(b) Rules. The department shall promulgate rules regarding all of the following:
1. Standards for determining whether an individual is eligible under par. (a) 3.
2. The scope of psychosocial services that may be provided under s. 49.46 (2) (b) 6. Lm.
3. Requirements for certification of community-based psychosocial service programs.
(c) Provider reimbursement. A county that elects to make the services under s. 49.46 (2) (b) 6. Lm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government. The department shall reimburse the provider only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.
27,1948m
Section 1948m. 49.45 (45) of the statutes is created to read:
49.45 (45) In-home and community mental health and alcohol and other drug abuse services. (a) Services under s. 49.46 (2) (b) 6. fm. provided to an individual are reimbursable under the medical assistance program only if all of the following conditions are met:
1. Reimbursement for the services under s. 49.46 (2) (b) 6. fm. in the manner provided under this subsection is permitted pursuant to federal law or pursuant to a waiver from the secretary of the federal department of health and human services.
2. The county, city, town or village in which the individual resides elects to make the services under s. 49.46 (2) (b) 6. fm. available in the county, city, town or village through the medical assistance program.
(b) A county, city, town or village that elects to make the services under s. 49.46 (2) (b) 6. fm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government. The department shall reimburse the provider only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.
27,1949
Section 1949
. 49.46 (1) (a) 1. of the statutes is amended to read:
49.46 (1) (a) 1. Any person included in the grant of aid to families with dependent children and any person who does not receive such aid solely because of the application of s. 49.19 (11) (a) 7. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1950b
Section 1950b. 49.46 (1) (a) 1m. of the statutes is amended to read:
49.46 (1) (a) 1m. Any pregnant woman who meets the resource and income limits under s. 49.19 (4) (bm) and (es) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1951
Section 1951
. 49.46 (1) (a) 4m. of the statutes is created to read:
49.46 (1) (a) 4m. Any child for whom a payment is made under s. 49.775.
27,1952
Section 1952
. 49.46 (1) (a) 6. of the statutes is amended to read:
49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who is considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1953b
Section 1953b. 49.46 (1) (a) 9. of the statutes is amended to read:
49.46 (1) (a) 9. Any pregnant woman not described under subd. 1. or 1m. whose family income does not exceed 133% of the poverty line for a family the size of the woman's family. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1954d
Section 1954d. 49.46 (1) (a) 10. of the statutes is amended to read:
49.46 (1) (a) 10. Any child not described under subd. 1. who is under 6 years of age and whose family income does not exceed 133% of the poverty line for a family the size of the child's family. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1955d
Section 1955d. 49.46 (1) (a) 11. of the statutes is amended to read:
49.46 (1) (a) 11. Any If a waiver under s. 49.665 is granted and in effect, any child not described under subd. 1. who was born after September 30, 1983, who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d) If a waiver under s. 49.665 is not granted or in effect, any child not described in subd. 1. who was born after September 30,1983, who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family.
27,1956b
Section 1956b. 49.46 (1) (a) 12. of the statutes is amended to read:
49.46 (1) (a) 12. Any child not described under subd. 1. who is under 19 years of age and who meets the resource and income limits under s. 49.19 (4). This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1957b
Section 1957b. 49.46 (1) (a) 13. of the statutes is amended to read:
49.46 (1) (a) 13. Any child who is under one year of age, whose mother was determined to be eligible under subd. 9. and who lives with his or her mother. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1958c
Section 1958c. 49.46 (1) (am) 3. of the statutes is repealed.
27,1959
Section 1959
. 49.46 (1) (c) (intro.) of the statutes is amended to read:
49.46 (1) (c) (intro.) Except as provided under
pars. par. (co) and (cs), a family that becomes ineligible for aid to families with dependent children under s. 49.19 because of increased income from employment or increased hours of employment or because of the expiration of the time during which the disregards under s. 49.19 (5) (a) 4. or 4m. or (am) apply shall receive medical assistance for:
27,1960b
Section 1960b. 49.46 (1) (cb) of the statutes is repealed.
27,1961b
Section 1961b. 49.46 (1) (cg) of the statutes is amended to read:
49.46 (1) (cg) Except as provided in par. (cs), medical Medical assistance shall be provided to a dependent child, a relative with whom the child is living or the spouse of the relative, if the spouse meets the requirements of s. 49.19 (1) (c) 2. a. or b., for 4 calendar months beginning with the month in which the child, relative or spouse is ineligible for aid to families with dependent children because of the collection or increased collection of maintenance or support, if the child, relative or spouse received aid to families with dependent children in 3 or more of the 6 months immediately preceding the month in which that ineligibility begins. This paragraph does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1962
Section 1962
. 49.46 (1) (co) 1. of the statutes is amended to read:
49.46 (1) (co) 1. Except as provided under subd. 2. and par. (cs), medical assistance shall be provided to a family for 12 consecutive calendar months following the month in which the family becomes ineligible for aid to families with dependent children because of increased income from employment, because the family no longer receives the earned income disregard under s. 49.19 (5) (a) 4. or 4m. or (am) due to the expiration of the time limit during which the disregards are applied or because of the application of the monthly employment time eligibility limitation under 45 CFR 233.100 (a) (1) (i).
27,1963b
Section 1963b. 49.46 (1) (co) 4. of the statutes is repealed.
27,1964
Section 1964
. 49.46 (1) (cr) of the statutes is repealed.
27,1965
Section 1965
. 49.46 (1) (cs) of the statutes is repealed.
27,1965m
Section 1965m. 49.46 (1) (d) 1. of the statutes is amended to read:
49.46 (1) (d) 1. Children who are placed in licensed foster homes or licensed treatment foster homes by the department and who would be eligible for payment of aid to families with dependent children in foster homes or treatment foster homes except that their placement is not made by a county department under s. 46.215, 46.22 or 46.23 will be considered as recipients of aid to families with dependent children. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1965p
Section 1965p. 49.46 (1) (e) 1. of the statutes is renumbered 49.46 (1) (e).
27,1966b
Section 1966b. 49.46 (1) (e) 2. of the statutes is repealed.
27,1967
Section 1967
. 49.46 (2) (a) 4. d. of the statutes is amended to read:
49.46 (2) (a) 4. d. Home health services, subject to the limitations limitation under s. 49.45 (8) and (8e), or, if a home health agency is unavailable, nursing services, subject to the limitations under s. 49.45 (8e).
27,1967d
Section 1967d. 49.46 (2) (a) 4. f. of the statutes is amended to read:
49.46 (2) (a) 4. f. Family planning services Services and supplies for family planning, as defined in s. 253.07 (1) (a).
27,1967m
Section 1967m. 49.46 (2) (b) 6. fm. of the statutes is created to read:
49.46 (2) (b) 6. fm. Subject to the limitations under s. 49.45 (45), mental health services and alcohol and other drug abuse services, including services provided by a psychiatrist, to an individual who is 21 years of age or older in the individual's home or in the community.
27,1968
Section 1968
. 49.46 (2) (b) 6. j. of the statutes is amended to read:
49.46 (2) (b) 6. j. Personal care services, subject to the limitations limitation under s. 49.45 (8e) and (42).
27,1968m
Section 1968m. 49.46 (2) (b) 6. Lm. of the statutes is created to read:
49.46 (2) (b) 6. Lm. Subject to the limitations under s. 49.45 (30e), psychosocial services, including case management services, provided by the staff of a community-based psychosocial service program.
27,1968s
Section 1968s. 49.46 (2) (be) of the statutes is amended to read:
49.46 (2) (be) Benefits for an individual eligible under sub. (1) (a) 9. are limited to those services under par. (a) or (b) that are related to pregnancy, including postpartum services and family planning services, as defined in s. 253.07 (1) (b), or related to other conditions which may complicate pregnancy.
27,1969b
Section 1969b. 49.465 (7) of the statutes is repealed.
27,1970
Section 1970
. 49.47 (1) of the statutes is amended to read:
49.47 (1) Purpose. Medical assistance as set forth herein shall be provided to persons over 65, if eligible under this section, all disabled children under 18, if eligible under this section, and persons who are blind or disabled, if eligible under this section.
27,1970m
Section 1970m. 49.47 (4) (a) (intro.) of the statutes is amended to read:
49.47 (4) (a) (intro.) Except as provided in par. (ag), any Any individual who meets the limitations on income and resources under pars. (b) and (c) and who complies with par. (cm) shall be eligible for medical assistance under this section if such individual is:
27,1971b
Section 1971b. 49.47 (4) (ag) of the statutes is repealed.
27,1972b
Section 1972b. 49.47 (4) (an) of the statutes is repealed.
27,1973b
Section 1973b. 49.47 (4) (c) 2. of the statutes is amended to read:
49.47 (4) (c) 2. Whenever an applicant has excess income under subd. 1. or par. (am), no certification may be issued until the excess income above the applicable limits has been obligated or expended for medical care or for any other type of remedial care recognized under state law or for personal health insurance premiums or both. No individual is eligible for medical assistance under this subdivision in a month in which the individual is eligible for health care coverage under s. 49.153.
27,1973t
Section 1973t. 49.47 (6) (a) 7. of the statutes is amended to read:
49.47 (6) (a) 7. Beneficiaries eligible under sub. (4) (a) 2. or (am) 1., for services under s. 49.46 (2) (a) and (b) that are related to pregnancy, including postpartum services and family planning services, as defined in s. 253.07 (1) (b), or related to other conditions which may complicate pregnancy.
27,1975
Section 1975
. 49.496 (5) of the statutes is amended to read:
49.496 (5) Use of funds. From the appropriation under s. 20.435 (1) (5) (im), the department shall pay the amount of the payments under sub. (4) that is not paid from federal funds, shall pay to the federal government the amount of the funds recovered under this section equal to the amount of federal funds used to pay the benefits recovered under this section and shall spend the remainder of the funds recovered under this section for medical assistance benefits under this subchapter
27,1976
Section 1976
. 49.496 (7) of the statutes is created to read:
49.496 (7) Instalment payments. If a recovery under sub. (3) does not work an undue hardship on the heirs of the estate, and if the heirs wish to satisfy the recovery claim without selling a nonliquid asset that is subject to recovery, the department may establish a reasonable payment schedule subject to reasonable interest.
27,1976m
Section 1976m. 49.498 (3) (b) 1. of the statutes is amended to read:
49.498 (3) (b) 1. Inform each resident, orally and in writing at the time of admission to the nursing facility, of the resident's legal rights during the stay at the nursing facility, including a description of the protection of personal funds under sub. (8) and a statement that a resident may file a complaint with the department under s. 146.40 (4r) (a) concerning neglect, abuse or misappropriation of property or neglect or abuse of a resident.
27,1979
Section 1979
. 49.498 (16) (g) of the statutes is amended to read:
49.498 (16) (g) All forfeitures, penalty assessments and interest, if any, shall be paid to the department within 10 days of receipt of notice of assessment or, if the forfeiture, penalty assessment and interest, if any, are contested under par. (f), within 10 days of receipt of the final decision after exhaustion of administrative review, unless the final decision is appealed and the order is stayed by court order under sub. (19) (b). The department shall remit all forfeitures paid to the state treasurer for deposit in the school fund. The department shall deposit all penalty assessments and interest in the appropriation under s. 20.435 (1) (6) (g).
27,1980
Section 1980
. 49.499 (intro.) of the statutes is amended to read:
49.499 Nursing facility resident protection. (intro.) From the appropriation under s. 20.435 (1)
(6) (g), the department shall contribute to the payment of all of the following, as needed by a resident in a nursing facility, as defined in s. 49.498 (1) (i), that is in violation of s. 49.498 or of a rule promulgated under s. 49.498:
27,1980p
Section 1980p. 49.665 of the statutes is created to read:
49.665 Badger care. (1) Definitions. In this section:
(a) “Custodial parent" has the meaning given in s. 49.141 (1) (b).
(b) “Dependent child" has the meaning given in s. 49.141 (c).
(c) “Employer-subsidized health care coverage" means family coverage under a group health insurance plan offered by an employer for which the employer pays at least 80% of the cost, excluding any deductibles or copayments that may be required under the plan.
(d) “Family" means a custodial parent and his or her dependent children.
(2) Waiver. 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 is granted and in effect, the department of health and family services shall implement the program under this section. 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 is granted and in effect.
The department of health and family services shall promulgate all rules required under this section no later than 60 days after the receipt of the waiver.
(3) Administration. The department shall administer a program to provide the health services and benefits described in s. 49.46 (2) to families 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 under circumstances in which the department determines that purchasing that coverage would not be more costly than providing the coverage under this section.
(4) Eligibility. (a) A family is eligible for health care coverage under this section if the family meets all of the following requirements:
1. The family's income does not exceed 185% of the poverty line, except that a family that is already receiving health care coverage under this section may have an income that does not exceed 200% of the poverty line. The department shall establish by rule the criteria to be used to determine income.
2. The family does not have access to employer-subsidized health care coverage.
3. The family has not had access to employer-subsidized health care coverage within the time period established by the department by rule, but not to exceed 18 months, immediately preceding application for health care coverage under this section. The department may establish exceptions to this subdivision by rule.
4. The family meets all other requirements established by the department by rule. In establishing other eligibility criteria, the department may not include any health condition requirements.
