,2522 2. If the federal department of health and human services approves of the
23conditions to make that individual ineligible for BadgerCare Plus, an individual who
24is any of the following is not eligible for BadgerCare Plus if he or she has the major
25medical insurance coverage described under subd. 1.:
AB40,580,3
1a. An individual who is not disabled and who is a child, or unborn child, of an
2individual whose family income is at a level determined by the department but no
3lower than 133 percent of the poverty line.
AB40,580,64 b. A parent or caretaker relative who is not disabled, not pregnant, and an adult
5and whose family income is at a level determined by the department but no lower
6than 100 percent of the poverty line.
AB40,1130 7Section 1130. 49.471 (8) (d) 1. a. of the statutes is amended to read:
AB40,580,98 49.471 (8) (d) 1. a. A pregnant woman, except as provided in pars. (cr) 1. c. and
9(fm) 4
.
AB40,1131 10Section 1131. 49.471 (8) (d) 1. b. of the statutes is amended to read:
AB40,580,1111 49.471 (8) (d) 1. b. A child described in sub. (4) (a) 2. or (b) 2.
AB40,1132 12Section 1132. 49.471 (8) (d) 1. g. of the statutes is created to read:
AB40,580,1313 49.471 (8) (d) 1. g. An adult who is disabled.
AB40,1133 14Section 1133. 49.471 (8) (d) 2. dg. of the statutes is created to read:
AB40,580,1615 49.471 (8) (d) 2. dg. The insurance is owned by someone not residing with the
16family and continuation of the coverage is beyond the family's control.
AB40,1134 17Section 1134. 49.471 (8) (d) 2. dr. of the statutes is created to read:
AB40,580,1918 49.471 (8) (d) 2. dr. The insurance only covers services provided in a service
19area that is beyond a reasonable driving distance.
AB40,1135 20Section 1135. 49.471 (8) (e) of the statutes is repealed.
AB40,1136 21Section 1136. 49.471 (8) (f) of the statutes is amended to read:
AB40,581,522 49.471 (8) (f) If an individual with a family income that exceeds 150 percent
23of the poverty line had the health insurance coverage specified in par. (b) 1. but no
24longer has the coverage, or if an individual who is an unborn child or an unborn
25child's mother, regardless of family income, had health insurance coverage but no

1longer has the coverage, or if a pregnant woman specified in par. (e) has health
2insurance coverage and does not maintain the coverage
, the individual or pregnant
3woman
is not eligible for BadgerCare Plus for the 3 calendar months following the
4month in which the insurance coverage ended without a good cause reason specified
5in par. (g).
AB40,1137 6Section 1137. 49.471 (8) (fm) of the statutes is created to read:
AB40,581,117 49.471 (8) (fm) If an individual who is one of the following individuals had the
8health insurance coverage specified in par. (cg) 1. or (ct) but no longer has the
9coverage, the individual is not eligible for BadgerCare Plus for the 3 calendar months
10following the month in which the insurance coverage ended without a good cause
11reason specified in par. (g):
AB40,581,1312 1. An individual who is not disabled and not pregnant, who is over 18 years of
13age, and whose family income exceeds 133 percent of the poverty line.
AB40,581,1714 2. If the federal department of health and human services approves of the
15department's request to make such an individual ineligible, an individual who is not
16disabled and who is a child of an individual whose family income is at a level
17determined by the department but no lower than 133 percent of the poverty line.
AB40,581,2218 3. If the federal department of health and human services approves of the
19department's request to make such an individual ineligible, a parent or caretaker
20relative who is not disabled, not pregnant, and an adult and whose family income is
21at a level determined by the department but no lower than 100 percent of the poverty
22line.
AB40,582,323 4. If the federal department of health and human services approves of the
24department's request to make such an individual ineligible, an adult, including a
25pregnant individual, who is not disabled, who is under 26 years of age; who is eligible

1to be covered under coverage a parent receives from an employer; and whose family
2income is at a level determined by the department but no lower than 100 percent of
3the poverty line.
AB40,1138 4Section 1138. 49.471 (8) (g) (intro.), 1., 2., 3., 4. and 5. of the statutes are
5amended to read:
AB40,582,76 49.471 (8) (g) (intro.) Any of the following is a good cause reason for purposes
7of par. pars. (f) and (fm):
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