49.46 (2) (br) If the federal department of health and human services approves the department's request to offer a benchmark plan under this paragraph, the department may enroll any child who is receiving services through the early intervention program under s. 51.44 in a benchmark plan under this paragraph. The department may not require a child who is receiving services through the early intervention program under s. 51.44 to enroll in a benchmark plan offered under this paragraph. The department may not charge a copayment to a child who is enrolled in the benchmark plan under this paragraph for services described in par. (b) 19.
20,1085
Section
1085. 49.47 (4) (a) 1. of the statutes is amended to read:
49.47 (4) (a) 1. Under 21 years of age and resides in an intermediate care facility, skilled nursing facility, or inpatient psychiatric hospital. The department shall apply the definition of family income in s. 49.471 (1) (f) to make determinations of income under this subdivision.
20,1088
Section
1088. 49.47 (4) (b) 2w. of the statutes is amended to read:
49.47 (4) (b) 2w. For a person who is eligible under par. (a) 3. or 4., life insurance with cash surrender values if the total face value of all life insurance policies, including riders and other attachments, is not more than $1,500.
20,1089
Section
1089. 49.47 (4) (c) 1. of the statutes is amended to read:
49.47
(4) (c) 1. Except as provided in par. (am)
and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% of the maximum aid to families with dependent children payment under s. 49.19 (11) for the applicant's family size or the combined benefit amount available under supplemental security income under
42 USC 1381 to
1383c and state supplemental aid under s. 49.77 whichever is
higher lower. In this subdivision "income" includes earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under
42 USC 1381 to
1385. "Income" does not include earned or unearned income which would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled individual under
42 USC 1381 to
1385.
20,1090
Section
1090. 49.47 (4) (c) 3. of the statutes is repealed.
20,1090f
Section 1090f. 49.47 (4) (k) of the statutes is amended to read:
49.47 (4) (k) Notwithstanding par. (b) 3. and s. 445.125 (1) (a), no later than 60 days after July 1, 2011 2013, the department shall seek approval from the federal Centers for Medicare and Medicaid Services to permit friends and family members of any individual receiving medical assistance under this section to contribute funds to an irrevocable burial trust for the individual, up to a total irrevocable trust amount of $4,500, without the individual losing eligibility for medical assistance under this section. If the federal Centers for Medicare and Medicaid Services approves the request, the department shall implement the change under this section within 60 days after receiving approval.
20,1091
Section
1091. 49.471 (1) (cm) of the statutes is created to read:
49.471
(1) (cm) "Disabled" means, when referring to an adult, meeting the disability standard for eligibility for federal supplemental security income under
42 USC 1382c (a) (3).
20,1092
Section
1092. 49.471 (1) (f) of the statutes is amended to read:
49.471
(1) (f) "Family income"
means the total gross earned and unearned income received by all members of a family has the meaning given for "household income" under 42 CFR 435.603 (d).
20,1093n
Section 1093n. 49.471 (2) of the statutes is amended to read:
49.471 (2) Waiver and state plan amendments. The department shall request a waiver from, and submit amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to implement BadgerCare Plus. If the state plan amendments are approved and a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted and in effect, the department shall implement BadgerCare Plus beginning on January 1, 2008, the effective date of the state plan amendments, or the effective date of the waiver, whichever is latest. If the state plan amendments are approved but the terms of approval do not allow for federal funding of the cost of benefits for all or any part of one or more of the eligibility categories under sub. (4) (b), the department may at its discretion pay for the cost of benefits for all or any part of any group for which federal funding was denied exclusively with moneys from the appropriation under s. 20.435 (4) (b). If the state plan amendments are not approved or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is not granted, BadgerCare Plus may not be implemented. If the state plan amendments are approved but approval is not continued or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted but not continued in effect, BadgerCare Plus shall be discontinued.
20,1093q
Section 1093q. 49.471 (3) (a) 1. of the statutes is amended to read:
49.471 (3) (a) 1. Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4), if the amendments to the state plan under sub. (2) are approved and a waiver under sub. (2) that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted and in effect, an individual described in sub. (4) (a) or (b) or (5) is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical Assistance or BadgerCare health program benefits. The eligibility of an individual described in sub. (4) (a) or (b) or (5) for Medical Assistance benefits shall be determined under this section.
20,1093s
Section 1093s. 49.471 (3) (a) 3. of the statutes is amended to read:
49.471 (3) (a) 3. Notwithstanding subd. 1., an individual described in sub. (4) (a) or (b) or (5) who is eligible for medical assistance under s. 49.46 (1) (a) 5., 6m., 14., 14m., or 15. or (d) or 49.47 (4) (a) or (as) may receive medical assistance benefits under this section or under s. 49.46 or 49.47.
20,1094
Section
1094. 49.471 (4) (a) (intro.) of the statutes is amended to read:
49.471 (4) (a) (intro.) Except as otherwise provided in this section, all of the following individuals are eligible for the benefits described in s. 49.46 (2) (a) and (b), subject to sub. (6) (k) and s. 49.45 (24j):
20,1096
Section
1096. 49.471 (4) (a) 4. a. of the statutes is amended to read:
49.471 (4) (a) 4. a. The individual is a parent or caretaker relative of a dependent child who is living in the home with the parent or caretaker relative or who is temporarily absent from the home for not more than 6 months or, if the dependent child has been removed from the home for more than 6 months, the parent or caretaker relative is working toward unifying the family by complying with a permanency plan under s. 48.38 or 938.38. For purposes of this subdivision, a "dependent child" means an individual who is under the age of 18 or an individual who is age 18 and a full-time student in secondary school or equivalent vocational or technical training if before attaining the age of 19 the individual is reasonably expected to complete the school or training.
20,1097
Section
1097. 49.471 (4) (a) 4. b. of the statutes is amended to read:
49.471
(4) (a) 4. b. Except as provided in
subd. 4. c. sub. (4m), the individual's family income does not exceed
200 100 percent of the poverty line
and does not include self-employment income before application of the 5 percent income disregard under 42 CFR 435.603 (d).
20,1098
Section
1098. 49.471 (4) (a) 4. c. of the statutes is repealed.
20,1099
Section
1099. 49.471 (4) (a) 5. of the statutes is amended to read:
49.471 (4) (a) 5. An individual who, regardless of family income, was born on or after January 1, 1990 1988, and who, on his or her 18th birthday, was in a foster care placement under the responsibility of a this state, or at the option of the department, under the responsibility of another state, and enrolled in Medical Assistance under this subchapter or a Medicaid program, as determined by the department. The coverage for an individual under this subdivision ends on the last day of the month in which the individual becomes 21 26 years of age, unless he or she otherwise loses eligibility sooner.
20,1100
Section
1100. 49.471 (4) (a) 7. of the statutes is amended to read:
49.471 (4) (a) 7. Individuals who qualify for a medical assistance eligibility extension under s. 49.46 (1) (c), (cg), or (co) when their income increases above the poverty line, except as provided in s. 49.46 (1) (cr).
20,1100b
Section 1100b. 49.471 (4) (a) 7. of the statutes, as affected by 2013 Wisconsin Act .... (this act), is amended to read:
49.471 (4) (a) 7. Individuals who qualify for a medical assistance eligibility extension under s. 49.46 (1) (c), or (cg), or (co) when their income increases above the poverty line, except as provided in s. 49.46 (1) (cr).
20,1100v
Section 1100v. 49.471 (4) (b) (intro.) of the statutes is repealed.
20,1101
Section
1101. 49.471 (4) (b) 1. of the statutes is renumbered 49.471 (4) (a) 1g.
20,1102
Section
1102. 49.471 (4) (b) 1m. of the statutes is renumbered 49.471 (4) (a) 1m.
20,1103
Section
1103. 49.471 (4) (b) 2. of the statutes is renumbered 49.471 (4) (a) 2m. and amended to read:
49.471 (4) (a) 2m. A child who is under one year of age, whose mother was determined to be eligible under subd. 1. 1g., and who lives with his or her mother in this state.
20,1104
Section
1104. 49.471 (4) (b) 3. of the statutes is renumbered 49.471 (4) (a) 3g.
20,1105
Section
1105. 49.471 (4) (b) 4. of the statutes is repealed.
20,1106
Section
1106. 49.471 (4) (c) of the statutes is repealed.
20,1107
Section
1107. 49.471 (4) (e) of the statutes is created to read:
49.471 (4) (e) If the department obtains approval from the federal department of health and human services to provide an alternate benchmark plan under sub. (11r), to the extent the federal department of health and human services approves, the department may enroll in the alternate benchmark plan under sub. (11r) any individual whose family income exceeds 100 percent of the poverty line, who is either an adult who is not pregnant or a child, and who applies and is otherwise eligible to receive benefits under this section, except that the department shall enroll a child who has a parent who is enrolled in a plan under this section in the same plan as his or her parent.
20,1107p
Section 1107p. 49.471 (4m) of the statutes is created to read:
49.471
(4m) Income eligibility exceptions based on exchange operation. (a) 1. If, by October 15, 2013, the department has not received a certification of an American health benefit exchange, as described in
42 USC 18031, from the federal department of health and human services, if such certification is required under federal law, the department shall do all of the following for 90 days after December 31, 2013:
a. Allow individuals whose family income does not exceed 200 percent of the poverty line and who would otherwise be eligible for benefits under sub. (4) (a) 4. except for the income limit to be eligible to receive benefits under sub. (4) (a) 4.
b. If approved by the federal department of health and human services, allow individuals whose family income does not exceed 200 percent of the poverty line, who are receiving benefits under s. 49.45 (23) as of December 31, 2013, and who would otherwise be eligible for benefits under s. 49.45 (23) (a) except for the income limit to be eligible to receive benefits under s. 49.45 (23).
2. If, before the 90 days under subd. 1. expire, the department determines it has not yet received a certification of an American health benefit exchange, as described in
42 USC 18031, from the federal department of health and human services, if such certification is required under federal law, the department shall apply subd. 1. a. and b. income eligibility levels to eligibility determinations under sub. (4) (a) 4. and s. 49.45 (23) for a 90-day period beginning on the day after the determination is made. The department may continue to apply the income eligibility levels under subd. 1. a. and b. for additional 90-day periods if the department has not yet received any required certification of an American health benefit exchange.
3. The department shall request any necessary approval from the federal department of health and human services to provide benefits under subd. 1. b. to only those individuals receiving benefits under s. 49.45 (23) as of December 31, 2013.
(b) 1. If, after consulting with the office of the commissioner of insurance, the department determines that in at least one county of the state, but not in all counties of the state, there is no qualified health plan, as defined in
42 USC 18021 (a), offered through an American health benefit exchange in which residents of the county may enroll, the department shall allow, for 90 days after the day the department makes the determination, individuals whose family income does not exceed 200 percent of the poverty line, who would otherwise be eligible for benefits under sub. (4) (a) 4. except for the income limit, and who reside in a county in which there is no qualified health plan available for enrollment under an American health benefit exchange to be eligible to receive benefits under sub. (4) (a) 4. if any of the following is satisfied.
a. The department determines that a waiver of federal Medicaid law is not required to implement the income eligibility levels described under this subdivision.
b. The department requests a waiver of federal Medicaid law to allow parents and caretaker relatives whose income levels do not exceed 200 percent of the poverty line and who would otherwise be eligible for benefits under sub. (4) (a) 4. to receive benefits and the federal department of health and human services approves the waiver request.
2. If, before the 90 days under subd. 1. expire, and before the expiration of any subsequent 90-day period expires, the department determines that a county still has no qualified health plan available for enrollment under an American health benefit exchange, the department shall apply the income eligibility exception under subd. 1.
20,1109
Section
1109. 49.471 (5) (b) 2. of the statutes is renumbered 49.471 (5) (b) 2. (intro.) and amended to read:
49.471 (5) (b) 2. (intro.) Except as provided in sub. (6) (a) 2., a child who is not an unborn child is eligible for the benefits described in s. 49.46 (2) (a) and (b) during the period beginning on the day on which a qualified entity determines, on the basis of preliminary information, that the child's family income does not exceed 150 percent of the poverty line any of the following and ending on the applicable day specified in subd. 3., unless the federal department of health and human services approves the department's request to not extend eligibility to children during this period:
20,1110
Section
1110. 49.471 (5) (b) 2. a. to c. of the statutes are created to read:
49.471 (5) (b) 2. a. 150 percent of the poverty line for a child who is 6 years of age or older but has not yet attained the age of 19.
b. 185 percent of the poverty line for a child who is one year of age or older but has not yet attained the age of 6.
c. 300 percent of the poverty line for a child who is under one year of age.
20,1111
Section
1111. 49.471 (5) (b) 3. a. of the statutes is amended to read:
49.471 (5) (b) 3. a. If the woman or child applies for benefits under sub. (4) within the time required under par. (d), the benefits specified in subd. 1. or 2., whichever is applicable, end on the day on which the department or the county department under s. 46.215, 46.22, or 46.23 determines whether the woman or child is eligible for benefits under sub. (4), except that a child who is not an unborn child is not eligible for benefits described in s. 49.46 (2) (a) and (b) during that time if the federal department of health and human services approves the department's request not to provide those benefits during that time.
20,1114
Section
1114. 49.471 (6) (a) 1. of the statutes is amended to read:
49.471 (6) (a) 1. Any Except as provided in subd. 4., any pregnant woman, including a pregnant woman under sub. (5) (b) 1., is eligible for medical assistance under this section for any of the 3 months prior to the month of application if she met the eligibility criteria under this section in that month.
20,1115
Section
1115. 49.471 (6) (a) 2. of the statutes is amended to read:
49.471 (6) (a) 2. Any Except as provided in subd. 3. or 4., any child who is not an unborn child, including a child under sub. (5) (b) 2., parent, or caretaker relative whose family income is less than 150 percent of the poverty line is eligible for medical assistance under this section for any of the 3 months prior to the month of application if the individual met the eligibility criteria under this section and had a family income of less than 150 percent of the poverty line in that month.
20,1116
Section
1116. 49.471 (6) (a) 3. of the statutes is created to read:
49.471 (6) (a) 3. Any individual described in subd. 2. who is not disabled, not elderly, and not pregnant, who is an adult, and whose family income exceeds 133 percent of the federal poverty level is not eligible for medical assistance under this section for any of the 3 months before the month of application for medical assistance benefits.
20,1117
Section
1117. 49.471 (6) (a) 4. of the statutes is created to read:
49.471 (6) (a) 4. To the extent allowed by the federal department of health and human services, any individual described in subd. 1. or 2. who is not disabled is not eligible for medical assistance under this section for any of the 3 months before the month of application for medical assistance benefits.
20,1117k
Section 1117k. 49.471 (6) (d) of the statutes is amended to read:
49.471 (6) (d) If an application under this section shows that an individual is an essential person, the individual shall be provided the benefits specified under sub. (4) (a) or (b).
20,1118
Section
1118. 49.471 (7) (a) of the statutes is repealed.
20,1119
Section
1119. 49.471 (7) (b) 1. of the statutes is amended to read:
49.471 (7) (b) 1. A pregnant woman whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's family income and the applicable income limit under sub. (4) (b)
(a) is obligated or expended for any member of the pregnant woman's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and to the last day of the month in which the 60th day after the last day of the woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family.
20,1120
Section
1120. 49.471 (7) (b) 2. of the statutes is amended to read:
49.471 (7) (b) 2. A child who is not an unborn child, whose family income exceeds 150 percent of the poverty line, and who is ineligible under this section solely because of sub. (8) (b), or whose family income exceeds 300 percent of the poverty line, may obtain eligibility under this section if the difference between the child's family income and 150 percent of the poverty line is obligated or expended on behalf of the child or any member of the child's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision during any 6-month period, as determined by the department, continues for the remainder of the 6-month period and extends to all children in the family.
20,1122
Section
1122. 49.471 (7) (c) (intro.) of the statutes is amended to read:
49.471 (7) (c) (intro.) When calculating an individual's family income, the department shall do all of the following, subject to par. (d):
20,1123
Section
1123. 49.471 (7) (c) of the statutes, as affected by 2013 Wisconsin Act .... (this act), is repealed.
20,1124
Section
1124. 49.471 (7) (d) of the statutes is created to read:
49.471 (7) (d) In addition to applying other income counting requirements the department shall do all of the following:
1. When calculating the family income of a member of a household who is not disabled, include the income of all adults residing in the home for at least 60 consecutive days but exclude the income of a grandparent in a household containing 3 generations, unless the grandparent applies for or receives benefits as a parent or caretaker relative under this section.
2. When determining the size of a family for purposes of determining income eligibility, exclude from family size an adult whose income is included in a calculation of family income solely under subd. 1.
3. Apply this paragraph only to the extent the federal department of health and human services approves the income eligibility calculation methods, if approval is required.
20,1125
Section
1125. 49.471 (7) (e) of the statutes is created to read:
49.471
(7) (e) For the purpose of determining family income, the department shall apply the regulations defining a household under
42 CFR 435.603 (f). To determine the family size for a pregnant woman, the department shall include the pregnant woman and the number of babies she is expecting.
20,1126
Section
1126. 49.471 (8) (b) (intro.) of the statutes is amended to read:
49.471 (8) (b) (intro.) Except as provided in pars. (c), (cg), (cr), (ct), and (d), an individual whose family income exceeds 150 percent of the poverty line is not eligible for BadgerCare Plus if any of the following applies:
20,1127
Section
1127. 49.471 (8) (cg) of the statutes is created to read:
