Amendment ASA1-AB414

AB414-ASA1,1 Section 1. 46.269 of the statutes is created to read:

AB414-ASA1,3,12 46.269 Determining financial eligibility and cost sharing for long-term care programs. To the extent approved by the federal government, the department or its designee shall exclude any assets accumulated in a person's independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from employment income or employer contributions while the person was employed and eligible for and receiving medical assistance under s. 46.27 or 49.472 in determining that person's financial eligibility and cost-sharing requirements, if any, for the long-term care program under s. 46.27, 46.275, or 46.277, for the family care benefit under s. 46.286, for the Family Care Partnership program, or for the long-term care program defined in s. 46.2899 (1).

AB414-ASA1,2 Section 2. 49.46 (1) (em) of the statutes is created to read:

AB414-ASA1,4,7 49.46 (1) (em) For purposes of determining the eligibility and any cost-sharing requirements of an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), to the extent approved by the federal government, the department shall exclude any assets accumulated in an independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from employment income or employer contributions while the individual was employed and eligible for and receiving medical assistance under s. 46.27 or 49.472.

AB414-ASA1,3 Section 3. 49.468 (1) (d) of the statutes is amended to read:

AB414-ASA1,4,16 49.468 (1) (d) Benefits under par. (b) or (c) are available for an individual who has resources that are equal to or less than 200% of the allowable resources as determined under 42 USC 1381 to 1385, excluding, to the extent approved by the federal government, any assets accumulated in an independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while the individual was employed and eligible for and receiving medical assistance under s. 46.27 or 49.472, and who has income that is equal to or less than 100% of the poverty line.

AB414-ASA1,4 Section 4. 49.468 (1m) (b) of the statutes is amended to read:

AB414-ASA1,5,2 49.468 (1m) (b) Benefits under par. (a) are available for an individual who has resources that are equal to or less than 200% of the allowable resources determined under 42 USC 1381 to 1385, excluding, to the extent approved by the federal government, any assets accumulated in an independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while the individual was employed and eligible for and receiving medical assistance under s. 46.27 or 49.472, and who has income that is greater than 100% of the poverty line but less than 120% of the poverty line.

AB414-ASA1,5 Section 5. 49.468 (2) (b) of the statutes is amended to read:

AB414-ASA1,5,11 49.468 (2) (b) Benefits under par. (a) are available for an individual who has resources that are equal to or less than 200% of the allowable resources under 42 USC 1381 to 1385, excluding, to the extent approved by the federal government, any assets accumulated in an independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while the individual was employed and eligible for and receiving medical assistance under s. 46.27 or 49.472, and who has income that is equal to or less than 200% of the poverty line.

AB414-ASA1,6 Section 6. 49.472 (1) (c) of the statutes is amended to read:

AB414-ASA1,5,16 49.472 (1) (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 on which while an individual began is receiving medical assistance under this section.

AB414-ASA1,7 Section 7. 49.472 (2) of the statutes is renumbered 49.472 (2) (a).

AB414-ASA1,8 Section 8. 49.472 (2) (b) of the statutes is created to read:

AB414-ASA1,6,3 49.472 (2) (b) If the department determines that a waiver, or an amendment to the waiver under par. (a), is necessary to require all individuals receiving medical assistance under this section, regardless of income, to pay a monthly premium, the department shall submit to the federal department of health and human services an amendment to the state medical assistance plan and shall request the necessary waiver or amendment to the waiver from the secretary of the federal department of health and human services and may not require every individual receiving medical assistance under this section, regardless of income, to pay a monthly premium unless the state plan amendment and waiver or amendment to the waiver are approved and in effect.

AB414-ASA1,9 Section 9. 49.472 (3) (a) of the statutes is renumbered 49.472 (3) (a) 1. and amended to read:

AB414-ASA1,6,12 49.472 (3) (a) 1. The Except as provided in subd. 2., the individual's family's total net income is less than 250% 250 percent 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), except that exclusions applied under 42 USC 1382a (b) (4) to earned income shall also be applied to unearned income, and shall exclude the individual's out-of-pocket costs for medical and remedial expenses and long-term care costs, if any.

AB414-ASA1,10 Section 10. 49.472 (3) (a) 2. of the statutes is created to read:

AB414-ASA1,6,18 49.472 (3) (a) 2. The individual's family's total net income equals or exceeds 250 percent of the poverty line for a family the size of the individual's family, but the department determines that the individual's family's earnings are insufficient to replace all of the publicly funded benefits that the individual would be eligible to receive in the absence of those earnings.

AB414-ASA1,11 Section 11. 49.472 (3) (b) of the statutes is amended to read:

AB414-ASA1,7,2 49.472 (3) (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; or, to the extent approved by the federal government, income or assets from retirement benefits earned or accumulated from income or employer contributions while the individual was employed and eligible for and receiving medical assistance under this section or s. 46.27. The department may exclude, in whole or in part, the value of a vehicle used by the individual for transportation to paid employment.

AB414-ASA1,12 Section 12. 49.472 (3) (f) of the statutes is amended to read:

AB414-ASA1,7,6 49.472 (3) (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) (c) or (5).

AB414-ASA1,13 Section 13. 49.472 (4) (a) (intro.) of the statutes is renumbered 49.472 (4) (intro.) and amended to read:

AB414-ASA1,7,13 49.472 (4) Premiums. (intro.) Except as provided in par. (b) (c) 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, calculated as follows:

AB414-ASA1,14 Section 14. 49.472 (4) (a) 1. of the statutes is repealed and recreated to read:

AB414-ASA1,7,19 49.472 (4) (a) 1. Except as provided in subds. 3. and 4., an individual whose total income is equal to or greater than 150 percent of the poverty line for a family the size of the individual's family shall pay a premium that is not more than 3 percent of the individual's total earned and unearned income, after the deductions specified in subd. 2.

AB414-ASA1,15 Section 15. 49.472 (4) (a) 2. (intro.) of the statutes is amended to read:

AB414-ASA1,7,23 49.472 (4) (a) 2. (intro.) In determining an individual's total earned and unearned income for purposes of determining the premium under subd. 1., the department shall disregard all of the following:

AB414-ASA1,16 Section 16. 49.472 (4) (a) 2m. of the statutes is repealed.

AB414-ASA1,17 Section 17. 49.472 (4) (a) 3. of the statutes is amended to read:

AB414-ASA1,8,3 49.472 (4) (a) 3. The Subject to subd. 4., the department may reduce the premium by 25% determined under subd. 1. by 25 percent for an individual who is covered by private health insurance.

AB414-ASA1,18 Section 18. 49.472 (4) (a) 4. of the statutes is created to read:

AB414-ASA1,8,6 49.472 (4) (a) 4. An individual's premium under this paragraph may not be less than $35.

AB414-ASA1,19 Section 19 . 49.472 (4) (b) of the statutes is repealed and recreated to read:

AB414-ASA1,8,9 49.472 (4) (b) An individual whose total income is less than 150 percent of the poverty line for a family the size of the individual's family shall pay a premium of $35.

AB414-ASA1,20 Section 20. 49.472 (4) (c) of the statutes is created to read:

AB414-ASA1,8,13 49.472 (4) (c) The department may waive monthly premiums for an individual if the department determines that payment of a premium would work an undue hardship on the individual.

AB414-ASA1,21 Section 21. 49.472 (5) of the statutes, as affected by 2015 Wisconsin Act 55, is amended to read:

AB414-ASA1,8,19 49.472 (5) Community options participants. From the appropriation under s. 20.435 (4) (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).

AB414-ASA1,22 Section 22 . Initial applicability.

AB414-ASA1,9,2 (1) Eligibility for the Medical Assistance purchase plan. The treatment of section 49.472 (3) (b) and (f) of the statutes, the renumbering and amendment of section 49.472 (3) (a) of the statutes, and the creation of section 49.472 (3) (a) 2. of the statutes first apply to individuals who apply for the Medical Assistance purchase plan, or whose continued eligibility for the Medical Assistance purchase plan is reviewed, on the effective date of this subsection.

AB414-ASA1,9,3 (2) Eligibility for certain Medical Assistance programs.

AB414-ASA1,9,8 (a) Long-term care. The treatment of section 46.269 of the statutes first applies to individuals who apply for any of the programs listed in section 46.269 of the statutes, as created by this act, or whose continued eligibility for any of the programs listed in section 46.269 of the statutes, as created by this act, is reviewed, on the effective date of this paragraph.

AB414-ASA1,9,11 (b) Medical Assistance. The treatment of section 49.46 (1) (em) of the statutes first applies to individuals who apply for Medical Assistance, or whose continued eligibility for Medical Assistance is reviewed, on the effective date of this paragraph.

AB414-ASA1,9,15 (c) Medicare buy-in. The treatment of section 49.468 (1) (d), (1m) (b), and (2) (b) of the statutes first applies to individuals who apply for the expanded medicare buy-in program, or whose continued eligibility for the expanded medicare buy-in program is reviewed, on the effective date of this paragraph.

AB414-ASA1,9,20 (3) Premiums for the Medical Assistance purchase plan. The treatment of section 49.472 (4) (a) (intro.), 1., 2. (intro.), 2m., 3., and 4., (b), and (c) and (5) of the statutes, the renumbering of section 49.472 (2) of the statutes, and the creation of section 49.472 (2) (b) of the statutes first apply to premiums for the Medical Assistance purchase plan that are payable on the effective date of this subsection.

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