AB40,583,137 49.471 (10) (b) 1. Except as provided in subd. subds. 1m. and 4., a recipient who
8is an adult, who is not a pregnant woman, and whose family income is greater than
9150 percent but not greater than 200 percent of the poverty line shall pay a premium
10for coverage under BadgerCare Plus that does not exceed 5 percent of his or her
11family income. If the recipient has self-employment income and is eligible under
12sub. (4) (b) 4., the premium may not exceed 5 percent of family income calculated
13before depreciation was deducted.
AB40,1143 14Section 1143 . 49.471 (10) (b) 1. of the statutes, as affected by 2013 Wisconsin
15Act .... (this act), is amended to read:
AB40,583,2216 49.471 (10) (b) 1. Except as provided in subds. 1m. and 4., a recipient who is
17an adult, who is not a pregnant woman, and whose family income is greater than 150
18percent but not greater than 200 percent of the poverty line shall pay a premium for
19coverage under BadgerCare Plus that does not exceed 5 percent of his or her family
20income. If the recipient has self-employment income and is eligible under sub. (4)
21(b) 4., the premium may not exceed 5 percent of family income calculated before
22depreciation was deducted.
AB40,1144 23Section 1144. 49.471 (10) (b) 1m. of the statutes is created to read:
AB40,584,724 49.471 (10) (b) 1m. Except as provided in subd. 4., a recipient who is an adult
25parent or adult caretaker relative; who is not disabled, pregnant, or American

1Indian; and whose family income exceeds 133 percent of the federal poverty line shall
2pay a premium for coverage under BadgerCare Plus in an amount determined by the
3department that is based on a formula in which costs decrease for those with lower
4family incomes and that is no less than 3 percent of family income but no greater than
59.5 percent of family income. If the recipient has self-employment income and is
6eligible under sub. (4) (b) 4., the premium may not exceed 5 percent of family income
7calculated before depreciation was deducted.
AB40,1145 8Section 1145 . 49.471 (10) (b) 1m. of the statutes, as affected by 2013 Wisconsin
9Act .... (this act), is repealed.
AB40,1146 10Section 1146. 49.471 (10) (b) 2. of the statutes is amended to read:
AB40,584,1511 49.471 (10) (b) 2. Except as provided in subds. 3. 3m. and 4., a recipient who
12is a child whose family income is greater than 200 percent of the poverty line shall
13pay a premium for coverage of the benefits described in sub. (11) that does not exceed
14the full per member per month cost of coverage for a child with a family income of
15300 percent of the poverty line.
AB40,1147 16Section 1147. 49.471 (10) (b) 3. of the statutes is repealed.
AB40,1148 17Section 1148. 49.471 (10) (b) 3m. of the statutes is created to read:
AB40,584,2318 49.471 (10) (b) 3m. A recipient who is a child, who is not disabled, and whose
19family income is at a level determined by the department that is at least 150 percent
20of the poverty line shall pay a premium in an amount determined by the department.
21The department may apply this subdivision only to the extent the federal
22department of health and human services approves applying a premium to those
23individuals, if approval is required.
AB40,1149 24Section 1149. 49.471 (10) (b) 4. (intro.) of the statutes is amended to read:
AB40,585,2
149.471 (10) (b) 4. (intro.) None of the following shall pay a premium, except as
2provided in subd. 3m.
:
AB40,1150 3Section 1150. 49.471 (10) (b) 4. b. of the statutes is amended to read:
AB40,585,44 49.471 (10) (b) 4. b. A child who is eligible under sub. (4) (a) 2. or (b) 2.
AB40,1151 5Section 1151. 49.471 (10) (b) 5. of the statutes is amended to read:
AB40,585,186 49.471 (10) (b) 5. If a recipient who is required to pay a premium under this
7paragraph or under sub. (2m) or (4) (c) either does not pay a premium when due or
8requests that his or her coverage under this section be terminated, the recipient's
9coverage terminates and. If the recipient is an adult, the recipient is not eligible for
10BadgerCare Plus for 6 12 consecutive calendar months following the date on which
11the recipient's coverage terminated, except for any month during that 6-month
1212-month period when the recipient's family income does not exceed 150 133 percent
13of the poverty line. If the recipient is a child, the recipient is not eligible for
14BadgerCare Plus for 6 consecutive calendar months, or 12 consecutive calendar
15months if the federal department of health and human services approves, following
16the date on which the recipient's coverage terminated, except for any month during
17that period when the recipient's family income does not exceed 150 percent of the
18poverty line.
AB40,1152 19Section 1152 . 49.471 (10) (b) 5. of the statutes, as affected by 2013 Wisconsin
20Act .... (this act), is amended to read:
AB40,586,721 49.471 (10) (b) 5. If a recipient who is required to pay a premium under this
22paragraph or under sub. (2m) or (4) (c) either does not pay a premium when due or
23requests that his or her coverage under this section be terminated, the recipient's
24coverage terminates. If the recipient is an adult, the recipient is not eligible for
25BadgerCare Plus for 12 consecutive calendar months following the date on which the

1recipient's coverage terminated, except for any month during that 12-month period
2when the recipient's family income does not exceed 133 percent of the poverty line.
3If the recipient is a child, the recipient is not eligible for BadgerCare Plus for 6
4consecutive calendar months, or 12 consecutive calendar months if the federal
5department of health and human services approves, following the date on which the
6recipient's coverage terminated, except for any month during that period when the
7recipient's family income does not exceed 150 percent of the poverty line.
AB40,1153 8Section 1153. 49.471 (11) (intro.) of the statutes is amended to read:
AB40,586,129 49.471 (11) Benchmark plan benefits and copayments. (intro.) Recipients
10Except as provided in sub. (11r) and s. 49.45 (24j), recipients who are not eligible for
11the benefits described in s. 49.46 (2) (a) and (b) shall have coverage of the following
12benefits and pay the following copayments:
AB40,1154 13Section 1154. 49.471 (11) (a) of the statutes is amended to read:
AB40,586,1614 49.471 (11) (a) Subject to sub. (6) (k), prescription drugs bearing only a generic
15name, as defined in s. 450.12 (1) (b), with a copayment of no more than $5 per
16prescription, and subject to the Badger Rx Gold program discounts.
AB40,1155 17Section 1155. 49.471 (11r) of the statutes is created to read:
AB40,586,2118 49.471 (11r) Alternate Benchmark plan benefits and copayments. (a) If the
19department chooses to provide the alternate benchmark plan under this subsection,
20the department shall provide to the recipients described under sub. (4) (e) coverage
21for benefits similar to those in a commercial, major medical insurance policy.
AB40,587,322 (b) The department may charge copayments to recipients receiving coverage
23under the alternate benchmark plan under this subsection that are higher than
24copayments charged to recipients receiving coverage under the standard plan under
25s. 49.46 (2). The department may not charge to a recipient of coverage under the

1alternate benchmark plan under this subsection whose family income is at or below
2150 percent of the poverty line a copayment that exceeds 5 percent of the individual's
3family income for all members of the family.
AB40,587,64 (c) 1. The department may only provide coverage under the alternate
5benchmark plan under this subsection to the extent the alternate benchmark plan
6is approved by the federal department of health and human services.
AB40,587,107 2. If the department is providing coverage under the alternate benchmark plan
8under this subsection the department may discontinue coverage under the
9benchmark plan under sub. (11) for those individuals eligible for the alternate
10benchmark plan under this subsection.
AB40,587,1311 3. The department may provide services to individuals enrolled in the alternate
12benchmark plan under this subsection through a medical home initiative similar to
13an initiative described under s. 49.45 (24j).
AB40,1156 14Section 1156. 49.472 (1) (c) of the statutes is amended to read:
AB40,587,1815 49.472 (1) (c) "Independence account" means an account approved by the
16department that consists solely of savings, and dividends or other gains derived from
17those savings, from income earned from paid employment after the initial date on
18which
while an individual began is receiving medical assistance under this section.
AB40,1157 19Section 1157. 49.472 (3) (a) of the statutes is amended to read:
AB40,588,220 49.472 (3) (a) The individual's family's and his or her spouse's total net income
21is less than 250% of the poverty line for a family the size of the individual's family.
22In For purposes of calculating the net income under this paragraph, the department
23shall apply all of the exclusions specified under 42 USC 1382a (b) , except that
24exclusions applied under 42 USC 1382a (b) (4) to earned income shall be applied to
25earned and unearned income combined, and shall exclude up to $500 per month of

1the individual's out-of-pocket medical and remedial expenses and long-term care
2costs, if any
.
AB40,1158 3Section 1158. 49.472 (3) (b) of the statutes is amended to read:
AB40,588,114 49.472 (3) (b) The individual's assets do not exceed $15,000. In determining
5assets, the department may not include assets that are excluded from the resource
6calculation under 42 USC 1382b (a) or; assets accumulated in an independence
7account; or, to the extent approved by the federal government, income or assets from
8retirement benefits earned or accumulated from income or employer contributions
9while the individual was employed and eligible for and receiving medical assistance
10under this section
. The department may exclude, in whole or in part, the value of a
11vehicle used by the individual for transportation to paid employment.
AB40,1159 12Section 1159. 49.472 (3) (f) of the statutes is amended to read:
AB40,588,1613 49.472 (3) (f) The individual, if required to pay a premium under sub. (4) (a)
141.,
maintains premium payments calculated by the department in accordance with
15sub. (4), unless the individual is exempted from premium payments under sub. (4)
16(b) or
(5).
AB40,1160 17Section 1160. 49.472 (3m) of the statutes is created to read:
AB40,588,2418 49.472 (3m) Verifying income. The department shall verify income from work
19activity under sub. (3) (a) and (g) through documentation provided by the individual.
20The department shall require that, for an individual to be engaged in gainful
21employment under sub. (3) (g), the individual must be working and paying, or having
22withheld, federal social security and Medicare taxes and other applicable state or
23federal income taxes. The department shall require that the individual provide
24documentation of the taxes paid or withheld.
AB40,1161 25Section 1161. 49.472 (4) (a) (intro.) of the statutes is repealed.
AB40,1162
1Section 1162. 49.472 (4) (a) 1. of the statutes is repealed and recreated to read:
AB40,589,52 49.472 (4) (a) 1. An individual who is eligible for medical assistance under sub.
3(3) and receives medical assistance shall pay a monthly premium to the department
4if the individual's total earned and unearned income is equal to at least 150 percent
5of the poverty line for an individual.
AB40,1163 6Section 1163. 49.472 (4) (a) 1m. of the statutes is created to read:
AB40,589,97 49.472 (4) (a) 1m. Except as provided in par. (b), the premium required under
8subd. 1. shall be equal to 3 percent of the individual's total earned and unearned
9income, after the deductions specified in subd. 2., rounded down to the nearest $25.
AB40,1164 10Section 1164. 49.472 (4) (a) 2. (intro.) of the statutes is amended to read:
AB40,589,1311 49.472 (4) (a) 2. (intro.) In determining an individual's total earned and
12unearned income under subd. 1. 1m., the department shall disregard all of the
13following:
AB40,1165 14Section 1165. 49.472 (4) (a) 2m. of the statutes is repealed.
AB40,1166 15Section 1166. 49.472 (4) (a) 3. of the statutes is amended to read:
AB40,589,1716 49.472 (4) (a) 3. The Subject to par. (b), the department may reduce the
17premium by 25% for an individual who is covered by private health insurance.
AB40,1167 18Section 1167 . 49.472 (4) (b) of the statutes is amended to read:
AB40,589,2419 49.472 (4) (b) The department may waive monthly premiums that are
20calculated to be below $10
minimum premium payable by an individual specified in
21par. (a) 1. is $50
per month. Unless otherwise provided by the department by a policy
22created under s. 49.45 (2m) (c), the department may not assess a monthly premium
23for any individual whose income level, after adding the individual's total earned
24income and unearned income, is below 150% of the poverty line for an individual.
AB40,1168
1Section 1168 . 49.472 (4) (b) of the statutes, as affected by 2011 Wisconsin Act
232
and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
AB40,590,63 49.472 (4) (b) The minimum premium payable by an individual specified in par.
4(a) 1. is $50 per month. The department may not assess a monthly premium for any
5individual whose total earned and unearned income is below 150 percent of the
6poverty line for an individual.
AB40,1169 7Section 1169. 49.472 (5) of the statutes is amended to read:
AB40,590,118 49.472 (5) Community options participants. From the appropriation under s.
920.435 (7) (bd), the department may pay all or a portion of the monthly premium
10calculated under sub. (4) (a) for an individual who is a participant in the community
11options program under s. 46.27 (11).
AB40,1170 12Section 1170. 49.475 (title) of the statutes is amended to read:
AB40,590,14 1349.475 (title) Information about assistance program beneficiaries;
14electronic submission of claims
.
AB40,1171 15Section 1171. 49.475 (2) (except 49.475 (2) (title)) of the statutes is
16renumbered 49.475 (2) (ac), and 49.475 (2) (ac) 1. b. and 4. (intro.), as renumbered,
17are amended to read:
AB40,590,2018 49.475 (2) (ac) 1. b. If subd. 1. a. applies, the nature and period of time of any
19coverage, benefit, or service provided, including the name, address, and identifying
20number of any applicable coverage plan.
AB40,590,2521 4. (intro.) If all of the following apply, agree not to deny a claim submitted by
22the department under par. (b) subd. 2. solely because of the claim's submission date,
23the type or format of the claim form, or failure by a recipient to present proper
24documentation at the time of delivery of the service, benefit, or item that is the basis
25of the claim:
AB40,1172
1Section 1172. 49.475 (2) (bc) of the statutes is created to read:
AB40,591,62 49.475 (2) (bc) A 3rd party shall accept the submission of claims from the
3department under par. (ac) 2. in electronic form and shall timely pay the claims in
4the manner provided in s. 628.46 (1) and (2). For purposes of timely payment of
5claims under this paragraph, "written notice" under s. 628.46 (1) includes receipt of
6a claim in electronic form.
AB40,1173 7Section 1173. 49.475 (2m) (a) of the statutes is amended to read:
AB40,591,118 49.475 (2m) (a) The information that the department may request under this
9section is limited to the information specified in sub. (2) (a) (ac) 1. and does not
10include an employer's name unless that information is necessary for the department
11or a provider to obtain 3rd-party payment for an item or service.
AB40,1174 12Section 1174. 49.475 (2m) (b) of the statutes is amended to read:
AB40,591,1713 49.475 (2m) (b) If information under sub. (2) (a) (ac) 1. may be available from
14more than one source that includes an employer operating a self-insured plan, the
15department shall seek the information first from a 3rd-party administrator or other
16entity identified in sub. (1) (f) 7. or pharmacy benefits manager before seeking the
17information from the employer.
AB40,1175 18Section 1175. 49.475 (3) (intro.) of the statutes is amended to read:
AB40,591,2119 49.475 (3) Written agreement. (intro.) Upon requesting a 3rd party to provide
20the information under sub. (2) (a) (ac) 1., the department and the 3rd party shall
21enter into a written agreement that satisfies all of the following:
AB40,1176 22Section 1176. 49.475 (4) (a) of the statutes is amended to read:
AB40,592,223 49.475 (4) (a) A 3rd party shall provide the information requested under sub.
24(2) (a) (ac) 1. within 180 days after receiving the department's request if it is the first

1time that the department has requested the 3rd party to disclose information under
2this section.
AB40,1177 3Section 1177. 49.475 (4) (b) of the statutes is amended to read:
AB40,592,74 49.475 (4) (b) A 3rd party shall provide the information requested under sub.
5(2) (a) (ac) 1. within 30 days after receiving the department's request if the
6department has previously requested the 3rd party to disclose information under
7this section.
AB40,1178 8Section 1178. 49.475 (5) of the statutes is amended to read:
AB40,592,139 49.475 (5) Reimbursement of costs. From the appropriations under s. 20.435
10(4) (bm) and (pa), the department shall reimburse a 3rd party that provides
11information under sub. (2) (a) (ac) 1. for the 3rd party's reasonable costs incurred in
12providing the requested information, including its reasonable costs, if any, to develop
13and operate automated systems specifically for the disclosure of the information.
AB40,1179 14Section 1179. 49.496 (1) (a) of the statutes is renumbered 49.496 (1) (ah).
AB40,1180 15Section 1180. 49.496 (1) (af) of the statutes is created to read:
AB40,592,1716 49.496 (1) (af) "Decedent" means a deceased recipient or a deceased
17nonrecipient surviving spouse, whichever is applicable.
AB40,1181 18Section 1181. 49.496 (1) (bk) of the statutes is created to read:
AB40,592,1919 49.496 (1) (bk) "Long-term care program" means any of the following:
AB40,592,2020 1. The family care program providing the benefit under s. 46.286.
AB40,592,2421 2. The self-directed services option that operates under a waiver from the
22secretary of the federal department of health and human services under 42 USC
231396n
(c) in which an enrolled individual selects his or her own services and service
24providers.
AB40,593,3
13. The family care partnership program that is an integrated health and
2long-term care program operated under an amendment to the state medical
3assistance plan under 42 USC 1396u-2 and a waiver under 42 USC 1396n (c).
AB40,593,444. The program for all-inclusive care for the elderly under 42 USC 1396u-4.
AB40,593,95 5. Any program that provides long-term care services and is operated by the
6department under an amendment to the state medical assistance plan under 42 USC
71396n
(i) or 42 USC 1396u-2; a waiver of medical assistance laws under 42 USC
81396n
(c), 42 USC 1396n (b) and (c), or 42 USC 1396u; or a demonstration project
9under 42 USC 1315 or 42 USC 1396n (c).
AB40,1182 10Section 1182. 49.496 (1) (bw) of the statutes is created to read:
AB40,593,1311 49.496 (1) (bw) "Nonrecipient surviving spouse" means any person who was
12married to a recipient while the recipient was receiving services for which the cost
13may be recovered under sub. (3) (a) and who survived the recipient.
AB40,1183 14Section 1183. 49.496 (1) (cm) of the statutes is created to read:
AB40,593,1915 49.496 (1) (cm) 1. "Property of a decedent" means all real and personal property
16to which the recipient held any legal title or in which the recipient had any legal
17interest immediately before death, to the extent of that title or interest, including
18assets transferred to a survivor, heir, or assignee through joint tenancy, tenancy in
19common, survivorship, life estate, living trust, or any other arrangement.
AB40,593,2520 2. Notwithstanding subd. 1., "property of a decedent" includes all real and
21personal property in which the nonrecipient surviving spouse had an ownership
22interest at the recipient's death and in which the recipient had a marital property
23interest with that nonrecipient surviving spouse at any time within 5 years before
24the recipient applied for medical assistance or during the time that the recipient was
25eligible for medical assistance.
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