AB40-ASA1,1058
7Section
1058. 49.45 (30g) (a) 3. of the statutes is amended to read:
AB40-ASA1,588,108
49.45
(30g) (a) 3. The individual, the community recovery services, and the
9community recovery services provider meet any condition set forth in the approved
10amendment to the medical assistance plan
submitted under 42 USC 1396n (i).
AB40-ASA1,1058k
11Section 1058k. 49.45 (59) (b) of the statutes is amended to read:
AB40-ASA1,588,2412
49.45
(59) (b) Health maintenance organizations shall pay all of the moneys
13they receive under par. (a) to eligible hospitals, as defined in s. 50.38 (1), within 15
14days after receiving the moneys. The department shall specify in contracts with
15health maintenance organizations to provide medical assistance a method that
16health maintenance organizations shall use to allocate the amounts received under
17par. (a) among eligible hospitals based on the number of discharges from inpatient
18stays and the number of outpatient visits for which the health maintenance
19organization paid such a hospital in the previous month for enrollees who are
20recipients of medical assistance
, except enrollees who receive medical assistance
21under s. 49.45 (23). Payments under this paragraph shall be in addition to any
22amount that a health maintenance organization is required by agreement between
23the health maintenance organization and a hospital to pay the hospital for providing
24services to the health maintenance organization's enrollees.
AB40-ASA1,1059
25Section
1059. 49.453 (2) (a) (intro.) of the statutes is amended to read:
AB40-ASA1,589,7
149.453
(2) (a)
Institutionalized individuals. (intro.) Except as provided in sub.
2(8), if an institutionalized individual or his or her spouse, or another person acting
3on behalf of the institutionalized individual or his or her spouse, transfers assets
;
4regardless of whether those assets, if retained, are excluded under 42 USC 1396p; 5for less than fair market value on or after the institutionalized individual's look-back
6date, the institutionalized individual is ineligible for medical assistance for the
7following services for the period specified under sub. (3):
AB40-ASA1,1060
8Section
1060. 49.453 (2) (b) (intro.) of the statutes is amended to read:
AB40-ASA1,589,159
49.453
(2) (b)
Noninstitutionalized individuals. (intro.) Except as provided in
10sub. (8), if a noninstitutionalized individual or his or her spouse, or another person
11acting on behalf of the noninstitutionalized individual or his or her spouse, transfers
12assets
; regardless of whether those assets, if retained, are excluded under 42 USC
131396p; for less than fair market value on or after the noninstitutionalized
14individual's look-back date, the noninstitutionalized individual is ineligible for
15medical assistance for the following services for the period specified under sub. (3):
AB40-ASA1,1061
16Section
1061. 49.453 (3) (a) (intro.) of the statutes is amended to read:
AB40-ASA1,589,1817
49.453
(3) (a) (intro.) The period of ineligibility under this subsection begins
18on either of the following
for an applicant for Medical Assistance:
AB40-ASA1,1062
19Section
1062. 49.453 (3) (ag) of the statutes is created to read:
AB40-ASA1,589,2320
49.453
(3) (ag) The period of ineligibility under this subsection for a transfer
21of assets made at the time the individual is receiving long-term care services through
22Medical Assistance begins on the first day of the month following the month in which
23the individual receives advance notice of the period of ineligibility.
AB40-ASA1,1063
24Section
1063. 49.453 (4c) (c) of the statutes is created to read:
AB40-ASA1,590,4
149.453
(4c) (c) A promissory note in which the debtor is a presumptive heir of
2the lender or in which neither the lender nor debtor has any incentive to enforce
3repayment is considered cancelled upon the death of the lender for purposes of this
4section.
AB40-ASA1,1064
5Section
1064. 49.453 (8) (a) 1. of the statutes is amended to read:
AB40-ASA1,590,106
49.453
(8) (a) 1. The assets are exempt under
42 USC 1396p (c) (2) (A), (B), or
7(C).
To make a satisfactory showing to the state under 42 USC 1396p (c) (2) (C) and
8adjust the ineligibility period under sub. (3), the individual shall demonstrate that
9all of the assets transferred for less than fair market value, or cash equal to the value
10of the assets transferred for less than fair market, have been returned to him or her.
AB40-ASA1,1065
11Section
1065. 49.455 (5) (title) of the statutes is amended to read:
AB40-ASA1,590,1212
49.455
(5) (title)
Rules for treatment of resources; ineligibility.
AB40-ASA1,1066
13Section
1066. 49.455 (5) (d) of the statutes is amended to read:
AB40-ASA1,590,2014
49.455
(5) (d) During a continuous period of institutionalization, after an
15institutionalized spouse is determined to be eligible for medical assistance, no
16resources of the community spouse are considered to be available to the
17institutionalized spouse
, except that a transfer of those resources or other assets by
18the community spouse within the first 5 years of eligibility of the institutionalized
19spouse may result in a period of ineligibility under s. 49.453 (2) and (3) for the
20institutionalized spouse.
AB40-ASA1,1067
21Section
1067. 49.455 (5) (e) of the statutes is created to read:
AB40-ASA1,591,222
49.455
(5) (e) The department may deny to the institutionalized spouse
23eligibility for Medical Assistance if, when requested by the department, the
24institutionalized spouse and the community spouse do not provide the total value of
1their assets and information on income and resources to the extent required under
2federal Medicaid law or sign the application for Medical Assistance.
AB40-ASA1,1068
3Section
1068. 49.455 (8) (d) of the statutes is renumbered 49.455 (8) (d) 1. and
4amended to read:
AB40-ASA1,591,125
49.455
(8) (d) 1. If either spouse establishes at a fair hearing that the
6community spouse resource allowance determined under sub. (6) (b)
1. to 2. or 4. 7without a fair hearing does not generate enough income to raise the community
8spouse's income to the minimum monthly maintenance needs allowance under sub.
9(4) (c), the department shall establish
, under subd. 2., an amount to be used under
10sub. (6) (b) 3. that results in a community spouse resource allowance that generates
11enough income to raise the community spouse's income to the minimum monthly
12maintenance needs allowance under sub. (4) (c).
AB40-ASA1,591,24
133. Except in exceptional cases which would result in financial duress for the
14community spouse, the department may not establish an amount to be used under
15sub. (6) (b) 3. unless the institutionalized spouse makes available to the community
16spouse the maximum monthly income allowance permitted under sub. (4) (b) or, if
17the institutionalized spouse does not have sufficient income to make available to the
18community spouse the maximum monthly income allowance permitted under sub.
19(4) (b), unless the institutionalized spouse makes all of his or her income, except for
20an amount equal to the sum of the personal needs allowance under sub. (4) (a) 1. and
21any family allowances under sub. (4) (a) 3. paid by the institutionalized spouse and
22the amount incurred as expenses for medical or remedial care for the
23institutionalized spouse under sub. (4) (a) 4., available to the community spouse as
24a community spouse monthly income allowance under sub. (4) (b).
AB40-ASA1,1069
25Section
1069. 49.455 (8) (d) 2. of the statutes is created to read:
AB40-ASA1,592,9
149.455
(8) (d) 2. The department shall base the amount to be used under sub.
2(6) (b) 3. on the cost of a single premium lifetime annuity that pays monthly amounts
3that, combined with other available income, raises the community spouse's income
4to the minimum monthly maintenance needs allowance. Any resource, regardless
5of whether the resource generates income, may be transferred in an amount that,
6combined with the community spouse resource allowance calculated before the fair
7hearing, provides the community spouse with sufficient funds to purchase the
8annuity. The community spouse is not required to purchase an annuity to obtain this
9amount.
AB40-ASA1,1070
10Section
1070. 49.46 (1) (a) 15. of the statutes is amended to read:
AB40-ASA1,592,1411
49.46
(1) (a) 15. Any individual who is infected with tuberculosis and meets the
12income and resource eligibility requirements for the federal Supplemental Security
13Income program under
42 USC 1381 to
1383d.
For purposes of this subdivision,
14"income" has the meaning given for "family income" in s. 49.471 (1) (f).
AB40-ASA1,1072
15Section
1072. 49.46 (1) (c) (intro.) of the statutes is amended to read:
AB40-ASA1,592,2016
49.46
(1) (c) (intro.) Except as provided under par. (co)
or (cr), a family that
17becomes ineligible for aid to families with dependent children under s. 49.19 because
18of increased income from employment or increased hours of employment or because
19of the expiration of the time during which the disregards under s. 49.19 (5) (a) 4. or
204m. or (am) apply shall receive medical assistance for:
AB40-ASA1,1072b
21Section 1072b. 49.46 (1) (c) (intro.) and 1. (intro.) of the statutes, as affected
22by 2013 Wisconsin Act .... (this act), are consolidated, renumbered 49.46 (1) (c) (intro.)
23and amended to read:
AB40-ASA1,593,624
49.46
(1) (c) (intro.) Except as provided under par.
(co) or (cr), a family that
25becomes ineligible for aid to families with dependent children under s. 49.19 because
1of increased income from employment or increased hours of employment
or because
2of the expiration of the time during which the disregards under s. 49.19 (5) (a) 4. or
34m. or (am) apply shall receive medical assistance for
: 1. Six 4 calendar months
, or,
4if required under federal law, up to 12 months, following the month in which
the 5family a parent, caretaker, or dependent child of the family becomes ineligible for aid
6to families with dependent children if all of the following apply:
AB40-ASA1,1072d
7Section 1072d. 49.46 (1) (c) 1. a. and b. of the statutes are renumbered 49.46
8(1) (c) 1g. and 1r.
AB40-ASA1,1072f
9Section 1072f. 49.46 (1) (c) 1. c. and 2. of the statutes are repealed.
AB40-ASA1,1073
10Section
1073. 49.46 (1) (cg) of the statutes is amended to read:
AB40-ASA1,593,1811
49.46
(1) (cg)
Medical Except as provided under par. (cr), medical assistance
12shall be provided to a dependent child, a relative with whom the child is living or the
13spouse of the relative, if the spouse meets the requirements of s. 49.19 (1) (c) 2. a. or
14b., for 4 calendar months beginning with the month in which the child, relative or
15spouse is ineligible for aid to families with dependent children because of the
16collection or increased collection of maintenance or support, if the child, relative or
17spouse received aid to families with dependent children in 3 or more of the 6 months
18immediately preceding the month in which that ineligibility begins.
AB40-ASA1,1073y
19Section 1073y. 49.46 (1) (co) of the statutes, as affected by 2013 Wisconsin Act
20.... (this act), is repealed.
AB40-ASA1,1074
21Section
1074. 49.46 (1) (co) 1. of the statutes is amended to read:
AB40-ASA1,594,422
49.46
(1) (co) 1. Except as provided under subd. 2.
or par. (cr), medical
23assistance shall be provided to a family for 12 consecutive calendar months following
24the month in which the family becomes ineligible for aid to families with dependent
25children because of increased income from employment
, because the family no longer
1receives the earned income disregard under s. 49.19 (5) (a) 4. or 4m. or (am) due to
2the expiration of the time limit during which the disregards are applied or because
3of the application of the monthly employment time eligibility limitation under 45
4CFR 233.100 (a) (1) (i).
AB40-ASA1,1075
5Section
1075. 49.46 (1) (co) 2. of the statutes is amended to read:
AB40-ASA1,594,96
49.46
(1) (co) 2. If a waiver under subd. 3. is granted
and except as provided
7in par. (cr), the department may select individuals to receive medical assistance
8benefits as provided under par. (c), rather than under subd. 1., as a control group for
9part or all of the period during which the waiver is in effect.
AB40-ASA1,1076
10Section
1076. 49.46 (1) (cr) of the statutes is created to read:
AB40-ASA1,594,2211
49.46
(1) (cr) To the extent approved by the federal department of health and
12human services, an individual or family described in par. (c), (cg), or (co) is not eligible
13for Medical Assistance if the federal department of health and human services
14approves a request from the department to deny all or some transitional Medical
15Assistance benefits to that individual or family, if approval is required. The
16department shall allow individuals who are receiving transitional Medical
17Assistance benefits on December 31, 2013, to continue to receive those benefits until
18their 12-month period ends, if required under federal law. If the federal department
19of health and human services approves the department's request to charge a
20premium to recipients of continued transitional Medical Assistance benefits, the
21department may charge a premium to any recipient of continued transitional
22Medical Assistance benefits whose income exceeds 100 percent of the poverty line.
AB40-ASA1,1076b
23Section 1076b. 49.46 (1) (cr) of the statutes, as created by 2013 Wisconsin Act
24.... (this act), is amended to read:
AB40-ASA1,595,12
149.46
(1) (cr) To the extent approved by the federal department of health and
2human services, an individual or family described in par. (c)
, or (cg)
, or (co) is not
3eligible for Medical Assistance if the federal department of health and human
4services approves a request from the department to deny all or some transitional
5Medical Assistance benefits to that individual or family, if approval is required. The
6department shall allow individuals who are receiving transitional Medical
7Assistance benefits on December 31, 2013, to continue to receive those benefits until
8their 12-month period ends, if required under federal law. If the federal department
9of health and human services approves the department's request to charge a
10premium to recipients of continued transitional Medical Assistance benefits, the
11department may charge a premium to any recipient of continued transitional
12Medical Assistance benefits whose income exceeds 100 percent of the poverty line.
AB40-ASA1,1078
13Section
1078. 49.46 (2) (b) 19. of the statutes is created to read:
AB40-ASA1,595,1614
49.46
(2) (b) 19. Subject to par. (br), services provided by early intervention
15teachers, home trainers, parent-to-parent mentors, and developmental specialists
16to children in the benchmark plan under par. (br).
AB40-ASA1,1079
17Section
1079. 49.46 (2) (b) 20. of the statutes is created to read:
AB40-ASA1,595,2018
49.46
(2) (b) 20. Subject to s. 49.45 (24j), any additional services, as determined
19by the department, that are targeted to a population enrolled in a medical home
20initiative under s. 49.45 (24j).
AB40-ASA1,1080
21Section
1080. 49.46 (2) (bc) of the statutes is created to read:
AB40-ASA1,595,2422
49.46
(2) (bc) Subject to s. 49.45 (24j), the department may provide any of the
23services described in par. (a) or (b) through a medical home initiative under s. 49.45
24(24j).
AB40-ASA1,1081
25Section
1081. 49.46 (2) (br) of the statutes is created to read:
AB40-ASA1,596,8
149.46
(2) (br) If the federal department of health and human services approves
2the department's request to offer a benchmark plan under this paragraph, the
3department may enroll any child who is receiving services through the early
4intervention program under s. 51.44 in a benchmark plan under this paragraph. The
5department may not require a child who is receiving services through the early
6intervention program under s. 51.44 to enroll in a benchmark plan offered under this
7paragraph. The department may not charge a copayment to a child who is enrolled
8in the benchmark plan under this paragraph for services described in par. (b) 19.
AB40-ASA1,1085
9Section
1085. 49.47 (4) (a) 1. of the statutes is amended to read:
AB40-ASA1,596,1310
49.47
(4) (a) 1. Under 21 years of age and resides in an intermediate care
11facility, skilled nursing facility, or inpatient psychiatric hospital.
The department
12shall apply the definition of family income in s. 49.471 (1) (f) to make determinations
13of income under this subdivision.
AB40-ASA1,1088
14Section
1088. 49.47 (4) (b) 2w. of the statutes is amended to read:
AB40-ASA1,596,1715
49.47
(4) (b) 2w. For a person who is eligible under par. (a) 3. or 4., life insurance
16with cash surrender values if the total face value of all life insurance policies
,
17including riders and other attachments, is not more than $1,500.
AB40-ASA1,1089
18Section
1089. 49.47 (4) (c) 1. of the statutes is amended to read:
AB40-ASA1,597,419
49.47
(4) (c) 1. Except as provided in par. (am)
and as limited by subd. 3.,
20eligibility exists if income does not exceed 133 1/3% of the maximum aid to families
21with dependent children payment under s. 49.19 (11) for the applicant's family size
22or the combined benefit amount available under supplemental security income
23under
42 USC 1381 to
1383c and state supplemental aid under s. 49.77 whichever
24is
higher lower. In this subdivision "income" includes earned or unearned income
25that would be included in determining eligibility for the individual or family under
1s. 49.19 or 49.77, or for the aged, blind or disabled under
42 USC 1381 to
1385.
2"Income" does not include earned or unearned income which would be excluded in
3determining eligibility for the individual or family under s. 49.19 or 49.77, or for the
4aged, blind or disabled individual under
42 USC 1381 to
1385.
AB40-ASA1,1090
5Section
1090. 49.47 (4) (c) 3. of the statutes is repealed.
AB40-ASA1,1090f
6Section 1090f. 49.47 (4) (k) of the statutes is amended to read:
AB40-ASA1,597,157
49.47
(4) (k) Notwithstanding par. (b) 3. and s. 445.125 (1) (a), no later than 60
8days after July 1,
2011 2013, the department shall seek approval from the federal
9Centers for Medicare and Medicaid Services to permit
friends and family members
10of any individual receiving medical assistance under this section to contribute funds
11to an irrevocable burial trust for the individual, up to a total irrevocable trust amount
12of $4,500, without the individual losing eligibility for medical assistance under this
13section. If the federal Centers for Medicare and Medicaid Services approves the
14request, the department shall implement the change under this section within 60
15days after receiving approval.
AB40-ASA1,1091
16Section
1091. 49.471 (1) (cm) of the statutes is created to read:
AB40-ASA1,597,1917
49.471
(1) (cm) "Disabled" means, when referring to an adult, meeting the
18disability standard for eligibility for federal supplemental security income under
42
19USC 1382c (a) (3).
AB40-ASA1,1092
20Section
1092. 49.471 (1) (f) of the statutes is amended to read:
AB40-ASA1,597,2321
49.471
(1) (f) "Family income"
means the total gross earned and unearned
22income received by all members of a family has the meaning given for "household
23income" under 42 CFR 435.603 (d).
AB40-ASA1,1093n
24Section 1093n. 49.471 (2) of the statutes is amended to read:
AB40-ASA1,598,18
149.471
(2) Waiver and state plan amendments. The department shall request
2a waiver from, and submit amendments to the state Medical Assistance plan to, the
3secretary of the federal department of health and human services to implement
4BadgerCare Plus. If the state plan amendments are approved and a waiver that is
5substantially consistent with the provisions of this section, excluding sub. (2m), is
6granted and in effect, the department shall implement BadgerCare Plus beginning
7on January 1, 2008, the effective date of the state plan amendments, or the effective
8date of the waiver, whichever is latest.
If the state plan amendments are approved
9but the terms of approval do not allow for federal funding of the cost of benefits for
10all or any part of one or more of the eligibility categories under sub. (4) (b), the
11department may at its discretion pay for the cost of benefits for all or any part of any
12group for which federal funding was denied exclusively with moneys from the
13appropriation under s. 20.435 (4) (b). If the state plan amendments are not approved
14or if a waiver that is substantially consistent with the provisions of this section,
15excluding sub. (2m), is not granted, BadgerCare Plus may not be implemented. If
16the state plan amendments are approved but approval is not continued or if a waiver
17that is substantially consistent with the provisions of this section, excluding sub.
18(2m), is granted but not continued in effect, BadgerCare Plus shall be discontinued.
AB40-ASA1,1093q
19Section 1093q. 49.471 (3) (a) 1. of the statutes is amended to read:
AB40-ASA1,599,220
49.471
(3) (a) 1. Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4),
21if the amendments to the state plan under sub. (2) are approved and a waiver under
22sub. (2) that is substantially consistent with the provisions of this section, excluding
23sub. (2m), is granted and in effect, an individual described in sub. (4) (a)
or (b) or (5)
24is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical Assistance or
25BadgerCare health program benefits. The eligibility of an individual described in
1sub. (4) (a)
or (b) or (5) for Medical Assistance benefits shall be determined under this
2section.
AB40-ASA1,1093s
3Section 1093s. 49.471 (3) (a) 3. of the statutes is amended to read:
AB40-ASA1,599,74
49.471
(3) (a) 3. Notwithstanding subd. 1., an individual described in sub. (4)
5(a)
or (b) or (5) who is eligible for medical assistance under s. 49.46 (1) (a) 5., 6m., 14.,
614m., or 15. or (d) or 49.47 (4) (a) or (as) may receive medical assistance benefits
7under this section or under s. 49.46 or 49.47.
AB40-ASA1,1094
8Section
1094. 49.471 (4) (a) (intro.) of the statutes is amended to read:
AB40-ASA1,599,119
49.471
(4) (a) (intro.) Except as otherwise provided in this section, all of the
10following individuals are eligible for the benefits described in s. 49.46 (2) (a) and (b),
11subject to sub. (6) (k)
and s. 49.45 (24j):
AB40-ASA1,1096
12Section
1096. 49.471 (4) (a) 4. a. of the statutes is amended to read:
AB40-ASA1,599,2213
49.471
(4) (a) 4. a. The individual is a parent or caretaker relative of a
14dependent child who is living in the home with the parent or caretaker relative or
15who is temporarily absent from the home for not more than 6 months or, if the
16dependent child has been removed from the home for more than 6 months, the parent
17or caretaker relative is working toward unifying the family by complying with a
18permanency plan under s. 48.38 or 938.38.
For purposes of this subdivision, a
19"dependent child" means an individual who is under the age of 18 or an individual
20who is age 18 and a full-time student in secondary school or equivalent vocational
21or technical training if before attaining the age of 19 the individual is reasonably
22expected to complete the school or training.
AB40-ASA1,1097
23Section
1097. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB40-ASA1,600,224
49.471
(4) (a) 4. b. Except as provided in
subd. 4. c. sub. (4m), the individual's
25family income does not exceed
200 100 percent of the poverty line
and does not
1include self-employment income before application of the 5 percent income
2disregard under 42 CFR 435.603 (d).
AB40-ASA1,1098
3Section
1098. 49.471 (4) (a) 4. c. of the statutes is repealed.
AB40-ASA1,1099
4Section
1099. 49.471 (4) (a) 5. of the statutes is amended to read:
AB40-ASA1,600,125
49.471
(4) (a) 5. An individual who, regardless of family income, was born on
6or after January 1,
1990 1988, and who, on his or her 18th birthday, was in a foster
7care placement under the responsibility of
a this state
, or at the option of the
8department, under the responsibility of another state, and enrolled in Medical
9Assistance under this subchapter or a Medicaid program, as determined by the
10department. The coverage for an individual under this subdivision ends on the last
11day of the month in which the individual becomes
21
26 years of age, unless he or she
12otherwise loses eligibility sooner.
AB40-ASA1,1100
13Section
1100. 49.471 (4) (a) 7. of the statutes is amended to read:
AB40-ASA1,600,1614
49.471
(4) (a) 7. Individuals who qualify for a medical assistance eligibility
15extension under s. 49.46 (1) (c), (cg), or (co) when their income increases above the
16poverty line
, except as provided in s. 49.46 (1) (cr).
AB40-ASA1,1100b
17Section 1100b. 49.471 (4) (a) 7. of the statutes, as affected by 2013 Wisconsin
18Act .... (this act), is amended to read:
AB40-ASA1,600,2119
49.471
(4) (a) 7. Individuals who qualify for a medical assistance eligibility
20extension under s. 49.46 (1) (c)
, or (cg)
, or (co) when their income increases above the
21poverty line, except as provided in s. 49.46 (1) (cr).
AB40-ASA1,1100v
22Section 1100v. 49.471 (4) (b) (intro.) of the statutes is repealed.
AB40-ASA1,1101
23Section
1101. 49.471 (4) (b) 1. of the statutes is renumbered 49.471 (4) (a) 1g.
AB40-ASA1,1102
24Section
1102. 49.471 (4) (b) 1m. of the statutes is renumbered 49.471 (4) (a)
251m.