SB40: Bill Text

SB40,724,18 b. At the time of the person's first recertification after the effective date of this subd. 2. b. .... [revisor inserts date], to a person not specified in subd. 2. a. who applied for medical assistance for nursing facility services or other long-term care services described in s. 49.453 (2) on or after January 1, 2006, and who was eligible for medical assistance for those services on the effective date of this subd. 2. b. .... [revisor inserts date].

SB40, s. 1601 Section 1601. 49.47 (4) (bm) of the statutes is created to read:

SB40,724,24 49.47 (4) (bm) For purposes of determining eligibility or benefits amount for a person described in par. (a) 3. or 4. who resides in a continuing care retirement community or a life care community, any entrance fee paid on admission to the community shall be considered a resource available to the person to the extent that all of the following apply:

SB40,725,3 1. The person has the ability to use the entrance fee, or the contract provides that the entrance fee may be used, to pay for care if the person's other resources or income are insufficient to pay for the care.

SB40,725,6 2. The person is eligible for a refund of any remaining entrance fee when the person dies or terminates the continuing care retirement community or life care community contract and leaves the community.

SB40,725,8 3. The entrance fee does not confer an ownership interest in the continuing care retirement community or life care community.

SB40, s. 1602 Section 1602. 49.47 (4) (cr) of the statutes is created to read:

SB40,725,20 49.47 (4) (cr) 1. As a condition of receiving medical assistance for long-term care services described in s. 49.453 (2) (a), an applicant for or recipient of the long-term care services shall disclose on the application or recertification form a description of any interest the individual or his or her community spouse, as defined in s. 49.453 (1) (ar), has in an annuity, regardless of whether the annuity is irrevocable or is treated as an asset. The application or recertification form shall include a statement that the state becomes a remainder beneficiary under any annuity in which the individual or his or her spouse has an interest by virtue of the provision of the medical assistance. The applicant or recipient shall, no later than 30 days after the department receives the application or recertification form, take any action required by the annuity issuer to make the state a remainder beneficiary.

SB40,725,24 2. The department shall notify the issuer of an annuity disclosed under subd. 1. of the state's right as a remainder beneficiary and shall request that the issuer notify the department of any changes to or payments made under the annuity contract.

SB40,725,25 3. This paragraph applies to all of the following:

SB40,726,1 a. Annuities purchased on or after February 8, 2006.

SB40,726,3 b. Annuities purchased before February 8, 2006, for which a transaction, as defined in s. 49.453 (4) (ac), has occurred on or after February 8, 2006.

SB40, s. 1603 Section 1603. 49.47 (6) (a) 1. of the statutes is amended to read:

SB40,726,6 49.47 (6) (a) 1. Except as provided in subds. 6. to 7., all beneficiaries, for all services under s. 49.46 (2) (a) and (b), subject to s. 49.46 (2) (dc).

SB40, s. 1604 Section 1604. 49.47 (9m) of the statutes is repealed.

SB40, s. 1605 Section 1605. 49.471 of the statutes is created to read:

SB40,726,10 49.471 BadgerCare Plus. (1) Definitions. In this section, unless the context requires otherwise:

SB40,726,12 (a) "BadgerCare Plus" means the Medical Assistance program described in this section.

SB40,726,16 (b) "Caretaker relative" means an individual who is maintaining a residence as a child's home, who exercises primary responsibility for the child's care and control, including making plans for the child, and who is any of the following with respect to the child:

SB40,726,19 1. A blood relative, including those of half-blood, and including first cousins, nephews, nieces, and individuals of preceding generations as denoted by prefixes of grand, great, or great-great.

SB40,726,20 2. A stepfather, stepmother, stepbrother, or stepsister.

SB40,726,22 3. An individual who is the adoptive parent of the child's parent, a natural or legally adopted child of such individual, or a relative of an adoptive parent.

SB40,726,24 4. A spouse of any individual named in this paragraph even if the marriage is terminated by death or divorce.

SB40,727,2 (c) "Child" means an individual who is under the age of 19 years. "Child" includes an unborn child.

SB40,727,3 (d) "Essential person" means an individual who satisfies all of the following:

SB40,727,4 1. Is related to an individual receiving benefits under this section.

SB40,727,6 2. Is otherwise nonfinancially eligible, except that the individual need not have a minor child under his or her care.

SB40,727,8 3. Provides at least one of the following to an individual receiving benefits under this section:

SB40,727,13 a. Child care that enables a caretaker to work outside the home for at least 30 hours per week for pay, to receive training for at least 30 hours per week, or to attend, on a full-time basis as defined by the school, high school or a course of study meeting the standards established by the state superintendent of public instruction for the granting of a declaration of equivalency of high school graduation under s. 115.29 (4).

SB40,727,14 b. Care for anyone who is incapacitated.

SB40,727,17 (e) "Family" means all children for whom assistance is requested, their minor siblings, including half brothers, half sisters, stepbrothers, and stepsisters, and any parents of these minors and their spouses.

SB40,727,19 (f) "Family income" means the total gross earned and unearned income received by all members of a family.

SB40,727,20 (g) "Group health plan" has the meaning given in 42 USC 300gg-91 (a) (1).

SB40,727,23 (h) "Health insurance coverage" has the meaning given in 42 USC 300gg-91 (b) (1), and also includes any arrangement under which a 3rd party agrees to pay for the health care costs of the individual.

SB40,727,24 (i) "Parent" has the meaning given in s. 49.141 (1) (j).

SB40,727,25 (j) "Recipient" means an individual receiving benefits under this section.

SB40,728,2 (k) "Unborn child" means an individual from conception until he or she is born alive for whom all of the following requirements are met:

SB40,728,4 1. The unborn child's mother is not eligible for medical assistance under this subchapter, except that she may be eligible for benefits under s. 49.45 (27).

SB40,728,7 2. The income of the unborn child's mother, mother and her spouse, or mother and her family, whichever is applicable, does not exceed 300 percent of the poverty line.

SB40,728,10 3. Each of the following applicable persons who is employed provides verification from his or her employer, in the manner specified by the department, of his or her earnings:

SB40,728,11 a. The unborn child's mother.

SB40,728,12 b. The spouse of the unborn child's mother.

SB40,728,13 c. Members of the unborn child's mother's family.

SB40,728,17 4. The unborn child's mother provides medical verification of her pregnancy, in the manner specified by the department. An unborn child's eligibility for coverage under this section does not begin before the first day of the month in which the unborn child's mother provides the medical verification.

SB40,728,20 5. The unborn child and the mother of the unborn child meet all other applicable eligibility requirements under this chapter or established by the department by rule except for any of the following:

SB40,728,22 a. The mother is not a U.S. citizen or an alien qualifying for Medicaid under 8 USC 1612.

SB40,728,23 b. The mother is an inmate of a public institution.

SB40,728,25 c. The mother does not provide a social security number, but only if subd. 5. a. applies.

SB40,729,12 (2) Waiver. The department shall request a waiver from, and submit amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to implement BadgerCare Plus. If the state plan amendments are approved and a waiver that is consistent with all of the provisions of this section is granted and in effect, the department shall implement BadgerCare Plus beginning on January 1, 2008, the effective date of the state plan amendments, or the effective date of the waiver, whichever is latest. If the state plan amendments are not approved or if a waiver that is consistent with all of the provisions of this section is not granted, BadgerCare Plus may not be implemented. If the state plan amendments are approved but approval is not continued or if a waiver that is consistent with all of the provisions of this section is granted but not continued in effect, BadgerCare Plus shall be discontinued.

SB40,729,20 (3) Ineligibility for other Medical Assistance benefits. (a) 1. Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4), if the amendments to the state plan under sub. (2) are approved and a waiver under sub. (2) that is consistent with all of the provisions of this section is granted and in effect, an individual described in sub. (4) (a) or (b) or (5) is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical Assistance or BadgerCare health program benefits. The eligibility of an individual described in sub. (4) (a) or (b) or (5) for Medical Assistance benefits shall be determined under this section.

SB40,729,22 2. Notwithstanding subd. 1., an individual who is eligible for medical assistance under s. 49.46 (1) (a) 3. or 4. may not receive benefits under this section.

SB40,730,2 3. Notwithstanding subd. 1., an individual described in sub. (4) (a) or (b) or (5) who is eligible for medical assistance under s. 49.46 (1) (a) 5., 6m., 14., 14m., or 15. or (d) or 49.47 (4) (a) or (as) may receive medical assistance benefits under this section or under s. 49.46 or 49.47.

SB40,730,9 (b) 1. If an individual over 18 years of age who is eligible for and receiving Medical Assistance benefits under s. 49.46, 49.47, or 49.665 in the month before BadgerCare Plus is implemented loses that eligibility solely due to the implementation of BadgerCare Plus and, because of his or her income, is not eligible for BadgerCare Plus, the individual shall continue receiving for 18 consecutive months the medical assistance he or she was receiving before the implementation of BadgerCare Plus if all of the following are satisfied:

SB40,730,12 a. The individual's eligibility for the Medical Assistance benefits in the month before the implementation of BadgerCare Plus was based on an application filed before the implementation of BadgerCare Plus.

SB40,730,15 b. The individual continues to pay any premium that he or she was required to pay for the Medical Assistance coverage in the same amount as the amount that was due in the month before the implementation of BadgerCare Plus.

SB40,730,18 c. The individual continues to meet all nonfinancial eligibility requirements for the coverage that he or she had in the month before the implementation of BadgerCare Plus.

SB40,730,20 d. The individual continues to be ineligible for BadgerCare Plus because of his or her income.

SB40,730,24 2. Notwithstanding subd. 1., if at any time during an individual's 18-month eligibility extension under subd. 1. any criterion under subd. 1. a. to d. is not satisfied, the individual's eligibility for the extended coverage is terminated and any time remaining in the eligibility period is lost.

SB40,731,3 (4) General eligibility criteria; applicable benefits. (a) Except as otherwise provided in this section, all of the following individuals are eligible for the benefits described in s. 49.46 (2) (a) and (b), subject to sub. (6) (k):

SB40,731,5 1. A pregnant woman whose family income does not exceed 200 percent of the poverty line.

SB40,731,8 2. A child who is under one year of age, whose mother was, on the day the child was born, eligible for and receiving medical assistance under subd. 1. or 5. or s. 49.46 or 49.47, and who lives with his or her mother in this state.

SB40,731,11 3. A child whose family income does not exceed 200 percent of the poverty line. For a child under this subdivision who is an unborn child, benefits are limited to prenatal care.

SB40,731,12 3m. A child who obtains eligibility under sub. (7) (b) 2.

SB40,731,13 4. An individual who satisfies all of the following criteria:

SB40,731,18 a. The individual is a parent or caretaker relative of a child who is living in the home with the parent or caretaker relative or who is temporarily absent from the home for not more than 6 months or, if the child has been removed from the home for more than 6 months, the parent or caretaker relative is working toward unifying the family by complying with a permanency plan under s. 48.38.

SB40,731,20 b. Except as provided in subd. 4. c., the individual's family income does not exceed 200 percent of the poverty line and does not include self-employment income.

SB40,731,23 c. If the individual's family income includes self-employment income, the individual's family income does not exceed 200 percent of the poverty line as calculated under sub. (7) (a) 2.

SB40,732,4 5. An individual who, regardless of family income, was born on or after January 1, 1990, and who, on his or her 18th birthday, was in a foster care or treatment foster care placement under the responsibility of a state, as determined by the department. The coverage for an individual under this subdivision ends on the last day of the month in which the individual becomes 21 years of age, unless he or she otherwise loses eligibility sooner.

SB40,732,6 6. Migrant workers and their dependents who are determined eligible under sub. (6) (f).

SB40,732,8 (b) Except as otherwise provided in this section, all of the following individuals are eligible for the benefits described in sub. (11):

SB40,732,10 1. A pregnant woman whose family income exceeds 200 percent but does not exceed 300 percent of the poverty line.

SB40,732,12 1m. A pregnant woman or unborn child who obtains eligibility under sub. (7) (b) 1.

SB40,732,14 2. A child who is under one year of age, whose mother was determined to be eligible under subd. 1., and who lives with his or her mother in this state.

SB40,732,17 3. A child whose family income exceeds 200 percent but does not exceed 300 percent of the poverty line. For a child under this subdivision who is an unborn child, benefits are limited to prenatal care.

SB40,732,18 4. An individual who satisfies all of the following criteria:

SB40,732,23 a. The individual is a parent or caretaker relative of a child who is living in the home with the parent or caretaker relative or who is temporarily absent from the home for not more than 6 months or, if the child has been removed from the home for more than 6 months, the parent or caretaker relative is working toward unifying the family by complying with a permanency plan under s. 48.38.

SB40,732,25 b. The individual's family income includes self-employment income and does not exceed 200 percent of the poverty line as calculated under sub. (7) (a) 3.

SB40,733,4 (c) Except as otherwise provided in this section, a child who is not an unborn child and whose family income exceeds 300 percent of the poverty line is eligible to purchase coverage of the benefits described in sub. (11), at the full per member per month cost of the coverage.

SB40,733,5 (5) Presumptive eligibility. (a) In this subsection:

SB40,733,7 1. "Qualified entity" means an entity that satisfies the requirements under 42 USC 1396r-1a (b) (3) (A), as determined by the department.

SB40,733,9 2. "Qualified provider" means a provider that satisfies the requirements under 42 USC 1396r-1 (b) (2), as determined by the department.

SB40,733,14 (b) 1. Except as provided in sub. (6) (a), a pregnant woman is eligible for the benefits specified in par. (c) during the period beginning on the day on which a qualified provider determines, on the basis of preliminary information, that the woman's family income does not exceed 300 percent of the poverty line and ending on the applicable day specified in subd. 3.

SB40,733,19 2. Except as provided in sub. (6) (a), a child who is not an unborn child is eligible for the benefits described in s. 49.46 (2) (a) and (b) during the period beginning on the day on which a qualified entity determines, on the basis of preliminary information, that the child's family income does not exceed 150 percent of the poverty line and ending on the applicable day specified in subd. 3.

SB40,733,24 3. a. If the woman or child applies for benefits under sub. (4) within the time required under par. (d), the benefits specified in subd. 1. or 2., whichever is applicable, end on the day on which the department or the county department under s. 46.215, 46.22, or 46.23 determines whether the woman or child is eligible for benefits under sub. (4).

SB40,734,4 b. If the woman or child does not apply for benefits under sub. (4) within the time required under par. (d), the benefits specified in subd. 1. or 2., whichever is applicable, end on the last day of the month following the month in which the provider or entity makes the determination under this paragraph.

SB40,734,7 (c) On behalf of a woman under par. (b) 1., the department shall audit and pay allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory prenatal care services under the benefits under sub. (11).

SB40,734,10 (d) A woman or child who is determined to be eligible under par. (b) shall apply for benefits under sub. (4) on or before the last day of the month following the month in which the qualified provider or entity makes the eligibility determination.

SB40,734,12 (e) A qualified provider or entity that determines that a woman or child is eligible under par. (b) shall do all of the following:

SB40,734,14 1. Notify the department of that determination within 5 working days after the day on which the determination is made.