AB40,1053 18Section 1053. 49.45 (23) (f) of the statutes is created to read:
AB40,558,2019 49.45 (23) (f) The department may provide services to individuals who are
20eligible under this subsection through a medical home initiative under sub. (24j).
AB40,1054 21Section 1054. 49.45 (24j) of the statutes is created to read:
AB40,559,222 49.45 (24j) Medical home pilot projects. (a) The department may administer
23the medical home initiative as a service delivery mechanism to provide and
24coordinate care for individuals who are eligible for a Medical Assistance program
25under this subchapter that provides services under a fee-for-service model. The

1department may administer a medical home initiative to serve individuals who are
2members of any of the following populations:
AB40,559,43 1. Children who are in out-of-home care or are receiving adoption assistance
4under 42 USC 670 to 679c.
AB40,559,55 2. Pregnant women.
AB40,559,66 3. Individuals who are exiting mental health facilities or correctional facilities.
AB40,559,87 4. Individuals with a diagnosis of serious mental illness or substance abuse
8disorder.
AB40,559,99 5. Adults with two or more chronic medical conditions.
AB40,559,1110 6. Other groups of individuals with conditions that the department determines
11would benefit from services through a medical home.
AB40,559,1712 (b) The department shall provide to individuals through any medical home
13initiative administered under this subsection the benefits described under s. 49.46
14(2) (a) and (b). The department may provide to individuals though any medical home
15initiative administered under this subsection benefits in addition to the standard
16plan benefits that are targeted to the population receiving services through the
17medical home.
AB40,559,1918 (c) The department may elect to administer any medical home initiative under
19this subsection in a limited geographical area.
AB40,559,2120 (d) The department may make an all-inclusive payment to the provider
21offering services through a medical home.
AB40,560,222 (e) If the federal department of health and human services approves the
23department's request to administer a medical home initiative, the department shall
24automatically enroll an individual who is eligible for a medical home initiative under
25this subsection in the medical home initiative. At any time after the first 6 months

1of enrollment in the medical home initiative, the individual who is enrolled in the
2medical home initiative may opt out of participation in the medical home initiative.
AB40,1055 3Section 1055. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1.
AB40,1056 4Section 1056. 49.45 (30e) (c) 2. of the statutes is created to read:
AB40,560,115 49.45 (30e) (c) 2. Notwithstanding subd. 1., in counties that elect to deliver the
6services under s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a
7regional basis according to criteria established by the department, the department
8shall reimburse a provider of the services for the amount of the allowable charges for
9those services under the Medical Assistance program that is provided by the federal
10government and for the amount of the allowable charges that is not provided by the
11federal government.
AB40,1057 12Section 1057. 49.45 (30g) (a) 1. of the statutes is amended to read:
AB40,560,1513 49.45 (30g) (a) 1. An approved amendment to the state medical assistance plan
14submitted under 42 USC 1396n (i) permits reimbursement for the services under s.
1549.46 (2) (b) 6. Lo. in the manner provided under this subsection.
AB40,1058 16Section 1058. 49.45 (30g) (a) 3. of the statutes is amended to read:
AB40,560,1917 49.45 (30g) (a) 3. The individual, the community recovery services, and the
18community recovery services provider meet any condition set forth in the approved
19amendment to the medical assistance plan submitted under 42 USC 1396n (i).
AB40,1059 20Section 1059. 49.453 (2) (a) (intro.) of the statutes is amended to read:
AB40,561,221 49.453 (2) (a) Institutionalized individuals. (intro.) Except as provided in sub.
22(8), if an institutionalized individual or his or her spouse, or another person acting
23on behalf of the institutionalized individual or his or her spouse, transfers assets;
24regardless of whether those assets, if retained, are excluded under 42 USC 1396p;

25for less than fair market value on or after the institutionalized individual's look-back

1date, the institutionalized individual is ineligible for medical assistance for the
2following services for the period specified under sub. (3):
AB40,1060 3Section 1060. 49.453 (2) (b) (intro.) of the statutes is amended to read:
AB40,561,104 49.453 (2) (b) Noninstitutionalized individuals. (intro.) Except as provided in
5sub. (8), if a noninstitutionalized individual or his or her spouse, or another person
6acting on behalf of the noninstitutionalized individual or his or her spouse, transfers
7assets; regardless of whether those assets, if retained, are excluded under 42 USC
81396p
;
for less than fair market value on or after the noninstitutionalized
9individual's look-back date, the noninstitutionalized individual is ineligible for
10medical assistance for the following services for the period specified under sub. (3):
AB40,1061 11Section 1061. 49.453 (3) (a) (intro.) of the statutes is amended to read:
AB40,561,1312 49.453 (3) (a) (intro.) The period of ineligibility under this subsection begins
13on either of the following for an applicant for Medical Assistance:
AB40,1062 14Section 1062. 49.453 (3) (ag) of the statutes is created to read:
AB40,561,1815 49.453 (3) (ag) The period of ineligibility under this subsection for a transfer
16of assets made at the time the individual is receiving long-term care services through
17Medical Assistance begins on the first day of the month following the month in which
18the individual receives advance notice of the period of ineligibility.
AB40,1063 19Section 1063. 49.453 (4c) (c) of the statutes is created to read:
AB40,561,2320 49.453 (4c) (c) A promissory note in which the debtor is a presumptive heir of
21the lender or in which neither the lender nor debtor has any incentive to enforce
22repayment is considered cancelled upon the death of the lender for purposes of this
23section.
AB40,1064 24Section 1064. 49.453 (8) (a) 1. of the statutes is amended to read:
AB40,562,5
149.453 (8) (a) 1. The assets are exempt under 42 USC 1396p (c) (2) (A), (B), or
2(C). To make a satisfactory showing to the state under 42 USC 1396p (c) (2) (C) and
3adjust the ineligibility period under sub. (3), the individual shall demonstrate that
4all of the assets transferred for less than fair market value, or cash equal to the value
5of the assets transferred for less than fair market, have been returned to him or her.
AB40,1065 6Section 1065. 49.455 (5) (title) of the statutes is amended to read:
AB40,562,77 49.455 (5) (title) Rules for treatment of resources; ineligibility.
AB40,1066 8Section 1066. 49.455 (5) (d) of the statutes is amended to read:
AB40,562,159 49.455 (5) (d) During a continuous period of institutionalization, after an
10institutionalized spouse is determined to be eligible for medical assistance, no
11resources of the community spouse are considered to be available to the
12institutionalized spouse, except that a transfer of those resources or other assets by
13the community spouse within the first 5 years of eligibility of the institutionalized
14spouse may result in a period of ineligibility under s. 49.453 (2) and (3) for the
15institutionalized spouse
.
AB40,1067 16Section 1067. 49.455 (5) (e) of the statutes is created to read:
AB40,562,2117 49.455 (5) (e) The department may deny to the institutionalized spouse
18eligibility for Medical Assistance if, when requested by the department, the
19institutionalized spouse and the community spouse do not provide the total value of
20their assets and information on income and resources to the extent required under
21federal Medicaid law or sign the application for Medical Assistance.
AB40,1068 22Section 1068. 49.455 (8) (d) of the statutes is renumbered 49.455 (8) (d) 1. and
23amended to read:
AB40,563,624 49.455 (8) (d) 1. If either spouse establishes at a fair hearing that the
25community spouse resource allowance determined under sub. (6) (b) 1. to 2. or 4.

1without a fair hearing does not generate enough income to raise the community
2spouse's income to the minimum monthly maintenance needs allowance under sub.
3(4) (c), the department shall establish, under subd. 2., an amount to be used under
4sub. (6) (b) 3. that results in a community spouse resource allowance that generates
5enough income to raise the community spouse's income to the minimum monthly
6maintenance needs allowance under sub. (4) (c).
AB40,563,18 73. Except in exceptional cases which would result in financial duress for the
8community spouse, the department may not establish an amount to be used under
9sub. (6) (b) 3. unless the institutionalized spouse makes available to the community
10spouse the maximum monthly income allowance permitted under sub. (4) (b) or, if
11the institutionalized spouse does not have sufficient income to make available to the
12community spouse the maximum monthly income allowance permitted under sub.
13(4) (b), unless the institutionalized spouse makes all of his or her income, except for
14an amount equal to the sum of the personal needs allowance under sub. (4) (a) 1. and
15any family allowances under sub. (4) (a) 3. paid by the institutionalized spouse and
16the amount incurred as expenses for medical or remedial care for the
17institutionalized spouse under sub. (4) (a) 4., available to the community spouse as
18a community spouse monthly income allowance under sub. (4) (b).
AB40,1069 19Section 1069. 49.455 (8) (d) 2. of the statutes is created to read:
AB40,564,320 49.455 (8) (d) 2. The department shall base the amount to be used under sub.
21(6) (b) 3. on the cost of a single premium lifetime annuity that pays monthly amounts
22that, combined with other available income, raises the community spouse's income
23to the minimum monthly maintenance needs allowance. Any resource, regardless
24of whether the resource generates income, may be transferred in an amount that,
25combined with the community spouse resource allowance calculated before the fair

1hearing, provides the community spouse with sufficient funds to purchase the
2annuity. The community spouse is not required to purchase an annuity to obtain this
3amount.
AB40,1070 4Section 1070. 49.46 (1) (a) 15. of the statutes is amended to read:
AB40,564,85 49.46 (1) (a) 15. Any individual who is infected with tuberculosis and meets the
6income and resource eligibility requirements for the federal Supplemental Security
7Income program under 42 USC 1381 to 1383d. For purposes of this subdivision,
8"income" has the meaning given for "family income" in s. 49.471 (1) (f).
AB40,1071 9Section 1071. 49.46 (1) (am) 1. a. of the statutes is amended to read:
AB40,564,1410 49.46 (1) (am) 1. a. A pregnant woman whose family income, before any income
11is disregarded under this paragraph, does not exceed, in state fiscal year 1994-95,
12155% of the poverty line for a family the size of the woman's family; and, in each state
13fiscal year after the 1994-95 state fiscal year, 185% 133 percent of the poverty line
14for a family the size of the woman's family.
AB40,1072 15Section 1072. 49.46 (1) (c) (intro.) of the statutes is amended to read:
AB40,564,2016 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:
AB40,1073 21Section 1073. 49.46 (1) (cg) of the statutes is amended to read:
AB40,565,422 49.46 (1) (cg) Medical Except as provided under par. (cr), medical assistance
23shall be provided to a dependent child, a relative with whom the child is living or the
24spouse of the relative, if the spouse meets the requirements of s. 49.19 (1) (c) 2. a. or
25b., for 4 calendar months beginning with the month in which the child, relative or

1spouse is ineligible for aid to families with dependent children because of the
2collection or increased collection of maintenance or support, if the child, relative or
3spouse received aid to families with dependent children in 3 or more of the 6 months
4immediately preceding the month in which that ineligibility begins.
AB40,1074 5Section 1074. 49.46 (1) (co) 1. of the statutes is amended to read:
AB40,565,136 49.46 (1) (co) 1. Except as provided under subd. 2. or par. (cr), medical
7assistance shall be provided to a family for 12 consecutive calendar months following
8the month in which the family becomes ineligible for aid to families with dependent
9children because of increased income from employment, because the family no longer
10receives the earned income disregard under s. 49.19 (5) (a) 4. or 4m. or (am) due to
11the expiration of the time limit during which the disregards are applied or because
12of the application of the monthly employment time eligibility limitation under 45
13CFR 233.100 (a) (1) (i)
.
AB40,1075 14Section 1075. 49.46 (1) (co) 2. of the statutes is amended to read:
AB40,565,1815 49.46 (1) (co) 2. If a waiver under subd. 3. is granted and except as provided
16in par. (cr)
, the department may select individuals to receive medical assistance
17benefits as provided under par. (c), rather than under subd. 1., as a control group for
18part or all of the period during which the waiver is in effect.
AB40,1076 19Section 1076. 49.46 (1) (cr) of the statutes is created to read:
AB40,565,2420 49.46 (1) (cr) To the extent approved by the federal department of health and
21human services, an individual or family described in par. (c), (cg), or (co) is not eligible
22for Medical Assistance if the federal department of health and human services
23approves a request from the department to deny all or some transitional Medical
24Assistance benefits to that individual or family, if approval is required.
AB40,1077 25Section 1077. 49.46 (1) (em) of the statutes is created to read:
AB40,566,7
149.46 (1) (em) For purposes of determining the eligibility and any cost-sharing
2requirements of an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), to the
3extent approved by the federal government, the department shall exclude any assets
4accumulated in an independence account, as defined in s. 49.472 (1) (c), and any
5income or assets from retirement benefits earned or accumulated from employment
6income or employer contributions while the individual was employed and eligible for
7and receiving medical assistance under s. 49.472.
AB40,1078 8Section 1078. 49.46 (2) (b) 19. of the statutes is created to read:
AB40,566,119 49.46 (2) (b) 19. Subject to par. (br), services provided by early intervention
10teachers, home trainers, parent-to-parent mentors, and developmental specialists
11to children in the benchmark plan under par. (br).
AB40,1079 12Section 1079. 49.46 (2) (b) 20. of the statutes is created to read:
AB40,566,1513 49.46 (2) (b) 20. Subject to s. 49.45 (24j), any additional services, as determined
14by the department, that are targeted to a population enrolled in a medical home
15initiative under s. 49.45 (24j).
AB40,1080 16Section 1080. 49.46 (2) (bc) of the statutes is created to read:
AB40,566,1917 49.46 (2) (bc) Subject to s. 49.45 (24j), the department may provide any of the
18services described in par. (a) or (b) through a medical home initiative under s. 49.45
19(24j).
AB40,1081 20Section 1081. 49.46 (2) (br) of the statutes is created to read:
AB40,567,321 49.46 (2) (br) If the federal department of health and human services approves
22the department's request to offer a benchmark plan under this paragraph, the
23department may enroll any child who is receiving services through the early
24intervention program under s. 51.44 in a benchmark plan under this paragraph. The
25department may not require a child who is receiving services through the early

1intervention program under s. 51.44 to enroll in a benchmark plan offered under this
2paragraph. The department may not charge a copayment to a child who is enrolled
3in the benchmark plan under this paragraph for services described in par. (b) 19.
AB40,1082 4Section 1082. 49.468 (1) (d) of the statutes is amended to read:
AB40,567,125 49.468 (1) (d) Benefits under par. (b) or (c) are available for an individual who
6has resources that are equal to or less than 200% of the allowable resources as
7determined under 42 USC 1381 to 1385, excluding, to the extent approved by the
8federal government, any assets accumulated in an independence account, as defined
9in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or
10accumulated from income or employer contributions while the individual was
11employed and eligible for and receiving medical assistance under s. 49.472,
and who
12has
income that is equal to or less than 100% of the poverty line.
AB40,1083 13Section 1083. 49.468 (1m) (b) of the statutes is amended to read:
AB40,567,2214 49.468 (1m) (b) Benefits under par. (a) are available for an individual who has
15resources that are equal to or less than 200% of the allowable resources determined
16under 42 USC 1381 to 1385, excluding, to the extent approved by the federal
17government, any assets accumulated in an independence account, as defined in s.
1849.472 (1) (c), and any income or assets from retirement benefits earned or
19accumulated from income or employer contributions while the individual was
20employed and eligible for and receiving medical assistance under s. 49.472,
and who
21has
income that is greater than 100% of the poverty line but less than 120% of the
22poverty line.
AB40,1084 23Section 1084. 49.468 (2) (b) of the statutes is amended to read:
AB40,568,624 49.468 (2) (b) Benefits under par. (a) are available for an individual who has
25resources that are equal to or less than 200% of the allowable resources under 42

1USC 1381 to 1385, excluding, to the extent approved by the federal government, any
2assets accumulated in an independence account, as defined in s. 49.472 (1) (c), and
3any income or assets from retirement benefits earned or accumulated from income
4or employer contributions while the individual was employed and eligible for and
5receiving medical assistance under s. 49.472,
and who has income that is equal to or
6less than 200% of the poverty line.
AB40,1085 7Section 1085. 49.47 (4) (a) 1. of the statutes is amended to read:
AB40,568,118 49.47 (4) (a) 1. Under 21 years of age and resides in an intermediate care
9facility, skilled nursing facility, or inpatient psychiatric hospital. The department
10shall apply the definition of family income in s. 49.471 (1) (f) to make determinations
11of income under this subdivision.
AB40,1086 12Section 1086. 49.47 (4) (am) 1. of the statutes is amended to read:
AB40,568,1713 49.47 (4) (am) 1. A pregnant woman whose family income does not exceed 155%
14of the poverty line for a family the size of the woman's family, except that if a waiver
15under par. (j) or a change in the approved state plan under s. 49.46 (1) (am) 2. is in
16effect, the income limit is 185% 133 percent of the poverty line for a family the size
17of the woman's family in each state fiscal year after the 1994-95 state fiscal year.
AB40,1087 18Section 1087. 49.47 (4) (b) (intro.) of the statutes is amended to read:
AB40,569,419 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the
20exclusion of
excluding any amounts under the Long-Term Care Partnership
21Program established under s. 49.45 (31), and, to the extent approved by the federal
22government,
any amounts assets accumulated in an independence account, as
23defined in s. 49.472 (1) (c), or and any income or assets from retirement assets that
24accrued
benefits earned or accumulated from employment income or employer
25contributions
while the applicant was employed and eligible for the community

1options program under s. 46.27 (11), or any other Medical Assistance program,
2including deferred compensation or the value of retirement accounts in the
3Wisconsin Retirement System or under the federal Social Security Act
and receiving
4medical assistance under s. 49.472
, does not exceed the following:
AB40,1088 5Section 1088. 49.47 (4) (b) 2w. of the statutes is amended to read:
AB40,569,86 49.47 (4) (b) 2w. For a person who is eligible under par. (a) 3. or 4., life insurance
7with cash surrender values if the total face combined cash surrender value of all life
8insurance policies, including riders and other attachments, is not more than $1,500.
AB40,1089 9Section 1089. 49.47 (4) (c) 1. of the statutes is amended to read:
AB40,569,2010 49.47 (4) (c) 1. Except as provided in par. (am) and as limited by subd. 3.,
11eligibility exists if income does not exceed 133 1/3% of the maximum aid to families
12with dependent children payment under s. 49.19 (11) for the applicant's family size
13or the combined benefit amount available under supplemental security income
14under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 whichever
15is higher lower. In this subdivision "income" includes earned or unearned income
16that would be included in determining eligibility for the individual or family under
17s. 49.19 or 49.77, or for the aged, blind or disabled under 42 USC 1381 to 1385.
18"Income" does not include earned or unearned income which would be excluded in
19determining eligibility for the individual or family under s. 49.19 or 49.77, or for the
20aged, blind or disabled individual under 42 USC 1381 to 1385.
AB40,1090 21Section 1090. 49.47 (4) (c) 3. of the statutes is repealed.
AB40,1091 22Section 1091. 49.471 (1) (cm) of the statutes is created to read:
AB40,569,2523 49.471 (1) (cm) "Disabled" means, when referring to an adult, meeting the
24disability standard for eligibility for federal supplemental security income under 42
25USC 1382c
(a) (3).
AB40,1092
1Section 1092. 49.471 (1) (f) of the statutes is amended to read:
AB40,570,42 49.471 (1) (f) "Family income" means the total gross earned and unearned
3income received by all members of a family
has the meaning given for "household
4income" under 42 CFR 435.603 (d)
.
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