AB133-SSA1,725,2221 (e) The individual is legally able to work in all employment settings without
22a permit under s. 103.70.
AB133-SSA1,725,2523 (f) The individual maintains premium payments calculated by the department
24in accordance with sub. (4), unless the individual is exempted from premium
25payments under sub. (4) (b) or (5).
AB133-SSA1,726,3
1(g) The individual is engaged in gainful employment or is participating in a
2program that is certified by the department to provide health and employment
3services that are aimed at helping the individual achieve employment goals.
AB133-SSA1,726,54 (h) The individual meets all other requirements established by the department
5by rule.
AB133-SSA1,726,9 6(4) Premiums. (a) Except as provided in par. (b) and sub. (5), an individual who
7is eligible for medical assistance under sub. (3) and receives medical assistance shall
8pay a monthly premium to the department. The department shall establish the
9monthly premiums by rule in accordance with the following guidelines:
AB133-SSA1,726,1010 1. The premium for any individual may not exceed the sum of the following:
AB133-SSA1,726,1211 a. Three and one-half percent of the individual's earned income after the
12disregards specified in subd. 2m.
AB133-SSA1,726,1413 b. One hundred percent of the individual's unearned income after the
14deductions specified in subd. 2.
AB133-SSA1,726,1615 2. In determining an individual's unearned income under subd. 1., the
16department shall disregard all of the following:
AB133-SSA1,726,2017 a. A maintenance allowance established by the department by rule. The
18maintenance allowance may not be less than the sum of $20, the federal
19supplemental security income payment level determined under 42 USC 1382 (b) and
20the state supplemental payment determined under s. 49.77 (2m).
AB133-SSA1,726,2121 b. Medical and remedial expenses and impairment-related work expenses.
AB133-SSA1,726,2422 2m. If the disregards under subd. 2. exceed the unearned income against which
23they are applied, the department shall disregard the remainder in calculating the
24individual's earned income.
AB133-SSA1,727,2
13. The department may reduce the premium by 25% for an individual who is
2covered by private health insurance.
AB133-SSA1,727,63 (b) The department may waive monthly premiums that are calculated to be
4below $10 per month. The department may not assess a monthly premium for any
5individual whose income level, after adding the individual's earned income and
6unearned income, is below 150% of the poverty line.
AB133-SSA1,727,10 7(5) Community options participants. From the appropriation under s. 20.435
8(7) (bd), the department may pay all or a portion of the monthly premium calculated
9under sub. (4) (a) for an individual who is a participant in the community options
10program under s. 46.27 (11).
AB133-SSA1,727,16 11(6) Insured persons. (a) Notwithstanding sub. (4) (a) 3., from the
12appropriation under s. 20.435 (4) (b), the department shall, on the part of an
13individual who is eligible for medical assistance under sub. (3), pay premiums for or
14purchase individual coverage offered by the individual's employer if the department
15determines that paying the premiums for or purchasing the coverage will not be more
16costly than providing medical assistance.
AB133-SSA1,727,1917 (b) If federal financial participation is available, from the appropriation under
18s. 20.435 (4) (b), the department may pay medicare Part A and Part B premiums for
19individuals who are eligible for medicare and for medical assistance under sub. (3).
AB133-SSA1,727,20 20(7) Department duties. The department shall do all of the following:
AB133-SSA1,727,2321 (a) Determine eligibility, or contract with a county department, as defined in
2249.45 (6c) (a) 3., or with a tribal governing body to determine eligibility, of individuals
23for the medical assistance purchase plan in accordance with sub. (3).
AB133-SSA1,728,224 (b) Ensure, to the extent practicable, continuity of care for a medical assistance
25recipient under this section who is engaged in paid employment, or is enrolled in a

1home-based or community-based waiver program under section 1915 (c) of the
2Social Security Act, and who becomes ineligible for medical assistance.
AB133-SSA1, s. 1441 3Section 1441. 49.475 (5) of the statutes is amended to read:
AB133-SSA1,728,94 49.475 (5) Reimbursement of costs. From the appropriations under s. 20.435
5(1) (4) (bm) and (p) (pa), the department shall reimburse an insurer that provides
6information under this section for the insurer's reasonable costs incurred in
7providing the requested information, including its reasonable costs, if any, to develop
8and operate automated systems specifically for the disclosure of information under
9this section.
AB133-SSA1, s. 1444 10Section 1444. 49.496 (2) (title) of the statutes is amended to read:
AB133-SSA1,728,1211 49.496 (2) (title) Liens on the homes of nursing home residents and inpatients
12at hospitals
.
AB133-SSA1, s. 1445 13Section 1445. 49.496 (2) (a) of the statutes is amended to read:
AB133-SSA1,728,2014 49.496 (2) (a) Except as provided in par. (b), the department may obtain a lien
15on a recipient's home if the recipient resides in a nursing home, or if the recipient
16resides in a hospital and is required to contribute to the cost of care,
and the recipient
17cannot reasonably be expected to be discharged from the nursing home or hospital
18and return home. The lien is for the amount of medical assistance paid on behalf of
19the recipient while the recipient resides in a nursing home that is recoverable under
20sub. (3) (a)
.
AB133-SSA1, s. 1446 21Section 1446. 49.496 (2) (b) 3. of the statutes is amended to read:
AB133-SSA1,728,2422 49.496 (2) (b) 3. The recipient's sibling who has an ownership interest in the
23home and who has lived in the home continuously beginning at least 12 months
24before the recipient was admitted to the nursing home or hospital.
AB133-SSA1, s. 1447 25Section 1447. 49.496 (2) (c) 1. of the statutes is amended to read:
AB133-SSA1,729,4
149.496 (2) (c) 1. Notify the recipient in writing of its determination that the
2recipient cannot reasonably be expected to be discharged from the nursing home or
3hospital
, its intent to impose a lien on the recipient's home and the recipient's right
4to a hearing on whether the requirements for the imposition of a lien are satisfied.
AB133-SSA1, s. 1448 5Section 1448. 49.496 (2) (f) 3. of the statutes is amended to read:
AB133-SSA1,729,96 49.496 (2) (f) 3. A child of any age who resides in the home, if that child resided
7in the home for at least 24 months before the recipient was admitted to the nursing
8home or hospital and provided care to the recipient that delayed the recipient's
9admission to the nursing home or hospital.
AB133-SSA1, s. 1449 10Section 1449. 49.496 (2) (f) 4. of the statutes is amended to read:
AB133-SSA1,729,1311 49.496 (2) (f) 4. A sibling who resides in the home, if the sibling resided in the
12home for at least 12 months before the recipient was admitted to the nursing home
13or hospital.
AB133-SSA1, s. 1450 14Section 1450. 49.496 (2) (h) of the statutes is amended to read:
AB133-SSA1,729,1715 49.496 (2) (h) The department shall file a release of a lien imposed under this
16subsection if the recipient is discharged from the nursing home or hospital and
17returns to live in the home.
AB133-SSA1, s. 1451 18Section 1451. 49.496 (3) (a) (intro.) of the statutes is amended to read:
AB133-SSA1,729,2219 49.496 (3) (a) (intro.) Except as provided in par. (b), the department shall file
20a claim against the estate of a recipient or against the estate of the surviving spouse
21of a recipient
for all of the following unless already recovered by the department
22under this section:
AB133-SSA1, s. 1452 23Section 1452. 49.496 (3) (a) 1. of the statutes is amended to read:
AB133-SSA1,730,224 49.496 (3) (a) 1. The amount of medical assistance paid on behalf of the
25recipient while the recipient resided in a nursing home or while the recipient was an

1inpatient in a medical institution hospital and was required to contribute to the cost
2of care.
AB133-SSA1, s. 1453 3Section 1453. 49.496 (3) (a) 2. a. of the statutes is amended to read:
AB133-SSA1,730,64 49.496 (3) (a) 2. a. Home-based or community-based services under 42 USC
51396d
(a) (7) and (8) and under any waiver granted under 42 USC 1396n (c) (4) (B)
6or 42 USC 1396u.
AB133-SSA1, s. 1454 7Section 1454. 49.496 (3) (a) 2. d. of the statutes is created to read:
AB133-SSA1,730,88 49.496 (3) (a) 2. d. Personal care services under s. 49.46 (2) (b) 6. j.
AB133-SSA1, s. 1455 9Section 1455. 49.496 (3) (am) (intro.) of the statutes is amended to read:
AB133-SSA1,730,1310 49.496 (3) (am) (intro.) The court shall reduce the amount of a claim under par.
11(a) by up to $3,000 the amount specified in s. 861.33 (2) if necessary to allow the
12recipient's heirs or the beneficiaries of the recipient's will to retain the following
13personal property:
AB133-SSA1, s. 1456 14Section 1456. 49.496 (3) (am) 3. of the statutes is amended to read:
AB133-SSA1,730,1715 49.496 (3) (am) 3. Other tangible personal property not used in trade,
16agriculture or other business, not to exceed $1,000 in value the amount specified in
17s. 861.33 (1) (a) 4
.
AB133-SSA1, s. 1458 18Section 1458. 49.496 (3) (c) of the statutes is renumbered 49.496 (3) (c) 1. and
19amended to read:
AB133-SSA1,731,220 49.496 (3) (c) 1. If the department's claim is not allowable because of par. (b)
21and the estate includes an interest in a home, the court exercising probate
22jurisdiction shall, in the final judgment or summary findings and order, assign the
23interest in the home subject to a lien in favor of the department for the amount
24described in par. (a). The personal representative or petitioner for summary

1settlement or summary assignment of the estate
shall record the final judgment as
2provided in s. 863.29, 867.01 (3) (h) or 867.02 (2) (h).
AB133-SSA1, s. 1459 3Section 1459. 49.496 (3) (c) 2. of the statutes is created to read:
AB133-SSA1,731,104 49.496 (3) (c) 2. If the department's claim is not allowable because of par. (b),
5the estate includes an interest in a home and the personal representative closes the
6estate by sworn statement under s. 865.16, the personal representative shall
7stipulate in the statement that the home is assigned subject to a lien in favor of the
8department for the amount described in par. (a). The personal representative shall
9record the statement in the same manner as described in s. 863.29, as if the
10statement were a final judgment.
AB133-SSA1, s. 1460 11Section 1460. 49.496 (3) (f) of the statutes is created to read:
AB133-SSA1,731,1312 49.496 (3) (f) The department may contract with or employ an attorney to
13probate estates to recover under this subsection the costs of care.
AB133-SSA1, s. 1460m 14Section 1460m. 49.496 (4) of the statutes is amended to read:
AB133-SSA1,732,315 49.496 (4) Administration. The department may require a county department
16under s. 46.215, 46.22 or 46.23 or the governing body of a federally recognized
17American Indian tribe administering medical assistance to gather and provide the
18department with information needed to recover medical assistance under this
19section. The department shall pay to a county department or tribal governing body
20an amount equal to 5% of the recovery collected by the department relating to a
21beneficiary for whom the county department or tribal governing body made the last
22determination of medical assistance eligibility. A county department or tribal
23governing body may use funds received under this subsection only to pay costs
24incurred under this subsection and, if any amount remains, to pay for improvements
25to functions required under s. 49.33 (2) 49.45 (2) (b) 1. The department may withhold

1payments under this subsection for failure to comply with the department's
2requirements under this subsection. The department shall treat payments made
3under this subsection as costs of administration of the medical assistance program.
AB133-SSA1, s. 1461 4Section 1461. 49.496 (5) of the statutes is amended to read:
AB133-SSA1,732,105 49.496 (5) Use of funds. From the appropriation under s. 20.435 (5) (4) (im),
6the department shall pay the amount of the payments under sub. (4) that is not paid
7from federal funds, shall pay to the federal government the amount of the funds
8recovered under this section equal to the amount of federal funds used to pay the
9benefits recovered under this section and shall spend the remainder of the funds
10recovered under this section for medical assistance benefits under this subchapter.
AB133-SSA1, s. 1462 11Section 1462. 49.499 (intro.) of the statutes, as affected by 1997 Wisconsin Act
1227
, is renumbered 49.499 (1) (intro.).
AB133-SSA1, s. 1463 13Section 1463. 49.499 (1) to (3) of the statutes are renumbered 49.499 (1) (a)
14to (c).
AB133-SSA1, s. 1464 15Section 1464. 49.499 (2m) of the statutes is created to read:
AB133-SSA1,732,1816 49.499 (2m) From the appropriation under s. 20.435 (6) (g), the department
17may distribute funds for innovative projects designed to protect the health and
18property of a resident in a nursing facility, as defined in s. 49.498 (1) (i).
AB133-SSA1, s. 1465 19Section 1465. 49.665 (1) (a) of the statutes is renumbered 49.665 (1) (e) and
20amended to read:
AB133-SSA1,732,2221 49.665 (1) (e) "Custodial parent Parent" has the meaning given in s. 49.141 (1)
22(b) (j).
AB133-SSA1, s. 1466 23Section 1466. 49.665 (1) (b) of the statutes is repealed and recreated to read:
AB133-SSA1,732,2424 49.665 (1) (b) "Child" means a person who is under the age of 19.
AB133-SSA1, s. 1467 25Section 1467. 49.665 (1) (d) of the statutes is amended to read:
AB133-SSA1,733,4
149.665 (1) (d) "Family" means a unit that consists of at least one dependent
2child and his or her custodial parent or parents, all of whom reside in the same
3household
. "Family" includes the spouse of an individual who is a custodial parent
4if the spouse resides in the same household as the individual.
AB133-SSA1, s. 1468 5Section 1468. 49.665 (1) (f) of the statutes is created to read:
AB133-SSA1,733,76 49.665 (1) (f) "State plan" means the state child health plan under 42 USC
71397aa
(b).
AB133-SSA1, s. 1469 8Section 1469. 49.665 (3) of the statutes is amended to read:
AB133-SSA1,733,199 49.665 (3) Administration. The department shall administer a program to
10provide the health services and benefits described in s. 49.46 (2) to families persons
11that meet the eligibility requirements specified in sub. (4). The department shall
12promulgate rules setting forth the application procedures and appeal and grievance
13procedures. The department may promulgate rules limiting access to the program
14under this section to defined enrollment periods. The department may also
15promulgate rules establishing a method by which the department may purchase
16family coverage offered by the employer of a member of an eligible family or by a
17member of a child's household
under circumstances in which the department
18determines that purchasing that coverage would not be more costly than providing
19the coverage under this section.
AB133-SSA1, s. 1470 20Section 1470. 49.665 (4) (a) 1. of the statutes is amended to read:
AB133-SSA1,733,2521 49.665 (4) (a) 1. The family's income does not exceed 185% of the poverty line,
22except as provided in par. (at) and except that a family that is already receiving
23health care coverage under this section may have an income that does not exceed
24200% of the poverty line. The department shall establish by rule the criteria to be
25used to determine income.
AB133-SSA1, s. 1470d
1Section 1470d. 49.665 (4) (a) 3. of the statutes is amended to read:
AB133-SSA1,734,92 49.665 (4) (a) 3. The family has not had access to employer-subsidized health
3care coverage within the time period established by the department by rule, but not
4to exceed 18 months, immediately preceding application for health care coverage
5under this section. The department may establish exceptions to this subdivision
6time period restriction by rule. An individual is not ineligible for health care
7coverage under this section solely because the individual had continuation coverage
8under 42 USC 300bb-1, et seq., at any time prior to applying for health care coverage
9under this section.
AB133-SSA1, s. 1471 10Section 1471. 49.665 (4) (am) of the statutes is created to read:
AB133-SSA1,734,1311 49.665 (4) (am) A child who does not reside with his or her parent is eligible
12for health care coverage under this section if the child meets all of the following
13requirements:
AB133-SSA1,734,1814 1. The child's income does not exceed 185% of the poverty line, except as
15provided in par. (at) and except that a child that is already receiving health care
16coverage under this section may have an income that does not exceed 200% of the
17poverty line. The department shall use the criteria established under par. (a) 1. to
18determine income under this subdivision.
AB133-SSA1,734,1919 2. The child does not have access to employer-subsidized health care coverage.
AB133-SSA1,734,2220 3. The child has not had access to employer-subsidized health care coverage
21within the time period established by the department under par. (a) 3. The
22department may establish exceptions to this subdivision.
AB133-SSA1,734,2523 4. The child meets all other requirements established by the department by
24rule. In establishing other eligibility criteria, the department may not include any
25health condition requirements.
AB133-SSA1, s. 1472
1Section 1472. 49.665 (4) (at) of the statutes is created to read:
AB133-SSA1,735,62 49.665 (4) (at) 1. a. Except as provided in subd. 1. b., the department shall
3establish a lower maximum income level for the initial eligibility determination if
4funding under s. 20.435 (4) (bc), (jz) and (p) is insufficient to accommodate the
5projected enrollment levels for the health care program under this section. The
6adjustment may not be greater than necessary to ensure sufficient funding.
AB133-SSA1,735,137 b. The department may not lower the maximum income level for initial
8eligibility unless the department first submits to the joint committee on finance its
9plans for lowering the maximum income level and the committee approves the plan.
10If, within 14 days after submitting the plan to the joint committee on finance, the
11cochairpersons of the committee do not notify the secretary that the committee has
12scheduled a meeting for the purpose of reviewing the plan, the plan is considered
13approved by the committee.
AB133-SSA1,735,1814 2. If, after the department has established a lower maximum income level
15under subd. 1., projections indicate that funding under s. 20.435 (4) (bc), (jz) and (p)
16is sufficient to raise the level, the department shall, by state plan amendment, raise
17the maximum income level for initial eligibility, but not to exceed 185% of the poverty
18line.
AB133-SSA1,735,2019 3. The department may not adjust the maximum income level of 200% of the
20poverty line for persons already receiving health care coverage under this section.
AB133-SSA1, s. 1473 21Section 1473. 49.665 (4) (b) of the statutes is amended to read:
AB133-SSA1,735,2422 49.665 (4) (b) Notwithstanding fulfillment of the eligibility requirements
23under this subsection, a family no person is not entitled to health care coverage under
24this section.
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