AB591-ASA3,88,1413 1. The individual is eligible for employer-subsidized health care coverage. This
14subdivision does not apply to any of the following:
AB591-ASA3,88,1615 a. A pregnant woman in a Wisconsin works group with an income that is equal
16to or less than 165% of the poverty line.
AB591-ASA3,88,1817 b. A child who has not attained the age of 6 in a Wisconsin works group with
18an income equal to or less than 165% of the poverty line.
AB591-ASA3,88,2119 c. A child who has attained the age of 6 and has not attained the age of 12 in
20a Wisconsin works group with an income that is equal to or less than 100% of the
21poverty line.
AB591-ASA3,89,222 d. A child who has attained the age of 6 and has not attained the age of 12 in
23a Wisconsin works group with an income in excess of 100% of the poverty line if the
24total amount obligated or expended for medical care or other type of remedial care
25and for health insurance premiums, when subtracted from the Wisconsin works

1group's income, places the Wisconsin works group at or below 100% of the poverty
2line.
AB591-ASA3,89,43 2. The individual fails to pay the established premium in a timely manner, as
4defined by the department of industry, labor and job development by rule.
AB591-ASA3,89,6 5(3g) Eligible groups. Subject to the requirements under sub. (3), the following
6individuals are eligible for benefits and services under this section:
AB591-ASA3,89,87 (a) Wisconsin works groups. Except as provided in par. (c), an individual who
8is a member of a Wisconsin works group, if all of the following conditions apply:
AB591-ASA3,89,109 1. The individual meets the criteria under s. 49.145 (2) (c), (f), (g), (i), (L) and
10(m) and resides in this state.
AB591-ASA3,89,1411 2. The Wisconsin works group meets the asset limitation under s. 49.145 (3) (a).
12In determining the assets under this subdivision, the Wisconsin works agency shall
13exclude all of the resources specified under 42 USC 1382b (a) if any of the following
14conditions is met:
AB591-ASA3,89,1515 a. The group contains a child who has not attained the age of 6.
AB591-ASA3,89,1816 b. The group contains a child who has attained the age of 6 and has not attained
17the age of 12 and the gross income of the group, as determined under subd. 3., does
18not exceed 100% of the poverty line.
AB591-ASA3,89,2319 3. The gross income of the Wisconsin works group is at or below 165% of the
20poverty line, or, for a Wisconsin works group that is already receiving health care
21coverage under this section, the gross income is at or below 200% of the poverty line.
22In calculating the gross income of the Wisconsin works group, the Wisconsin works
23agency shall include income described under s. 49.145 (3) (b) 1. to 3.
AB591-ASA3,90,3
1(b) Pregnant women. A pregnant woman whose pregnancy has been medically
2verified and who has no dependent children, if she meets all of the following
3conditions:
AB591-ASA3,90,54 1. The woman meets the criteria under s. 49.145 (2) (c), (g), (i), (L) and (m) and
5resides in this state.
AB591-ASA3,90,86 2. The woman meets the asset limitation under s. 49.145 (3) (a). In determining
7the assets of the woman, the Wisconsin works agency shall exclude all of the
8resources specified under 42 USC 1382b (a).
AB591-ASA3,90,119 3. The gross income of the woman is at or below 165% of the poverty line. In
10calculating gross income under this subdivision, the Wisconsin works agency shall
11include income described under s. 49.145 (3) (b) 1. and 3.
AB591-ASA3,90,1412 (c) Minor parents. An individual who is a custodial parent and who is under
13the age of 18, and any dependent children with respect to whom the individual is a
14custodial parent, only if the individual meets one of the following conditions:
AB591-ASA3,90,1915 1. The individual resides with his or her custodial parent and the gross income
16of the Wisconsin works group of which the individual is a member does not exceed
17165% of the poverty line. In calculating the gross income of the Wisconsin works
18group, the Wisconsin works agency shall include income described under s. 49.145
19(3) (b) 1. to 3.
AB591-ASA3,90,2320 2. The individual is in an independent living arrangement supervised by an
21adult and the gross income of the individual does not exceed 165% of the poverty line.
22In calculating the gross income of the individual, the Wisconsin works agency shall
23include income described under s. 49.145 (3) (b) 1. to 3.
AB591-ASA3,91,4 24(3m) Medically needy. (a) An individual who meets all of the requirements
25of sub. (3g) (a) or (c), except that the income calculated for the individual under sub.

1(3g) (a) 3. or (c) 1. or 2. exceeds the applicable income limit under sub. (3g) (a) 3. or
2(c) 1. or 2., is eligible for benefits and services under this section only if all of the
3excess income above the applicable limit has been obligated or expended for medical
4care or other type of remedial care.
AB591-ASA3,91,125 (am) Notwithstanding par. (a) and sub. (3) (a) 2. a., (e) and (f) 1., if the individual
6is a pregnant woman or a child who has not attained the age of 6, and the individual
7meets all of the requirements of sub. (3g) (a), (b) or (c), except that the income
8calculated for the individual under sub. (3g) (a) 3., (b) 3. or (c) 1. or 2. exceeds the
9applicable income limit under sub. (3g) (a) 3., (b) 3. or (c) 1. or 2., the individual is
10eligible for benefits and services under this section if all of the excess income above
11the applicable limit has been obligated or expended for medical care or other type of
12remedial care or for personal health insurance premiums.
AB591-ASA3,91,2013 (as) Notwithstanding par. (a) and sub. (3) (a) 2. a., if the individual is a child
14who has attained the age of 6 and has not attained the age of 12, and the individual
15meets all of the requirements of sub. (3g) (a) except that the income calculated for the
16individual under sub. (3g) (a) 3. exceeds the income level under sub. (3g) (a) 3., the
17individual is eligible for benefits and services under this section if the total amount
18obligated or expended for medical care or other type of remedial care and for health
19insurance premiums, when subtracted from the Wisconsin works group's income,
20places the Wisconsin works group at 100% of the poverty line.
AB591-ASA3,91,2321 (b) In determining the income for an individual under this subsection for
22purposes of determining the premium amount under sub. (4) (d), the Wisconsin
23works agency shall exclude the excess income specified under par. (a), (am) or (as).
AB591-ASA3,92,6 24(3p) Presumptive eligibility for pregnant women. (a) Notwithstanding sub.
25(3g) (a), (b) and (c), a pregnant woman is eligible under this subsection for

1ambulatory prenatal care services under this section during the period beginning on
2the day on which an authorized health care provider under contract under sub. (4)
3(a) determines, on the basis of preliminary information, that the woman's family
4income does not exceed 165% of the poverty line and that the woman's family's assets
5do not exceed the asset limits under s. 49.145 (3) (a). Eligibility under this subsection
6ends as follows:
AB591-ASA3,92,107 1. If the woman applies under sub. (3g) (a), (b) or (c) for benefits and services
8under this section within the time required under par. (c), on the day on which the
9Wisconsin works agency determines whether the woman is eligible for benefits and
10services under sub. (3g) (a), (b) or (c).
AB591-ASA3,92,1411 2. If the woman does not apply under sub. (3g) (a), (b) or (c) for benefits and
12services under this section within the time required under par. (c), on the last day
13of the month following the month in which the health care provider makes the
14determination under this paragraph.
AB591-ASA3,92,1715 (c) A woman who is determined to be eligible under this subsection shall apply
16under sub. (3g) (a), (b) or (c) for benefits and services under this section within 14
17days after the date on which the health care provider makes that determination.
AB591-ASA3,92,2018 (cm) A woman who receives services under this subsection is liable for a
19monthly premium payable in the amount and in the manner prescribed under sub.
20(4) (d) beginning with the first month in which she receives those services.
AB591-ASA3,92,2321 (d) A health care provider under contract under sub. (4) (a) that determines
22that a woman is eligible under this subsection for benefits and services under this
23section shall do all of the following:
AB591-ASA3,92,2524 1. Notify the Wisconsin works agency of that determination within 5 working
25days after the day on which the determination is made.
AB591-ASA3,93,1
12. Notify the woman of the requirements under pars. (c) and (cm).
AB591-ASA3,93,42 (e) The Wisconsin works agency shall provide health care providers under
3contract under sub. (4) (a) with application forms for benefits and services under this
4section and information on how to assist women in completing the forms.
AB591-ASA3,93,65 (f) No provider may make more than one eligibility determination under this
6subsection with respect to an individual.
AB591-ASA3,93,13 7(4) Administration and benefits. (a) Health maintenance organization
8contract.
The department of health and family services shall contract with health
9maintenance organizations or other health care providers, including federally
10qualified health centers, to provide health care services under this subsection. A
11health maintenance organization or other health care provider that contracts under
12this subsection shall meet the certification criteria established by the department of
13health and family services under s. 49.45 (2) (a) 11.
AB591-ASA3,93,1614 (b) Health care services provided. 1. Except as provided in subd. 2., the
15Wisconsin works health plan shall cover the care and services specified under s.
1649.46 (2).
AB591-ASA3,93,1917 1m. The Wisconsin works health plan shall cover in-home psychotherapy for
18individuals who are under the age of 21 if the in-home psychotherapy is prescribed
19pursuant to a physical examination under 42 USC 1396 (r) (1).
AB591-ASA3,93,2120 1s. The Wisconsin works health plan shall cover insulin if it is prescribed by
21a physician.
AB591-ASA3,93,24222. Except as otherwise required under a federal waiver received under 42 USC
231315
, the Wisconsin works health plan shall not cover the following goods and
24services:
AB591-ASA3,94,2
1a. Home care, as defined in s. 632.895 (1) (b), in excess of the minimum required
2under s. 632.895 (2).
AB591-ASA3,94,33 b. Skilled nursing care in excess of the minimum required under s. 632.895 (3).
AB591-ASA3,94,44 c. Over-the-counter drugs.
AB591-ASA3,94,65 d. Treatment of alcoholism or other drug abuse problems in excess of the
6minimum coverage required under s. 632.89 (2).
AB591-ASA3,94,87e. Services described under 42 USC 1396d (r) (5), unless the services are
8otherwise covered under this section.
AB591-ASA3,94,99 (bm) Abortion coverage excluded. 1. In this paragraph:
AB591-ASA3,94,1010 a. "Abortion" means the intentional destruction of the life of an unborn child.
AB591-ASA3,94,1211 b. "Unborn child" means a human being from the time of conception until it is
12born alive.
AB591-ASA3,94,1513 2. Except as provided in subd. 3., each contract that is entered into under par.
14(a) shall explicitly provide that it does not include coverage for the performance of
15an abortion.
AB591-ASA3,94,1616 3. This paragraph does not apply to any of the following:
AB591-ASA3,95,217 a. The performance by a physician of an abortion which is directly and
18medically necessary to save the life of the woman or in a case of sexual assault or
19incest, provided that prior thereto the physician signs a certification which so states,
20and provided that, in the case of sexual assault or incest the crime has been reported
21to the law enforcement authorities. The certification shall be affixed to the claim
22form or invoice when submitted to any agency or fiscal intermediary of the state for
23payment or when submitted by an individual health care provider to the coverage
24provider for payment or for submittal to any agency or fiscal intermediary of the state
25for payment, and shall specify and attest to the direct medical necessity of the

1abortion upon the best clinical judgment of the physician or attest to his or her belief
2that sexual assault or incest has occurred.
AB591-ASA3,95,123 b. The performance by a physician of an abortion if, due to a medical condition
4existing prior to the abortion, the physician determines that the abortion is directly
5and medically necessary to prevent grave, long-lasting physical health damage to
6the woman, provided that prior thereto the physician signs a certification which so
7states. The certification shall be affixed to the claim form or invoice when submitted
8to any agency or fiscal intermediary of the state for payment or when submitted by
9an individual health care provider to the coverage provider for payment or for
10submittal to any agency or fiscal intermediary of the state for payment, and shall
11specify and attest to the direct medical necessity of the abortion upon the best clinical
12judgment of the physician.
AB591-ASA3,95,1513 c. The authorization or payment of funds to a physician or surgeon or a hospital,
14clinic or medical facility for or in connection with the prescription of a drug or the
15insertion of a device to prevent the implantation of a fertilized ovum.
AB591-ASA3,95,2316 4. Quarterly, as determined by the department of health and family services,
17following any annual quarter in which health care services have been provided under
18coverage that is affected by this paragraph, the coverage provider shall submit a
19written report to the agency which contracted for the services of the provider. The
20report shall specify the number of abortions provided in the previous quarter by the
21provider to individuals who have coverage for the abortion under this subsection, as
22permitted under subd. 3. a. or b., the reason for each abortion, and the total cost of
23each abortion.
AB591-ASA3,96,224 5. A copy of each report submitted under subd. 4. shall be forwarded to the
25department of health and family services, which shall review the data for compliance

1with this paragraph and annually publish a summary of the information obtained
2under this subdivision.
AB591-ASA3,96,73 (c) Distribution of payments. From the appropriations under s. 20.435 (1) (b)
4and (o), the department of health and family services shall make payments to a
5health maintenance organization or other health care provider with which the
6department of health and family services has contracted under par. (a) in accordance
7with a payment schedule established by contract.
AB591-ASA3,96,108 (d) Premiums. 1. Subject to a modification made pursuant to subd. 2, an
9individual who receives the Wisconsin works health plan shall pay, in the manner
10prescribed in subd. 3., the following monthly premium:
AB591-ASA3,96,1211 a. For an individual with an income equal to or less than 159% of the poverty
12line, $20.
AB591-ASA3,96,1513 b. For an individual with an income greater than 159% of the poverty line and
14not greater than 200% of the poverty line, $20 plus $3 for every percentage point by
15which the individual's income exceeds 159%.
AB591-ASA3,97,216 2. The department of health and family services may submit a proposal to the
17joint committee on finance to modify the premium amounts under subd. 1. If, within
1814 days after the date of receipt of the department's proposal, the cochairpersons of
19the committee do not notify the secretary that the committee has scheduled a
20meeting for the purpose of reviewing the proposed modifications, the department of
21health and family services may make the modifications specified in the proposal. If,
22within 14 days after the date of receipt of the department's proposal, the
23cochairpersons of the committee notify the secretary that the committee has
24scheduled a meeting for the purpose of reviewing the proposed modifications, the

1department of health and family services may not make the modifications specified
2in the proposal until the committee approves the proposal.
AB591-ASA3,97,33 3. Payment of the premium shall be made as follows:
AB591-ASA3,97,64 a. For a participant in a trial job, the Wisconsin works agency shall deduct the
5premium from the subsidy that is paid to the employer under s. 49.147 (3) (a). The
6employer shall deduct the premium from the trial job participant's wages.
AB591-ASA3,97,97 b. For a participant in a community service job or transitional placement, the
8Wisconsin works agency shall deduct the premium from the participant's monthly
9grant amount under s. 49.148 (1) (b) or (c).
AB591-ASA3,97,1310 c. For an individual not specified under subd. 3. a. or b., the individual shall
11pay the premium directly to the Wisconsin works agency, or, if the individual and his
12or her employer agree, the individual's employer may deduct the premium from the
13individual's payroll and pay the premium to the Wisconsin works agency.
AB591-ASA3,97,1714 4. The Wisconsin works agency shall remit to the department of industry, labor
15and job development in the manner prescribed by the department of industry, labor
16and job development all premium payments that the Wisconsin works agency
17receives under this paragraph.
AB591-ASA3, s. 94 18Section 94. 49.155 of the statutes is created to read:
AB591-ASA3,97,20 1949.155 Wisconsin works; child care subsidy. (1) Definitions. In this
20section:
AB591-ASA3,97,2221 (a) "Level I certified family day care provider" means a day care provider
22certified under s. 48.651 (1) (a).
AB591-ASA3,97,2423 (b) "Level II certified family day care provider" means a day care provider
24certified under s. 48.651 (1) (b).
AB591-ASA3,98,4
1(1m) Eligibility. A Wisconsin works agency shall determine eligibility for a
2child care subsidy under this section. Under this section, an individual may receive
3a subsidy for child care for a child who has not attained the age of 13 if the individual
4meets all of the following conditions:
AB591-ASA3,98,85 (a) The individual is a custodial parent of a child who is under the age of 13,
6or is a person who, under s. 48.57 (3m), is providing care and maintenance for a child
7who is under the age of 13, and child care services for that child are needed in order
8for the individual to do any of the following:
AB591-ASA3,98,99 1. Meet the school attendance requirement under s. 49.26 (1) (ge).
AB591-ASA3,98,1110 2. Work in an unsubsidized job, including training provided by an employer
11during the regular hours of employment.
AB591-ASA3,98,1312 3. Work in a Wisconsin works employment position, including participation in
13education or training activities under s. 49.147 (3) (am), (4) (am) or (5) (bm).
AB591-ASA3,98,2214 4. Participate in other employment skills training, including an English as a
152nd language course, if the Wisconsin works agency determines that the course
16would facilitate the individual's efforts to obtain employment; a course of study
17meeting the standards established by the secretary of education under s. 115.29 (4)
18for the granting of a declaration of equivalency of high school graduation; a course
19of study at a technical college; or participation in educational courses that provide
20an employment skill, as determined by the department. An individual may receive
21aid under this subdivision for up to one year. An individual may not receive aid under
22this subdivision unless the individual meets at least one of the following conditions:
AB591-ASA3,98,2423 a. The individual has been employed in unsubsidized employment for 9
24consecutive months and continues to be so employed.
AB591-ASA3,98,2525 b. The individual is a participant in a Wisconsin works employment position.
AB591-ASA3,99,4
1(b) The individual meets the eligibility conditions under s. 49.145 (2) (c) to (g)
2and (3) (a), except that an individual may be eligible for a child care subsidy under
3this section regardless of the number of days the individual has resided in this state
4prior to applying for the child care subsidy.
AB591-ASA3,99,85 (c) The gross income of the individual's family is at or below 165% of the poverty
6line for a family the size of the individual's family. In calculating the gross income
7of the family, the Wisconsin works agency shall include income described under s.
849.145 (3) (b) 1. to 3.
AB591-ASA3,99,109 (d) The individual satisfies other eligibility criteria established by the
10department by rule.
AB591-ASA3,99,13 11(3) County administration. (a) A Wisconsin works agency shall refer an
12individual who has been determined eligible under sub. (1m) to a county department
13under s. 46.215, 46.22 or 46.23 for child care assistance.
AB591-ASA3,99,1714 (b) The county department under s. 46.215, 46.22 or 46.23 shall administer
15child care assistance under this section. In administering child care assistance
16under this section, the county department under s. 46.215, 46.22 or 46.23 shall do
17all of the following:
AB591-ASA3,99,1818 1. Determine an individual's liability under sub. (5).
AB591-ASA3,99,2119 2. Provide a voucher to an eligible individual for the payment of child care
20services provided by a child care provider or otherwise reimburse child care
21providers.
AB591-ASA3,99,2222 3. Set maximum reimbursement rates as provided under sub. (6) (b).
AB591-ASA3,99,2323 5. Certify child care providers under s. 48.651.
AB591-ASA3,100,3
16. Assist individuals who are eligible for child care subsidies under this section
2to identify available child care providers and select appropriate child care
3arrangements.
AB591-ASA3,100,7 4(4) Choice of provider. An eligible individual shall choose whether the child
5care will be provided by a day care center licensed under s. 48.65, a Level I certified
6family day care provider, a Level II certified family day care provider or a day care
7program provided or contracted for by a school board under s. 120.13 (14).
AB591-ASA3,100,10 8(5) Liability for payment. (a) Subject to a modification made pursuant to par.
9(b), an individual is liable for the following percentages of the cost of child care
10received:
AB591-ASA3,100,1211 1. For an individual with an income equal to or less than 75% of the poverty
12line, 7.5%.
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