SB40-SSA1,717,99
2. An elective withdrawal.
SB40-SSA1,717,1010
3. A request to change the distribution of the annuity.
SB40-SSA1,717,1111
4. An election to annuitize the contract.
SB40-SSA1,717,1212
5. A change in ownership.
SB40-SSA1,717,1614
49.453
(4) (am) Paragraph
(a) (ag) 1. does not apply to a variable annuity that
15is tied to a mutual fund that is registered with the federal securities and exchange
16commission.
SB40-SSA1,717,2018
49.453
(4) (b) The amount of assets that is transferred for less than fair market
19value under par.
(a) (ag) is the amount by which the transferred amount exceeds the
20expected value of the benefit.
SB40-SSA1,718,622
49.453
(4) (c) The department shall promulgate rules specifying the method to
23be used in calculating the expected value of the benefit, based on
26 CFR 1.72-
1 to
241.72-
18, and specifying the criteria for adjusting the expected value of the benefit
25based on a medical condition diagnosed by a physician before the assets were
1transferred to the annuity, or transferred by promissory note or similar instrument.
2In calculating the amount of the divestment when a transfer to an annuity, or a
3transfer by promissory note or similar instrument, is made, payments made to the
4transferor in any year subsequent to the year in which the transfer was made shall
5be discounted to the year in which the transfer was made by the applicable federal
6rate specified under par.
(a) (ag) on the date of the transfer.
SB40-SSA1,718,98
49.453
(4) (cm) Paragraphs (ag) to (c) apply to annuities purchased before
9February 8, 2006, for which no transaction has occurred on or after February 8, 2006.
SB40-SSA1,718,1411
49.453
(4) (d) For purposes of sub. (2), the purchase of an annuity by an
12institutionalized individual or his or her community spouse, or anyone acting on
13their behalf, shall be treated as a transfer of assets for less than fair market value
14unless any of the following applies:
SB40-SSA1,718,1715
1. The state is designated as the remainder beneficiary in the first position for
16at least the total amount of medical assistance paid on behalf of the institutionalized
17individual.
SB40-SSA1,718,2118
2. The state is named as a beneficiary in the 2nd position after the community
19spouse or a minor or disabled child and is named in the first position if the community
20spouse or a representative of the minor or disabled child disposes of any remainder
21for less than fair market value.
SB40-SSA1,718,2222
3. The annuity satisfies the requirements under par. (e) 1. or 2.
SB40-SSA1,719,224
49.453
(4) (e) For purposes of sub. (2), the purchase of an annuity by or on behalf
25of an annuitant who has applied for medical assistance for nursing facility services
1or other long-term care services described in sub. (2) is a transfer of assets for less
2than fair market value unless either of the following applies:
SB40-SSA1,719,431. The annuity is either an annuity described in section
408 (b) or (q) of the
4Internal Revenue Code of 1986 or purchased with proceeds from any of the following:
SB40-SSA1,719,65a. An account or trust described in section
408 (a), (c), or (p) of the Internal
6Revenue Code of 1986.
SB40-SSA1,719,87b. A simplified employee pension, within the meaning of section
408 (k) of the
8Internal Revenue Code of 1986.
SB40-SSA1,719,99c. A Roth IRA described in section
408A of the Internal Revenue Code of 1986.
SB40-SSA1,719,1010
2. All of the following apply with respect to the annuity:
SB40-SSA1,719,1111
a. The annuity is irrevocable and nonassignable.
SB40-SSA1,719,1312
b. The annuity is actuarily sound, as determined in accordance with actuarial
13publications of the office of the chief actuary of the social security administration.
SB40-SSA1,719,1514
c. The annuity provides for payments in equal amounts during the term of the
15annuity, with no deferral and no balloon payments made.
SB40-SSA1,719,1717
49.453
(4) (em) Paragraphs (d) and (e) apply to all of the following:
SB40-SSA1,719,1818
1. Annuities purchased on or after February 8, 2006.
SB40-SSA1,719,2019
2. Annuities purchased before February 8, 2006, for which a transaction has
20occurred on or after February 8, 2006.
SB40-SSA1,719,2522
49.453
(4c) Purchase of note, loan, or mortgage. (a) For purposes of sub. (2),
23the purchase by an individual or his or her spouse of a promissory note, loan, or
24mortgage after February 8, 2006, is a transfer of assets for less than fair market
25value unless all of the following apply with respect to the note, loan, or mortgage:
SB40-SSA1,720,1
11. The repayment term is actuarially sound.
SB40-SSA1,720,32
2. The payments are to be made in equal amounts during the term of the loan,
3with no deferral and no balloon payment.
SB40-SSA1,720,44
3. Cancellation of the balance upon the death of the lender is prohibited.
SB40-SSA1,720,85
(b) The value of a promissory note, loan, or mortgage that does not satisfy the
6requirements under par. (a) 1. to 3. is the outstanding balance due on the date that
7the individual applies for medical assistance for nursing facility services or other
8long-term care services described in sub. (2).
SB40-SSA1,720,1310
49.453
(4m) Purchase of life estate. For purposes of sub. (2), the purchase
11by an individual or his or her spouse of a life estate in another individual's home after
12February 8, 2006, is a transfer of assets for less than fair market value unless the
13purchaser resides in the home for at least one year after the date of the purchase.
SB40-SSA1, s. 1585
14Section
1585. 49.453 (8) of the statutes is renumbered 49.453 (8) (a) (intro.)
15and amended to read:
SB40-SSA1,720,1716
49.453
(8) (a) (intro.) Subsections (2) and (3) do not apply to transfers of assets
17if
the any of the following applies:
SB40-SSA1,720,18
181. The assets are exempt under
42 USC 1396p (c) (2)
or if the (A), (B), or (C).
SB40-SSA1,720,21
192. The department determines
under the process under par. (b) that application
20of this section would work an undue hardship
. The department shall promulgate
21rules concerning the transfer of assets exempt under 42 USC 1396p (c) (2).
SB40-SSA1,720,2423
49.453
(8) (b) The department shall establish a hardship waiver process that
24includes all of the following:
SB40-SSA1,721,4
11. The department determines that undue hardship exists if the application of
2subs. (2) and (3) would deprive the individual of medical care to the extent that the
3individual's health or life would be endangered, or would deprive the individual of
4food, clothing, shelter, or other necessities of life.
SB40-SSA1,721,85
2. A facility in which an institutionalized individual who has transferred assets
6resides is permitted to file an application for undue hardship on behalf of the
7individual with the consent of the individual or the individual's authorized
8representative.
SB40-SSA1,721,129
3. The department may, during the pendency of an undue hardship
10determination, pay the full payment rate under s. 49.45 (6m) for nursing facility
11services for up to 30 days for the individual who transferred assets, to hold a bed in
12the facility in which the individual resides.
SB40-SSA1,721,1614
49.46
(1) (a) 5. Any child in an adoption assistance, foster care,
kinship care,
15long-term kinship care, treatment foster care, or subsidized guardianship
16placement under ch. 48 or 938, as determined by the department.
SB40-SSA1,721,2318
49.46
(1) (a) 14m. Any person who would meet the financial and other eligibility
19requirements for home or community-based services under the family care benefit
20but for the fact that the person engages in substantial gainful activity under
42 USC
211382c (a) (3), if a waiver under s. 46.281
(1) (c)
(1d) is in effect or federal law permits
22federal financial participation for medical assistance coverage of the person and if
23funding is available for the person under the family care benefit.
SB40-SSA1, s. 1589
24Section
1589. 49.46 (2) (b) (intro.) of the statutes is amended to read:
SB40-SSA1,722,3
149.46
(2) (b) (intro.) Except as provided in
par. pars. (be)
and (dc), the
2department shall audit and pay allowable charges to certified providers for medical
3assistance on behalf of recipients for the following services:
SB40-SSA1,722,95
49.46
(2) (b) 8. Home or community-based services, if provided under s. 46.27
6(11), 46.275, 46.277, 46.278, or 46.2785, under the family care benefit if a waiver is
7in effect under s. 46.281
(1) (c) (1d), or under
a waiver requested under 2001
8Wisconsin Act 16, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c) the
9disabled children's long-term support program, as defined in s. 46.011 (1g).
SB40-SSA1,722,1611
49.46
(2) (dc) For an individual who is eligible for medical assistance and who
12is eligible for coverage under Part D of Medicare under
42 USC 1395w-101 et seq.,
13benefits under par. (b) 6. h. do not include payment for any Part D drug, as defined
14in
42 CFR 423.100, regardless of whether the individual is enrolled in Part D of
15Medicare or whether, if the individual is enrolled, his or her Part D plan, as defined
16in
42 CFR 423.4, covers the Part D drug.
SB40-SSA1,723,618
49.468
(1) (b) For an elderly or disabled individual who is entitled to coverage
19under part A of medicare, entitled to coverage under part B of medicare and who does
20not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465
or, 2149.47 (4)
, or 49.471 but meets the limitations on income and resources under par. (d),
22medical assistance shall pay the deductible and coinsurance portions of medicare
23services under
42 USC 1395 to
1395zz which are not paid under
42 USC 1395 to
241395zz, including those medicare services that are not included in the approved state
25plan for services under
42 USC 1396; the monthly premiums payable under
42 USC
11395v; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late
2enrollment penalty, if applicable, for premiums under part A of medicare. Payment
3of coinsurance for a service under part B of medicare under
42 USC 1395j to
1395w,
4other than payment of coinsurance for outpatient hospital services, may not exceed
5the allowable charge for the service under medical assistance minus the medicare
6payment.
SB40-SSA1,723,168
49.468
(1) (c) For an elderly or disabled individual who is only entitled to
9coverage under part A of medicare and who does not meet the eligibility criteria for
10medical assistance under s. 49.46 (1), 49.465
or, 49.47 (4)
, or 49.471 but meets the
11limitations on income and resources under par. (d), medical assistance shall pay the
12deductible and coinsurance portions of medicare services under
42 USC 1395 to
131395i which are not paid under
42 USC 1395 to
1395i, including those medicare
14services that are not included in the approved state plan for services under
42 USC
151396; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late
16enrollment penalty for premiums under part A of medicare, if applicable.
SB40-SSA1,723,2318
49.468
(1m) (a) Beginning on January 1, 1993, for an elderly or disabled
19individual who is entitled to coverage under part A of medicare and is entitled to
20coverage under part B of medicare, does not meet the eligibility criteria for medical
21assistance under s. 49.46 (1), 49.465
or, 49.47 (4)
, or 49.471 but meets the limitations
22on income and resources under par. (b), medical assistance shall pay the monthly
23premiums under
42 USC 1395r.
SB40-SSA1,724,6
149.468
(2) (a) Beginning on January 1, 1991, for a disabled working individual
2who is entitled under P.L.
101-239, section 6012 (a), to coverage under part A of
3medicare and who does not meet the eligibility criteria for medical assistance under
4s. 49.46 (1), 49.465
or, 49.47 (4)
, or 49.471 but meets the limitations on income and
5resources under par. (b), medical assistance shall pay the monthly premiums for the
6coverage under part A of medicare, including late enrollment fees, if applicable.
SB40-SSA1, s. 1596
7Section
1596. 49.47 (4) (a) (intro.) of the statutes is amended to read:
SB40-SSA1,724,108
49.47
(4) (a) (intro.) Any individual who meets the limitations on income and
9resources under pars. (b)
and to (c) and who complies with
par. pars. (cm)
and (cr) 10shall be eligible for medical assistance under this section if such individual is:
SB40-SSA1,724,1612
49.47
(4) (as) 1. The person would meet the financial and other eligibility
13requirements for home or community-based services under s. 46.27 (11), 46.277, or
1446.2785 or under the family care benefit if a waiver is in effect under s. 46.281
(1) (c) 15(1d) but for the fact that the person engages in substantial gainful activity under
42
16USC 1382c (a) (3).
SB40-SSA1,724,2018
49.47
(4) (as) 3. Funding is available for the person under s. 46.27 (11), 46.277,
19or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281
(1)
20(c) (1d).
SB40-SSA1, s. 1598r
21Section 1598r. 49.47 (4) (b) (intro.) of the statutes is amended to read:
SB40-SSA1,724,2422
49.47
(4) (b) (intro.) Eligibility exists if the applicant's property
, subject to the
23exclusion of any amounts under the Long-Term Care Partnership Program
24established under s. 49.45 (31), does not exceed the following:
SB40-SSA1,725,3
149.47
(4) (b) 1.
A Subject to par. (bc), a home and the land used and operated
2in connection therewith or in lieu thereof a mobile home if the home or mobile home
3is used as the person's or his or her family's place of abode.
SB40-SSA1,725,95
49.47
(4) (bc) 1. Subject to subd. 2., a person shall be ineligible under this
6section for medical assistance for nursing facility services or other long-term care
7services described in s. 49. 453 (2) if the equity in his or her home and the land used
8and operated in connection with the home exceeds $750,000. This subdivision does
9not apply if any of the following persons lawfully resides in the home:
SB40-SSA1,725,1010
a. The person's spouse.
SB40-SSA1,725,1211
b. The person's child who is under age 21 or who is disabled, as defined in s.
1249.468 (1) (a) 1.
SB40-SSA1,725,1313
2. Subdivision 1. applies to all of the following:
SB40-SSA1,725,1614
a. At the time of application, to a person who applies for medical assistance for
15nursing facility services or other long-term care services described in s. 49.453 (2)
16after the effective date of this subd. 2. a. .... [revisor inserts date].
SB40-SSA1,725,2217
b. At the time of the person's first recertification after the effective date of this
18subd. 2. b. .... [revisor inserts date], to a person not specified in subd. 2. a. who applied
19for medical assistance for nursing facility services or other long-term care services
20described in s. 49.453 (2) on or after January 1, 2006, and who was eligible for medical
21assistance for those services on the effective date of this subd. 2. b. .... [revisor inserts
22date].
SB40-SSA1,726,324
49.47
(4) (bm) For purposes of determining eligibility or benefits amount for
25a person described in par. (a) 3. or 4. who resides in a continuing care retirement
1community or a life care community, any entrance fee paid on admission to the
2community shall be considered a resource available to the person to the extent that
3all of the following apply:
SB40-SSA1,726,64
1. The person has the ability to use the entrance fee, or the contract provides
5that the entrance fee may be used, to pay for care if the person's other resources or
6income are insufficient to pay for the care.
SB40-SSA1,726,97
2. The person is eligible for a refund of any remaining entrance fee when the
8person dies or terminates the continuing care retirement community or life care
9community contract and leaves the community.
SB40-SSA1,726,1110
3. The entrance fee does not confer an ownership interest in the continuing care
11retirement community or life care community.
