Amendment SSA1-AB133

AB133-SSA1,724,18 (c) "Independence account" means an account approved by the department that consists solely of savings, and dividends or other gains derived from those savings, from income earned from paid employment after the initial date that an individual began receiving medical assistance under this section.

AB133-SSA1,724,20 (d) "Medical assistance purchase plan" means medical assistance, eligibility for which is determined under this section.

AB133-SSA1,724,21 (e) "Unearned income" has the meaning given in 42 USC 1382a (a) (2).

AB133-SSA1,725,5 (2) Waivers and amendments. The department shall submit to the federal department of health and human services an amendment to the state medical assistance plan, and shall request any necessary waivers from the secretary of the federal department of health and human services, to permit the department to expand medical assistance eligibility as provided in this section. If the state plan amendment and all necessary waivers are approved and in effect, the department shall implement the medical assistance eligibility expansion under this section not later than January 1, 2000, or 3 months after full federal approval, whichever is later.

AB133-SSA1,725,8 (3) Eligibility. Except as provided in sub. (6) (a), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:

AB133-SSA1,725,11 (a) The individual's family's net income is less than 250% of the poverty line for a family the size of the individual's family. In calculating the net income, the department shall apply all of the exclusions specified under 42 USC 1382a (b).

AB133-SSA1,725,16 (b) The individual's assets do not exceed $15,000. In determining assets, the department may not include assets that are excluded from the resource calculation under 42 USC 1382b (a) or assets accumulated in an independence account. The department may exclude, in whole or in part, the value of a vehicle used by the individual for transportation to paid employment.

AB133-SSA1,725,20 (c) The individual would be eligible for supplemental security income for purposes of receiving medical assistance but for evidence of work, attainment of the substantial gainful activity level, earned income and unearned income in excess of the limit established under 42 USC 1396d (q) (2) (B) and (D).

AB133-SSA1,725,22 (e) The individual is legally able to work in all employment settings without a permit under s. 103.70.

AB133-SSA1,725,25 (f) The individual maintains premium payments calculated by the department in accordance with sub. (4), unless the individual is exempted from premium payments under sub. (4) (b) or (5).

AB133-SSA1,726,3 (g) The individual is engaged in gainful employment or is participating in a program that is certified by the department to provide health and employment services that are aimed at helping the individual achieve employment goals.

AB133-SSA1,726,5 (h) The individual meets all other requirements established by the department by rule.

AB133-SSA1,726,9 (4) Premiums. (a) Except as provided in par. (b) and sub. (5), an individual who is eligible for medical assistance under sub. (3) and receives medical assistance shall pay a monthly premium to the department. The department shall establish the monthly premiums by rule in accordance with the following guidelines:

AB133-SSA1,726,10 1. The premium for any individual may not exceed the sum of the following:

AB133-SSA1,726,12 a. Three and one-half percent of the individual's earned income after the disregards specified in subd. 2m.

AB133-SSA1,726,14 b. One hundred percent of the individual's unearned income after the deductions specified in subd. 2.

AB133-SSA1,726,16 2. In determining an individual's unearned income under subd. 1., the department shall disregard all of the following:

AB133-SSA1,726,20 a. A maintenance allowance established by the department by rule. The maintenance allowance may not be less than the sum of $20, the federal supplemental security income payment level determined under 42 USC 1382 (b) and the state supplemental payment determined under s. 49.77 (2m).

AB133-SSA1,726,21 b. Medical and remedial expenses and impairment-related work expenses.

AB133-SSA1,726,24 2m. If the disregards under subd. 2. exceed the unearned income against which they are applied, the department shall disregard the remainder in calculating the individual's earned income.

AB133-SSA1,727,2 3. The department may reduce the premium by 25% for an individual who is covered by private health insurance.

AB133-SSA1,727,6 (b) The department may waive monthly premiums that are calculated to be below $10 per month. The department may not assess a monthly premium for any individual whose income level, after adding the individual's earned income and unearned income, is below 150% of the poverty line.

AB133-SSA1,727,10 (5) Community options participants. From the appropriation under s. 20.435 (7) (bd), the department may pay all or a portion of the monthly premium calculated under sub. (4) (a) for an individual who is a participant in the community options program under s. 46.27 (11).

AB133-SSA1,727,16 (6) Insured persons. (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s. 20.435 (4) (b), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

AB133-SSA1,727,19 (b) If federal financial participation is available, from the appropriation under s. 20.435 (4) (b), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).

AB133-SSA1,727,20 (7) Department duties. The department shall do all of the following:

AB133-SSA1,727,23 (a) Determine eligibility, or contract with a county department, as defined in 49.45 (6c) (a) 3., or with a tribal governing body to determine eligibility, of individuals for the medical assistance purchase plan in accordance with sub. (3).

AB133-SSA1,728,2 (b) Ensure, to the extent practicable, continuity of care for a medical assistance recipient under this section who is engaged in paid employment, or is enrolled in a home-based or community-based waiver program under section 1915 (c) of the Social Security Act, and who becomes ineligible for medical assistance.

AB133-SSA1, s. 1441 Section 1441. 49.475 (5) of the statutes is amended to read:

AB133-SSA1,728,9 49.475 (5) Reimbursement of costs. From the appropriations under s. 20.435 (1) (4) (bm) and (p) (pa), the department shall reimburse an insurer that provides information under this section for the insurer's reasonable costs incurred in providing the requested information, including its reasonable costs, if any, to develop and operate automated systems specifically for the disclosure of information under this section.

AB133-SSA1, s. 1444 Section 1444. 49.496 (2) (title) of the statutes is amended to read:

AB133-SSA1,728,12 49.496 (2) (title) Liens on the homes of nursing home residents and inpatients at hospitals.

AB133-SSA1, s. 1445 Section 1445. 49.496 (2) (a) of the statutes is amended to read:

AB133-SSA1,728,20 49.496 (2) (a) Except as provided in par. (b), the department may obtain a lien on a recipient's home if the recipient resides in a nursing home, or if the recipient resides in a hospital and is required to contribute to the cost of care, and the recipient cannot reasonably be expected to be discharged from the nursing home or hospital and return home. The lien is for the amount of medical assistance paid on behalf of the recipient while the recipient resides in a nursing home that is recoverable under sub. (3) (a).

AB133-SSA1, s. 1446 Section 1446. 49.496 (2) (b) 3. of the statutes is amended to read:

AB133-SSA1,728,24 49.496 (2) (b) 3. The recipient's sibling who has an ownership interest in the home and who has lived in the home continuously beginning at least 12 months before the recipient was admitted to the nursing home or hospital.

AB133-SSA1, s. 1447 Section 1447. 49.496 (2) (c) 1. of the statutes is amended to read:

AB133-SSA1,729,4 49.496 (2) (c) 1. Notify the recipient in writing of its determination that the recipient cannot reasonably be expected to be discharged from the nursing home or hospital, its intent to impose a lien on the recipient's home and the recipient's right to a hearing on whether the requirements for the imposition of a lien are satisfied.

AB133-SSA1, s. 1448 Section 1448. 49.496 (2) (f) 3. of the statutes is amended to read:

AB133-SSA1,729,9 49.496 (2) (f) 3. A child of any age who resides in the home, if that child resided in the home for at least 24 months before the recipient was admitted to the nursing home or hospital and provided care to the recipient that delayed the recipient's admission to the nursing home or hospital.

AB133-SSA1, s. 1449 Section 1449. 49.496 (2) (f) 4. of the statutes is amended to read:

AB133-SSA1,729,13 49.496 (2) (f) 4. A sibling who resides in the home, if the sibling resided in the home for at least 12 months before the recipient was admitted to the nursing home or hospital.

AB133-SSA1, s. 1450 Section 1450. 49.496 (2) (h) of the statutes is amended to read:

AB133-SSA1,729,17 49.496 (2) (h) The department shall file a release of a lien imposed under this subsection if the recipient is discharged from the nursing home or hospital and returns to live in the home.

AB133-SSA1, s. 1451 Section 1451. 49.496 (3) (a) (intro.) of the statutes is amended to read:

AB133-SSA1,729,22 49.496 (3) (a) (intro.) Except as provided in par. (b), the department shall file a claim against the estate of a recipient or against the estate of the surviving spouse of a recipient for all of the following unless already recovered by the department under this section:

AB133-SSA1, s. 1452 Section 1452. 49.496 (3) (a) 1. of the statutes is amended to read:

AB133-SSA1,730,2 49.496 (3) (a) 1. The amount of medical assistance paid on behalf of the recipient while the recipient resided in a nursing home or while the recipient was an inpatient in a medical institution hospital and was required to contribute to the cost of care.

AB133-SSA1, s. 1453 Section 1453. 49.496 (3) (a) 2. a. of the statutes is amended to read:

AB133-SSA1,730,6 49.496 (3) (a) 2. a. Home-based or community-based services under 42 USC 1396d (a) (7) and (8) and under any waiver granted under 42 USC 1396n (c) (4) (B) or 42 USC 1396u.

AB133-SSA1, s. 1454 Section 1454. 49.496 (3) (a) 2. d. of the statutes is created to read:

AB133-SSA1,730,8 49.496 (3) (a) 2. d. Personal care services under s. 49.46 (2) (b) 6. j.

AB133-SSA1, s. 1455 Section 1455. 49.496 (3) (am) (intro.) of the statutes is amended to read:

AB133-SSA1,730,13 49.496 (3) (am) (intro.) The court shall reduce the amount of a claim under par. (a) by up to $3,000 the amount specified in s. 861.33 (2) if necessary to allow the recipient's heirs or the beneficiaries of the recipient's will to retain the following personal property:

AB133-SSA1, s. 1456 Section 1456. 49.496 (3) (am) 3. of the statutes is amended to read:

AB133-SSA1,730,17 49.496 (3) (am) 3. Other tangible personal property not used in trade, agriculture or other business, not to exceed $1,000 in value the amount specified in s. 861.33 (1) (a) 4.

AB133-SSA1, s. 1458 Section 1458. 49.496 (3) (c) of the statutes is renumbered 49.496 (3) (c) 1. and amended to read:

AB133-SSA1,731,2 49.496 (3) (c) 1. If the department's claim is not allowable because of par. (b) and the estate includes an interest in a home, the court exercising probate jurisdiction shall, in the final judgment or summary findings and order, assign the interest in the home subject to a lien in favor of the department for the amount described in par. (a). The personal representative or petitioner for summary settlement or summary assignment of the estate shall record the final judgment as provided in s. 863.29, 867.01 (3) (h) or 867.02 (2) (h).

AB133-SSA1, s. 1459 Section 1459. 49.496 (3) (c) 2. of the statutes is created to read:

AB133-SSA1,731,10 49.496 (3) (c) 2. If the department's claim is not allowable because of par. (b), the estate includes an interest in a home and the personal representative closes the estate by sworn statement under s. 865.16, the personal representative shall stipulate in the statement that the home is assigned subject to a lien in favor of the department for the amount described in par. (a). The personal representative shall record the statement in the same manner as described in s. 863.29, as if the statement were a final judgment.

AB133-SSA1, s. 1460 Section 1460. 49.496 (3) (f) of the statutes is created to read:

AB133-SSA1,731,13 49.496 (3) (f) The department may contract with or employ an attorney to probate estates to recover under this subsection the costs of care.

AB133-SSA1, s. 1460m Section 1460m. 49.496 (4) of the statutes is amended to read:

AB133-SSA1,732,3 49.496 (4) Administration. The department may require a county department under s. 46.215, 46.22 or 46.23 or the governing body of a federally recognized American Indian tribe administering medical assistance to gather and provide the department with information needed to recover medical assistance under this section. The department shall pay to a county department or tribal governing body an amount equal to 5% of the recovery collected by the department relating to a beneficiary for whom the county department or tribal governing body made the last determination of medical assistance eligibility. A county department or tribal governing body may use funds received under this subsection only to pay costs incurred under this subsection and, if any amount remains, to pay for improvements to functions required under s. 49.33 (2) 49.45 (2) (b) 1. The department may withhold payments under this subsection for failure to comply with the department's requirements under this subsection. The department shall treat payments made under this subsection as costs of administration of the medical assistance program.

AB133-SSA1, s. 1461 Section 1461. 49.496 (5) of the statutes is amended to read:

AB133-SSA1,732,10 49.496 (5) Use of funds. From the appropriation under s. 20.435 (5) (4) (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.

AB133-SSA1, s. 1462 Section 1462. 49.499 (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is renumbered 49.499 (1) (intro.).

AB133-SSA1, s. 1463 Section 1463. 49.499 (1) to (3) of the statutes are renumbered 49.499 (1) (a) to (c).

AB133-SSA1, s. 1464 Section 1464. 49.499 (2m) of the statutes is created to read:

AB133-SSA1,732,18 49.499 (2m) From the appropriation under s. 20.435 (6) (g), the department may distribute funds for innovative projects designed to protect the health and property of a resident in a nursing facility, as defined in s. 49.498 (1) (i).

AB133-SSA1, s. 1465 Section 1465. 49.665 (1) (a) of the statutes is renumbered 49.665 (1) (e) and amended to read:

AB133-SSA1,732,22 49.665 (1) (e) "Custodial parent Parent" has the meaning given in s. 49.141 (1) (b) (j).

AB133-SSA1, s. 1466 Section 1466. 49.665 (1) (b) of the statutes is repealed and recreated to read:

AB133-SSA1,732,24 49.665 (1) (b) "Child" means a person who is under the age of 19.

AB133-SSA1, s. 1467 Section 1467. 49.665 (1) (d) of the statutes is amended to read:

AB133-SSA1,733,4 49.665 (1) (d) "Family" means a unit that consists of at least one dependent child and his or her custodial parent or parents, all of whom reside in the same household. "Family" includes the spouse of an individual who is a custodial parent if the spouse resides in the same household as the individual.

AB133-SSA1, s. 1468 Section 1468. 49.665 (1) (f) of the statutes is created to read:

AB133-SSA1,733,7 49.665 (1) (f) "State plan" means the state child health plan under 42 USC 1397aa (b).

AB133-SSA1, s. 1469 Section 1469. 49.665 (3) of the statutes is amended to read:

AB133-SSA1,733,19 49.665 (3) Administration. The department shall administer a program to provide the health services and benefits described in s. 49.46 (2) to families persons 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 or by a member of a child's household under circumstances in which the department determines that purchasing that coverage would not be more costly than providing the coverage under this section.

AB133-SSA1, s. 1470 Section 1470. 49.665 (4) (a) 1. of the statutes is amended to read:

AB133-SSA1,733,25 49.665 (4) (a) 1. The family's income does not exceed 185% of the poverty line, except as provided in par. (at) and 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.

AB133-SSA1, s. 1470d Section 1470d. 49.665 (4) (a) 3. of the statutes is amended to read:

AB133-SSA1,734,9 49.665 (4) (a) 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 time period restriction by rule. An individual is not ineligible for health care coverage under this section solely because the individual had continuation coverage under 42 USC 300bb-1, et seq., at any time prior to applying for health care coverage under this section.

AB133-SSA1, s. 1471 Section 1471. 49.665 (4) (am) of the statutes is created to read:

AB133-SSA1,734,13 49.665 (4) (am) A child who does not reside with his or her parent is eligible for health care coverage under this section if the child meets all of the following requirements:

AB133-SSA1,734,18 1. The child's income does not exceed 185% of the poverty line, except as provided in par. (at) and except that a child 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 use the criteria established under par. (a) 1. to determine income under this subdivision.

AB133-SSA1,734,19 2. The child does not have access to employer-subsidized health care coverage.

AB133-SSA1,734,22 3. The child has not had access to employer-subsidized health care coverage within the time period established by the department under par. (a) 3. The department may establish exceptions to this subdivision.