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2015 - 2016 LEGISLATURE
October 15, 2015 - Introduced by Representatives Jacque, Macco, Genrich,
Steffen, Rohrkaste, Ballweg, Barnes, Berceau, Billings, Born, Brandtjen,
Brostoff, Considine, Edming, Goyke, Hintz, Johnson, Kahl, Katsma,
Kolste, Kremer, Krug, Mason, Meyers, Milroy, Murphy, Mursau, Petryk,
Pope, Quinn, Sargent, Sinicki, Skowronski, Spreitzer, Stuck, Subeck,
Thiesfeldt, Tittl, Weatherston and Zepnick, cosponsored by Senators
Lasee, Hansen, Bewley, Harris Dodd, Lassa, Ringhand, Risser, Vinehout,
Wirch and L. Taylor. Referred to Committee on Public Benefit Reform.
AB414,1,10 1An Act to repeal 49.472 (4) (a) 2m.; to renumber and amend 49.472 (3) (a) and
249.472 (4) (a) (intro.); to amend 49.468 (1) (d), 49.468 (1m) (b), 49.468 (2) (b),
349.472 (1) (c), 49.472 (3) (b), 49.472 (3) (f), 49.472 (4) (a) 2. (intro.), 49.472 (4) (a)
43. and 49.472 (5); to repeal and recreate 49.472 (4) (a) 1. and 49.472 (4) (b);
5and to create 46.2896, 49.46 (1) (em), 49.472 (3) (a) 2. and 49.472 (4) (a) 4. of
6the statutes; relating to: eligibility for and premiums under the Medical
7Assistance purchase plan and disregarding assets in an independence account
8and retirement benefits for purposes of determining eligibility and
9cost-sharing requirements under a number of Medical Assistance and
10long-term care programs.
Analysis by the Legislative Reference Bureau
This bill makes various changes to the Medical Assistance purchase plan
(MAPP) and requires the Department of Health Services (DHS) to exclude certain
types of assets when determining eligibility and cost-sharing requirements for
certain Medical Assistance (MA) and long-term care programs.
Under current law, an individual who would be eligible for MA based on
eligibility for supplemental security income (SSI), but who is not eligible for SSI

because he or she is employed and has too much earned and unearned income to be
eligible, may pay premiums for coverage under MA if his or her family's net income
is less than 250 percent of the poverty line and his or her assets do not exceed $15,000,
excluding certain assets. This program is known as MAPP. When determining the
value of the individual's assets for continued eligibility under MAPP, DHS excludes
amounts in a DHS-approved account that consists solely of savings from the
individual's employment after the individual's coverage under MAPP began. These
accounts are known as "independence accounts."
This bill makes changes to the eligibility and premium requirements under
MAPP. Under current law, when determining whether an individual's net income is
less than 250 percent of the poverty line, certain disregards are deducted from the
individual's and his or her spouse's total earned income, then the individual's and his
or her spouse's total unearned income is added, and then another general disregard
is deducted. Under the bill, an individual's net income is determined by subtracting
the same disregards as under current law from the individual's total earned and
unearned income alone, then the individual's out-of-pocket medical and remedial
expenses and long-term care costs, if any, are deducted. In addition, the bill provides
that, if an individual whose income is equal to or greater than 250 percent of the
poverty line satisfies all of the other eligibility requirements, he or she is eligible for
MAPP if DHS determines that his or her earnings are insufficient to replace all of
the publicly funded benefits that he or she would be eligible to receive in the absence
of those earnings. The bill also requires DHS, when determining eligibility for
MAPP, to exclude from assets, to the extent approved by the federal government,
income or assets from retirement benefits that accumulated or were earned from
employment income or employer contributions while the individual was employed
and receiving MA coverage under MAPP.
Premiums for MA coverage under MAPP currently are calculated for an
individual by adding together all of the individual's unearned income, after certain
specified amounts are deducted, and then adding, in practice, 3 percent of the
individual's earned income, although the statutes provide that 3.5 percent of the
individual's earned income is to be added. DHS may waive any premiums that are
calculated to be below $10 per month, although, in practice, DHS waives any
premiums below $25 per month. In addition, the statutes prohibit DHS from
assessing a premium to an individual whose earned and unearned income is below
150 percent of the poverty line. Under the bill, an individual whose total earned and
unearned income is at least 150 percent of the poverty line for an individual is
required to pay a monthly premium equal to 3 percent of the individual's total earned
and unearned income, after deducting the same specified amounts that are deducted
under current law from an individual's unearned income, with a minimum premium
payment of $25. An individual whose total earned and unearned income is less than
150 percent of the poverty line for an individual is required to pay a monthly
premium of $25.
Finally, certain other MA and long-term care programs, including Family
Care, the long-term support community options program, the community
integration program, the self-directed services option program, and the expanded

Medicare buy-in MA program, consider an individual's income and assets when
determining eligibility and any cost-sharing requirements. The bill requires DHS
to exclude, to the extent approved by the federal government, amounts in an
independence account and assets and income from retirement benefits that
accumulated or were earned through employment income or employer contributions
while an individual was employed and receiving MA coverage under MAPP when
DHS determines the individual's eligibility or cost-sharing requirements under any
of those MA or long-term care programs.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB414,1 1Section 1. 46.2896 of the statutes is created to read:
AB414,3,11 246.2896 Determining financial eligibility and cost sharing for
3long-term care programs.
To the extent approved by the federal government, the
4department or its designee shall exclude any assets accumulated in a person's
5independence account, as defined in s. 49.472 (1) (c), and any income or assets from
6retirement benefits earned or accumulated from employment income or employer
7contributions while the person was employed and eligible for and receiving medical
8assistance under s. 49.472 in determining that person's financial eligibility and
9cost-sharing requirements, if any, for the long-term care program under s. 46.27,
1046.275, or 46.277, for the family care benefit under s. 46.286, for the Family Care
11Partnership program, or for the long-term care program defined in s. 46.2899 (1).
AB414,2 12Section 2. 49.46 (1) (em) of the statutes is created to read:
AB414,4,213 49.46 (1) (em) For purposes of determining the eligibility and any cost-sharing
14requirements of an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), to the
15extent approved by the federal government, the department shall exclude any assets
16accumulated in an independence account, as defined in s. 49.472 (1) (c), and any
17income or assets from retirement benefits earned or accumulated from employment

1income or employer contributions while the individual was employed and eligible for
2and receiving medical assistance under s. 49.472.
AB414,3 3Section 3. 49.468 (1) (d) of the statutes is amended to read:
AB414,4,114 49.468 (1) (d) Benefits under par. (b) or (c) are available for an individual who
5has resources that are equal to or less than 200% of the allowable resources as
6determined under 42 USC 1381 to 1385, excluding, to the extent approved by the
7federal government, any assets accumulated in an independence account, as defined
8in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or
9accumulated from income or employer contributions while the individual was
10employed and eligible for and receiving medical assistance under s. 49.472,
and who
11has
income that is equal to or less than 100% of the poverty line.
AB414,4 12Section 4. 49.468 (1m) (b) of the statutes is amended to read:
AB414,4,2113 49.468 (1m) (b) Benefits under par. (a) are available for an individual who has
14resources that are equal to or less than 200% of the allowable resources determined
15under 42 USC 1381 to 1385, excluding, to the extent approved by the federal
16government, any assets accumulated in an independence account, as defined in s.
1749.472 (1) (c), and any income or assets from retirement benefits earned or
18accumulated from income or employer contributions while the individual was
19employed and eligible for and receiving medical assistance under s. 49.472,
and who
20has
income that is greater than 100% of the poverty line but less than 120% of the
21poverty line.
AB414,5 22Section 5. 49.468 (2) (b) of the statutes is amended to read:
AB414,5,523 49.468 (2) (b) Benefits under par. (a) are available for an individual who has
24resources that are equal to or less than 200% of the allowable resources under 42
25USC 1381
to 1385, excluding, to the extent approved by the federal government, any

1assets accumulated in an independence account, as defined in s. 49.472 (1) (c), and
2any income or assets from retirement benefits earned or accumulated from income
3or employer contributions while the individual was employed and eligible for and
4receiving medical assistance under s. 49.472,
and who has income that is equal to or
5less than 200% of the poverty line.
AB414,6 6Section 6. 49.472 (1) (c) of the statutes is amended to read:
AB414,5,107 49.472 (1) (c) "Independence account" means an account approved by the
8department that consists solely of savings, and dividends or other gains derived from
9those savings, from income earned from paid employment after the initial date on
10which
while an individual began is receiving medical assistance under this section.
AB414,7 11Section 7. 49.472 (3) (a) of the statutes is renumbered 49.472 (3) (a) 1. and
12amended to read:
AB414,5,1813 49.472 (3) (a) 1. The Except as provided in subd. 2., the individual's family's
14total net income is less than 250% 250 percent of the poverty line for a family the
15size of the individual's family
an individual. In calculating the net income, the
16department shall apply all of the exclusions specified under 42 USC 1382a (b), and
17shall exclude the individual's out-of-pocket medical and remedial expenses and
18long-term care costs, if any
.
AB414,8 19Section 8. 49.472 (3) (a) 2. of the statutes is created to read:
AB414,5,2320 49.472 (3) (a) 2. The individual's total net income equals or exceeds 250 percent
21of the poverty line for an individual, but the department determines that the
22individual's earnings are insufficient to replace all of the publicly funded benefits
23that the individual would be eligible to receive in the absence of those earnings.
AB414,9 24Section 9. 49.472 (3) (b) of the statutes is amended to read:
AB414,6,8
149.472 (3) (b) The individual's assets do not exceed $15,000. In determining
2assets, the department may not include assets that are excluded from the resource
3calculation under 42 USC 1382b (a) or; assets accumulated in an independence
4account; or, to the extent approved by the federal government, income or assets from
5retirement benefits earned or accumulated from income or employer contributions
6while the individual was employed and eligible for and receiving medical assistance
7under this section
. The department may exclude, in whole or in part, the value of a
8vehicle used by the individual for transportation to paid employment.
AB414,10 9Section 10. 49.472 (3) (f) of the statutes is amended to read:
AB414,6,1210 49.472 (3) (f) The individual maintains premium payments calculated by the
11department
in accordance with sub. (4), unless the individual is exempted from
12premium payments under sub. (4) (b) or (5).
AB414,11 13Section 11. 49.472 (4) (a) (intro.) of the statutes is renumbered 49.472 (4)
14(intro.) and amended to read:
AB414,6,1915 49.472 (4) Premiums. (intro.) Except as provided in par. (b) and sub. (5), an
16individual who is eligible for medical assistance under sub. (3) and receives medical
17assistance shall pay a monthly premium to the department. The department shall
18establish the monthly premiums by rule in accordance with the following guidelines
,
19calculated as follows
:
AB414,12 20Section 12. 49.472 (4) (a) 1. of the statutes is repealed and recreated to read:
AB414,6,2521 49.472 (4) (a) 1. Except as provided in subds. 3. and 4., an individual whose
22total net income, as calculated under sub. (3) (a), is equal to or greater than 150
23percent of the poverty line for an individual shall pay a premium that is equal to 3
24percent of the individual's total earned and unearned income, after the deductions
25specified in subd. 2.
AB414,13
1Section 13. 49.472 (4) (a) 2. (intro.) of the statutes is amended to read:
AB414,7,42 49.472 (4) (a) 2. (intro.) In determining an individual's total earned and
3unearned income for purposes of determining the premium under subd. 1., the
4department shall disregard all of the following:
AB414,14 5Section 14. 49.472 (4) (a) 2m. of the statutes is repealed.
AB414,15 6Section 15. 49.472 (4) (a) 3. of the statutes is amended to read:
AB414,7,97 49.472 (4) (a) 3. The Subject to subd. 4., the department may reduce the
8premium by 25% determined under subd. 1. by 25 percent for an individual who is
9covered by private health insurance.
AB414,16 10Section 16. 49.472 (4) (a) 4. of the statutes is created to read:
AB414,7,1211 49.472 (4) (a) 4. An individual's premium under this paragraph may not be less
12than $25.
AB414,17 13Section 17 . 49.472 (4) (b) of the statutes is repealed and recreated to read:
AB414,7,1614 49.472 (4) (b) An individual whose total net income, as calculated under sub.
15(3) (a), is less than 150 percent of the poverty line for an individual shall pay a
16premium of $25.
AB414,18 17Section 18. 49.472 (5) of the statutes is amended to read:
AB414,7,2118 49.472 (5) Community options participants. From the appropriation under s.
1920.435 (7) (bd), the department may pay all or a portion of the monthly premium
20calculated under sub. (4) (a) for an individual who is a participant in the community
21options program under s. 46.27 (11).
AB414,19 22Section 19 . Initial applicability.
AB414,8,323 (1) Eligibility for the Medical Assistance purchase plan. The treatment of
24section 49.472 (3) (b) and (f) of the statutes, the renumbering and amendment of
25section 49.472 (3) (a) of the statutes, and the creation of section 49.472 (3) (a) 2. of

1the statutes first apply to individuals who apply for the Medical Assistance purchase
2plan, or whose continued eligibility for the Medical Assistance purchase plan is
3reviewed, on the effective date of this subsection.
AB414,8,44 (2) Eligibility for certain Medical Assistance programs.
AB414,8,95 (a) Long-term care. The treatment of section 46.2896 of the statutes first
6applies to individuals who apply for any of the programs listed in section 46.2896 of
7the statutes, as created by this act, or whose continued eligibility for any of the
8programs listed in section 46.2896 of the statutes, as created by this act, is reviewed,
9on the effective date of this paragraph.
AB414,8,1210 (b) Medical Assistance. The treatment of section 49.46 (1) (em) of the statutes
11first applies to individuals who apply for Medical Assistance, or whose continued
12eligibility for Medical Assistance is reviewed, on the effective date of this paragraph.
AB414,8,1613 (c) Medicare buy-in. The treatment of section 49.468 (1) (d), (1m) (b), and (2)
14(b) of the statutes first applies to individuals who apply for the expanded medicare
15buy-in program, or whose continued eligibility for the expanded medicare buy-in
16program is reviewed, on the effective date of this paragraph.
AB414,8,2017 (3) Premiums for the Medical Assistance purchase plan. The treatment of
18section 49.472 (4) (a) (intro.), 1., 2. (intro.), 2m., 3., and 4. and (b) and (5) of the
19statutes first applies to premiums for the Medical Assistance purchase plan that are
20payable on the effective date of this subsection.
AB414,8,2121 (End)
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