AB40: Bill Text

AB40,566,15 49.46 (2) (b) 20. Subject to s. 49.45 (24j), any additional services, as determined by the department, that are targeted to a population enrolled in a medical home initiative under s. 49.45 (24j).

AB40,1080 Section 1080. 49.46 (2) (bc) of the statutes is created to read:

AB40,566,19 49.46 (2) (bc) Subject to s. 49.45 (24j), the department may provide any of the services described in par. (a) or (b) through a medical home initiative under s. 49.45 (24j).

AB40,1081 Section 1081. 49.46 (2) (br) of the statutes is created to read:

AB40,567,3 49.46 (2) (br) If the federal department of health and human services approves the department's request to offer a benchmark plan under this paragraph, the department may enroll any child who is receiving services through the early intervention program under s. 51.44 in a benchmark plan under this paragraph. The department may not require a child who is receiving services through the early intervention program under s. 51.44 to enroll in a benchmark plan offered under this paragraph. The department may not charge a copayment to a child who is enrolled in the benchmark plan under this paragraph for services described in par. (b) 19.

AB40,1082 Section 1082. 49.468 (1) (d) of the statutes is amended to read:

AB40,567,12 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. 49.472, and who has income that is equal to or less than 100% of the poverty line.

AB40,1083 Section 1083. 49.468 (1m) (b) of the statutes is amended to read:

AB40,567,22 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. 49.472, and who has income that is greater than 100% of the poverty line but less than 120% of the poverty line.

AB40,1084 Section 1084. 49.468 (2) (b) of the statutes is amended to read:

AB40,568,6 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. 49.472, and who has income that is equal to or less than 200% of the poverty line.

AB40,1085 Section 1085. 49.47 (4) (a) 1. of the statutes is amended to read:

AB40,568,11 49.47 (4) (a) 1. Under 21 years of age and resides in an intermediate care facility, skilled nursing facility, or inpatient psychiatric hospital. The department shall apply the definition of family income in s. 49.471 (1) (f) to make determinations of income under this subdivision.

AB40,1086 Section 1086. 49.47 (4) (am) 1. of the statutes is amended to read:

AB40,568,17 49.47 (4) (am) 1. A pregnant woman whose family income does not exceed 155% of the poverty line for a family the size of the woman's family, except that if a waiver under par. (j) or a change in the approved state plan under s. 49.46 (1) (am) 2. is in effect, the income limit is 185% 133 percent of the poverty line for a family the size of the woman's family in each state fiscal year after the 1994-95 state fiscal year.

AB40,1087 Section 1087. 49.47 (4) (b) (intro.) of the statutes is amended to read:

AB40,569,4 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the exclusion of excluding any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31), and, to the extent approved by the federal government, any amounts assets accumulated in an independence account, as defined in s. 49.472 (1) (c), or and any income or assets from retirement assets that accrued benefits earned or accumulated from employment income or employer contributions while the applicant was employed and eligible for the community options program under s. 46.27 (11), or any other Medical Assistance program, including deferred compensation or the value of retirement accounts in the Wisconsin Retirement System or under the federal Social Security Act and receiving medical assistance under s. 49.472, does not exceed the following:

AB40,1088 Section 1088. 49.47 (4) (b) 2w. of the statutes is amended to read:

AB40,569,8 49.47 (4) (b) 2w. For a person who is eligible under par. (a) 3. or 4., life insurance with cash surrender values if the total face combined cash surrender value of all life insurance policies, including riders and other attachments, is not more than $1,500.

AB40,1089 Section 1089. 49.47 (4) (c) 1. of the statutes is amended to read:

AB40,569,20 49.47 (4) (c) 1. Except as provided in par. (am) and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% of the maximum aid to families with dependent children payment under s. 49.19 (11) for the applicant's family size or the combined benefit amount available under supplemental security income under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 whichever is higher lower. In this subdivision "income" includes earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under 42 USC 1381 to 1385. "Income" does not include earned or unearned income which would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled individual under 42 USC 1381 to 1385.

AB40,1090 Section 1090. 49.47 (4) (c) 3. of the statutes is repealed.

AB40,1091 Section 1091. 49.471 (1) (cm) of the statutes is created to read:

AB40,569,25 49.471 (1) (cm) "Disabled" means, when referring to an adult, meeting the disability standard for eligibility for federal supplemental security income under 42 USC 1382c (a) (3).

AB40,1092 Section 1092. 49.471 (1) (f) of the statutes is amended to read:

AB40,570,4 49.471 (1) (f) "Family income" means the total gross earned and unearned income received by all members of a family has the meaning given for "household income" under 42 CFR 435.603 (d).

AB40,1093 Section 1093. 49.471 (1) (k) 5. d. of the statutes is created to read:

AB40,570,7 49.471 (1) (k) 5. d. The mother's family income exceeds 133 percent of the poverty line.

AB40,1094 Section 1094. 49.471 (4) (a) (intro.) of the statutes is amended to read:

AB40,570,11 49.471 (4) (a) (intro.) 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) and s. 49.45 (24j):

AB40,1095 Section 1095. 49.471 (4) (a) 1. of the statutes is amended to read:

AB40,570,14 49.471 (4) (a) 1. A pregnant woman whose family income does not exceed 200 133 percent of the poverty line.

AB40,1096 Section 1096. 49.471 (4) (a) 4. a. of the statutes is amended to read:

AB40,570,25 49.471 (4) (a) 4. a. The individual is a parent or caretaker relative of a dependent 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 dependent 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 or 938.38. For purposes of this subdivision, a "dependent child" means an individual who is under the age of 18 or an individual who is age 18 and a full-time student in secondary school or equivalent vocational or technical training if before attaining the age of 19 the individual is reasonably expected to complete the school or training.

AB40,1097 Section 1097. 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB40,571,5 49.471 (4) (a) 4. b. Except as provided in subd. 4. c., the The individual's family income does not exceed 200 100 percent of the poverty line and does not include self-employment income before application of the 5 percent income disregard under 42 CFR 435.603 (d).

AB40,1098 Section 1098. 49.471 (4) (a) 4. c. of the statutes is repealed.

AB40,1099 Section 1099. 49.471 (4) (a) 5. of the statutes is amended to read:

AB40,571,15 49.471 (4) (a) 5. An individual who, regardless of family income, was born on or after January 1, 1990 1988, and who, on his or her 18th birthday, was in a foster care placement under the responsibility of a this state, or at the option of the department, under the responsibility of another state, and enrolled in Medical Assistance under this subchapter or a Medicaid program, 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 26 years of age, unless he or she otherwise loses eligibility sooner.

AB40,1100 Section 1100. 49.471 (4) (a) 7. of the statutes is amended to read:

AB40,571,19 49.471 (4) (a) 7. Individuals who qualify for a medical assistance eligibility extension under s. 49.46 (1) (c), (cg), or (co) when their income increases above the poverty line, except as provided in s. 49.46 (1) (cr).

AB40,1101 Section 1101. 49.471 (4) (b) 1. of the statutes is repealed.

AB40,1102 Section 1102. 49.471 (4) (b) 1m. of the statutes is repealed.

AB40,1103 Section 1103. 49.471 (4) (b) 2. of the statutes is repealed.

AB40,1104 Section 1104. 49.471 (4) (b) 3. of the statutes is amended to read:

AB40,571,25 49.471 (4) (b) 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

AB40,572,2 3m. An unborn child, whose family income exceeds 200 percent but does not exceed 300 percent of the poverty line, except benefits are limited to prenatal care.

AB40,1105 Section 1105. 49.471 (4) (b) 4. of the statutes is repealed.

AB40,1106 Section 1106. 49.471 (4) (c) of the statutes is repealed.

AB40,1107 Section 1107. 49.471 (4) (e) of the statutes is created to read:

AB40,572,14 49.471 (4) (e) If the department obtains approval from the federal department of health and human services to provide an alternate benchmark plan under sub. (11r), to the extent the federal department of health and human services approves, the department may enroll in the alternate benchmark plan under sub. (11r) any individual whose family income exceeds 100 percent of the poverty line, who is either an adult who is not pregnant or a child, and who applies and is otherwise eligible to receive benefits under this section, except that the department shall enroll a child who has a parent who is enrolled in a plan under this section in the same plan as his or her parent.

AB40,1108 Section 1108. 49.471 (5) (b) 1. of the statutes is amended to read:

AB40,572,20 49.471 (5) (b) 1. Except as provided in sub. (6) (a) 1., 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 300 133 percent of the poverty line and ending on the applicable day specified in subd. 3.

AB40,1109 Section 1109. 49.471 (5) (b) 2. of the statutes is renumbered 49.471 (5) (b) 2. (intro.) and amended to read:

AB40,573,5 49.471 (5) (b) 2. (intro.) Except as provided in sub. (6) (a) 2., 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 any of the following and ending on the applicable day specified in subd. 3., unless the federal department of health and human services approves the department's request to not extend eligibility to children during this period:

AB40,1110 Section 1110. 49.471 (5) (b) 2. a. to c. of the statutes are created to read:

AB40,573,8 49.471 (5) (b) 2. a. 150 percent of the poverty line for a child who is 6 years of age or older but has not yet attained the age of 19.

AB40,573,10 b. 185 percent of the poverty line for a child who is one year of age or older but has not yet attained the age of 6.

AB40,573,11 c. 300 percent of the poverty line for a child who is under one year of age.

AB40,1111 Section 1111. 49.471 (5) (b) 3. a. of the statutes is amended to read:

AB40,573,20 49.471 (5) (b) 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), except that a child who is not an unborn child is not eligible for benefits described in s. 49.46 (2) (a) and (b) during that time if the federal department of health and human services approves the department's request not to provide those benefits during that time.

AB40,1112 Section 1112. 49.471 (5) (c) 1. of the statutes is renumbered 49.471 (5) (c) and amended to read:

AB40,574,2 49.471 (5) (c) On behalf of a woman under par. (b) 1. whose family income does not exceed 200 percent of the poverty line, 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 described in s. 49.46 (2) (a) and (b).

AB40,1113 Section 1113. 49.471 (5) (c) 2. of the statutes is repealed.

AB40,1114 Section 1114. 49.471 (6) (a) 1. of the statutes is amended to read:

AB40,574,8 49.471 (6) (a) 1. Any Except as provided in subd. 4., any pregnant woman, including a pregnant woman under sub. (5) (b) 1., is eligible for medical assistance under this section for any of the 3 months prior to the month of application if she met the eligibility criteria under this section in that month.

AB40,1115 Section 1115. 49.471 (6) (a) 2. of the statutes is amended to read:

AB40,574,15 49.471 (6) (a) 2. Any Except as provided in subd. 3. or 4., any child who is not an unborn child, including a child under sub. (5) (b) 2., parent, or caretaker relative whose family income is less than 150 percent of the poverty line is eligible for medical assistance under this section for any of the 3 months prior to the month of application if the individual met the eligibility criteria under this section and had a family income of less than 150 percent of the poverty line in that month.

AB40,1116 Section 1116. 49.471 (6) (a) 3. of the statutes is created to read:

AB40,574,21 49.471 (6) (a) 3. Any individual described in subd. 2. who is not disabled, not elderly, and not pregnant, who is an adult, and whose family income exceeds 133 percent of the federal poverty level is not eligible for medical assistance under this section for any of the 3 months before the month of application for medical assistance benefits.

AB40,1117 Section 1117. 49.471 (6) (a) 4. of the statutes is created to read:

AB40,575,2 49.471 (6) (a) 4. To the extent allowed by the federal department of health and human services, any individual described in subd. 1. or 2. who is not disabled is not eligible for medical assistance under this section for any of the 3 months before the month of application for medical assistance benefits.

AB40,1118 Section 1118. 49.471 (7) (a) of the statutes is repealed.

AB40,1119 Section 1119. 49.471 (7) (b) 1. of the statutes is amended to read:

AB40,575,16 49.471 (7) (b) 1. A Eligibility for a pregnant woman whose family income exceeds 300 133 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's family income and the applicable income limit under sub. (4) (b) is obligated or expended for any member of the pregnant woman's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and to the last day of the month in which the 60th day after the last day of the woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family is determined under the method described in s. 49.47 (4) (c).

AB40,1120 Section 1120. 49.471 (7) (b) 2. of the statutes is amended to read:

AB40,576,2 49.471 (7) (b) 2. A child who is not an unborn child, whose family income exceeds 150 percent of the poverty line, and who is ineligible under this section solely because of sub. (8) (b), or whose family income exceeds 300 percent of the poverty line, may obtain eligibility under this section if the difference between the child's family income and 150 percent of the poverty line is obligated or expended on behalf of the child or any member of the child's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision during any 6-month period, as determined by the department, continues for the remainder of the 6-month period and extends to all children in the family.

AB40,1121 Section 1121. 49.471 (7) (b) 3. of the statutes is amended to read:

AB40,576,11 49.471 (7) (b) 3. For a pregnant woman to obtain eligibility under subd. 1., the amount that must be obligated or expended in any 6-month period is equal to the sum of the differences in each of those 6 months between the pregnant woman's monthly family income and the monthly family income that is 300 percent of the poverty line. For a child to obtain eligibility under subd. 2., the amount that must be obligated or expended in any 6-month period is equal to the sum of the differences in each of those 6 months between the child's monthly family income and the monthly family income that is 150 percent of the poverty line.

AB40,1122 Section 1122. 49.471 (7) (c) (intro.) of the statutes is amended to read:

AB40,576,14 49.471 (7) (c) (intro.) When calculating an individual's family income, the department shall do all of the following, subject to par. (d):

AB40,1123 Section 1123. 49.471 (7) (c) of the statutes, as affected by 2013 Wisconsin Act .... (this act), is repealed.

AB40,1124 Section 1124. 49.471 (7) (d) of the statutes is created to read:

AB40,576,19 49.471 (7) (d) In addition to applying other income counting requirements the department shall do all of the following:

AB40,576,24 1. When calculating the family income of a member of a household who is not disabled, include the income of all adults residing in the home for at least 60 consecutive days but exclude the income of a grandparent in a household containing 3 generations, unless the grandparent applies for or receives benefits as a parent or caretaker relative under this section.

AB40,577,3 2. When determining the size of a family for purposes of determining income eligibility, exclude from family size an adult whose income is included in a calculation of family income solely under subd. 1.

AB40,577,6 3. Apply this paragraph only to the extent the federal department of health and human services approves the income eligibility calculation methods, if approval is required.

AB40,1125 Section 1125. 49.471 (7) (e) of the statutes is created to read:

AB40,577,11 49.471 (7) (e) For the purpose of determining family income, the department shall apply the regulations defining a household under 42 CFR 435.603 (f). To determine the family size for a pregnant woman, the department shall include the pregnant woman and the number of babies she is expecting.