SB40-CSA1,746,15 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-CSA1,746,18 (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-CSA1,746,20 1. A pregnant woman whose family income does not exceed 200 percent of the poverty line.

SB40-CSA1,746,23 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-CSA1,747,3 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-CSA1,747,4 3m. A child who obtains eligibility under sub. (7) (b) 2.

SB40-CSA1,747,5 4. An individual who satisfies all of the following criteria:

SB40-CSA1,747,10 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-CSA1,747,12 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-CSA1,747,15 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-CSA1,747,21 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-CSA1,747,23 6. Migrant workers and their dependents who are determined eligible under sub. (6) (f).

SB40-CSA1,747,25 (b) Except as otherwise provided in this section, all of the following individuals are eligible for the benefits described in sub. (11):

SB40-CSA1,748,2 1. A pregnant woman whose family income exceeds 200 percent but does not exceed 300 percent of the poverty line.

SB40-CSA1,748,4 1m. A pregnant woman or unborn child who obtains eligibility under sub. (7) (b) 1.

SB40-CSA1,748,6 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-CSA1,748,9 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-CSA1,748,10 4. An individual who satisfies all of the following criteria:

SB40-CSA1,748,15 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-CSA1,748,17 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-CSA1,748,21 (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-CSA1,748,22 (5) Presumptive eligibility. (a) In this subsection:

SB40-CSA1,748,24 1. "Qualified entity" means an entity that satisfies the requirements under 42 USC 1396r-1a (b) (3) (A), as determined by the department.

SB40-CSA1,749,2 2. "Qualified provider" means a provider that satisfies the requirements under 42 USC 1396r-1 (b) (2), as determined by the department.

SB40-CSA1,749,7 (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-CSA1,749,12 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-CSA1,749,17 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-CSA1,749,21 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-CSA1,749,24 (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).