SB40, s. 1585 14Section 1585. 49.453 (8) of the statutes is renumbered 49.453 (8) (a) (intro.)
15and amended to read:
SB40,719,1716 49.453 (8) (a) (intro.) Subsections (2) and (3) do not apply to transfers of assets
17if the any of the following applies:
SB40,719,18 181. The assets are exempt under 42 USC 1396p (c) (2) or if the (A), (B), or (C).
SB40,719,21 192. 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, s. 1586 22Section 1586. 49.453 (8) (b) of the statutes is created to read:
SB40,719,2423 49.453 (8) (b) The department shall establish a hardship waiver process that
24includes all of the following:
SB40,720,4
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.
SB40,720,85 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.
SB40,720,129 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, s. 1587 13Section 1587. 49.46 (1) (a) 5. of the statutes is amended to read:
SB40,720,1614 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, s. 1588 17Section 1588. 49.46 (1) (a) 14m. of the statutes is amended to read:
SB40,720,2318 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, s. 1589 24Section 1589. 49.46 (2) (b) (intro.) of the statutes is amended to read:
SB40,721,3
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, s. 1590 4Section 1590. 49.46 (2) (b) 8. of the statutes is amended to read:
SB40,721,95 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, s. 1591 10Section 1591. 49.46 (2) (dc) of the statutes is created to read:
SB40,721,1611 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, s. 1592 17Section 1592. 49.468 (1) (b) of the statutes is amended to read:
SB40,722,618 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, s. 1593 7Section 1593. 49.468 (1) (c) of the statutes is amended to read:
SB40,722,168 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, s. 1594 17Section 1594. 49.468 (1m) (a) of the statutes is amended to read:
SB40,722,2318 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, s. 1595 24Section 1595. 49.468 (2) (a) of the statutes is amended to read:
SB40,723,6
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, s. 1596 7Section 1596. 49.47 (4) (a) (intro.) of the statutes is amended to read:
SB40,723,108 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, s. 1597 11Section 1597. 49.47 (4) (as) 1. of the statutes is amended to read:
SB40,723,1612 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, s. 1598 17Section 1598. 49.47 (4) (as) 3. of the statutes is amended to read:
SB40,723,2018 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, s. 1599 21Section 1599. 49.47 (4) (b) 1. of the statutes is amended to read:
SB40,723,2422 49.47 (4) (b) 1. A Subject to par. (bc), a home and the land used and operated
23in connection therewith or in lieu thereof a mobile home if the home or mobile home
24is used as the person's or his or her family's place of abode.
SB40, s. 1600 25Section 1600. 49.47 (4) (bc) of the statutes is created to read:
SB40,724,5
149.47 (4) (bc) 1. Subject to subd. 2., a person shall be ineligible under this
2section for medical assistance for nursing facility services or other long-term care
3services described in s. 49. 453 (2) if the equity in his or her home and the land used
4and operated in connection with the home exceeds $750,000. This subdivision does
5not apply if any of the following persons lawfully resides in the home:
SB40,724,66 a. The person's spouse.
SB40,724,87 b. The person's child who is under age 21 or who is disabled, as defined in s.
849.468 (1) (a) 1.
SB40,724,99 2. Subdivision 1. applies to all of the following:
SB40,724,1210 a. At the time of application, to a person who applies for medical assistance for
11nursing facility services or other long-term care services described in s. 49.453 (2)
12after the effective date of this subd. 2. a. .... [revisor inserts date].
SB40,724,1813 b. At the time of the person's first recertification after the effective date of this
14subd. 2. b. .... [revisor inserts date], to a person not specified in subd. 2. a. who applied
15for medical assistance for nursing facility services or other long-term care services
16described in s. 49.453 (2) on or after January 1, 2006, and who was eligible for medical
17assistance for those services on the effective date of this subd. 2. b. .... [revisor inserts
18date].
SB40, s. 1601 19Section 1601. 49.47 (4) (bm) of the statutes is created to read:
SB40,724,2420 49.47 (4) (bm) For purposes of determining eligibility or benefits amount for
21a person described in par. (a) 3. or 4. who resides in a continuing care retirement
22community or a life care community, any entrance fee paid on admission to the
23community shall be considered a resource available to the person to the extent that
24all of the following apply:
SB40,725,3
11. The person has the ability to use the entrance fee, or the contract provides
2that the entrance fee may be used, to pay for care if the person's other resources or
3income are insufficient to pay for the care.
SB40,725,64 2. The person is eligible for a refund of any remaining entrance fee when the
5person dies or terminates the continuing care retirement community or life care
6community contract and leaves the community.
SB40,725,87 3. The entrance fee does not confer an ownership interest in the continuing care
8retirement community or life care community.
SB40, s. 1602 9Section 1602. 49.47 (4) (cr) of the statutes is created to read:
SB40,725,2010 49.47 (4) (cr) 1. As a condition of receiving medical assistance for long-term
11care services described in s. 49.453 (2) (a), an applicant for or recipient of the
12long-term care services shall disclose on the application or recertification form a
13description of any interest the individual or his or her community spouse, as defined
14in s. 49.453 (1) (ar), has in an annuity, regardless of whether the annuity is
15irrevocable or is treated as an asset. The application or recertification form shall
16include a statement that the state becomes a remainder beneficiary under any
17annuity in which the individual or his or her spouse has an interest by virtue of the
18provision of the medical assistance. The applicant or recipient shall, no later than
1930 days after the department receives the application or recertification form, take
20any action required by the annuity issuer to make the state a remainder beneficiary.
SB40,725,2421 2. The department shall notify the issuer of an annuity disclosed under subd.
221. of the state's right as a remainder beneficiary and shall request that the issuer
23notify the department of any changes to or payments made under the annuity
24contract.
SB40,725,2525 3. This paragraph applies to all of the following:
SB40,726,1
1a. Annuities purchased on or after February 8, 2006.
SB40,726,32 b. Annuities purchased before February 8, 2006, for which a transaction, as
3defined in s. 49.453 (4) (ac), has occurred on or after February 8, 2006.
SB40, s. 1603 4Section 1603. 49.47 (6) (a) 1. of the statutes is amended to read:
SB40,726,65 49.47 (6) (a) 1. Except as provided in subds. 6. to 7., all beneficiaries, for all
6services under s. 49.46 (2) (a) and (b), subject to s. 49.46 (2) (dc).
SB40, s. 1604 7Section 1604. 49.47 (9m) of the statutes is repealed.
SB40, s. 1605 8Section 1605. 49.471 of the statutes is created to read:
SB40,726,10 949.471 BadgerCare Plus. (1) Definitions. In this section, unless the context
10requires otherwise:
SB40,726,1211 (a) "BadgerCare Plus" means the Medical Assistance program described in this
12section.
SB40,726,1613 (b) "Caretaker relative" means an individual who is maintaining a residence
14as a child's home, who exercises primary responsibility for the child's care and
15control, including making plans for the child, and who is any of the following with
16respect to the child:
SB40,726,1917 1. A blood relative, including those of half-blood, and including first cousins,
18nephews, nieces, and individuals of preceding generations as denoted by prefixes of
19grand, great, or great-great.
SB40,726,2020 2. A stepfather, stepmother, stepbrother, or stepsister.
SB40,726,2221 3. An individual who is the adoptive parent of the child's parent, a natural or
22legally adopted child of such individual, or a relative of an adoptive parent.
SB40,726,2423 4. A spouse of any individual named in this paragraph even if the marriage is
24terminated by death or divorce.
SB40,727,2
1(c) "Child" means an individual who is under the age of 19 years. "Child"
2includes an unborn child.
SB40,727,33 (d) "Essential person" means an individual who satisfies all of the following:
SB40,727,44 1. Is related to an individual receiving benefits under this section.
SB40,727,65 2. Is otherwise nonfinancially eligible, except that the individual need not have
6a minor child under his or her care.
SB40,727,87 3. Provides at least one of the following to an individual receiving benefits
8under this section:
SB40,727,139 a. Child care that enables a caretaker to work outside the home for at least 30
10hours per week for pay, to receive training for at least 30 hours per week, or to attend,
11on a full-time basis as defined by the school, high school or a course of study meeting
12the standards established by the state superintendent of public instruction for the
13granting of a declaration of equivalency of high school graduation under s. 115.29 (4).
SB40,727,1414 b. Care for anyone who is incapacitated.
SB40,727,1715 (e) "Family" means all children for whom assistance is requested, their minor
16siblings, including half brothers, half sisters, stepbrothers, and stepsisters, and any
17parents of these minors and their spouses.
SB40,727,1918 (f) "Family income" means the total gross earned and unearned income
19received by all members of a family.
SB40,727,2020 (g) "Group health plan" has the meaning given in 42 USC 300gg-91 (a) (1).
SB40,727,2321 (h) "Health insurance coverage" has the meaning given in 42 USC 300gg-91
22(b) (1), and also includes any arrangement under which a 3rd party agrees to pay for
23the health care costs of the individual.
SB40,727,2424 (i) "Parent" has the meaning given in s. 49.141 (1) (j).
SB40,727,2525 (j) "Recipient" means an individual receiving benefits under this section.
SB40,728,2
1(k) "Unborn child" means an individual from conception until he or she is born
2alive for whom all of the following requirements are met:
SB40,728,43 1. The unborn child's mother is not eligible for medical assistance under this
4subchapter, except that she may be eligible for benefits under s. 49.45 (27).
SB40,728,75 2. The income of the unborn child's mother, mother and her spouse, or mother
6and her family, whichever is applicable, does not exceed 300 percent of the poverty
7line.
SB40,728,108 3. Each of the following applicable persons who is employed provides
9verification from his or her employer, in the manner specified by the department, of
10his or her earnings:
SB40,728,1111 a. The unborn child's mother.
SB40,728,1212 b. The spouse of the unborn child's mother.
SB40,728,1313 c. Members of the unborn child's mother's family.
SB40,728,1714 4. The unborn child's mother provides medical verification of her pregnancy,
15in the manner specified by the department. An unborn child's eligibility for coverage
16under this section does not begin before the first day of the month in which the
17unborn child's mother provides the medical verification.
SB40,728,2018 5. The unborn child and the mother of the unborn child meet all other
19applicable eligibility requirements under this chapter or established by the
20department by rule except for any of the following:
SB40,728,2221 a. The mother is not a U.S. citizen or an alien qualifying for Medicaid under
228 USC 1612.
SB40,728,2323 b. The mother is an inmate of a public institution.
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