SB518,3,54 46.286 (1) (b) 1c. In this paragraph, "medical assistance" does not include
5coverage of the benefits under s. 49.471 (11).

SB518,4,65 46.286 (3) (a) 4m. The person is financially eligible under sub. (1) (b) 1m. 2m.
6a., and fulfills any applicable cost-sharing requirements.

SB518,4,129 49.45 (18) (am) 1. No Except as provided in subd. 2., no person is liable under
10this subsection for services provided through prepayment contracts. This paragraph
11does not apply to a person who is eligible for the benefits under s. 49.46 (2) (a) and
12(b) under s. 49.471.

SB518,4,1714 49.45 (18) (am) 2. A person who is eligible for the benefits under s. 49.46 (2) (a)
15and (b) under s. 49.471 is liable under this subsection for services provided through
16a prepayment contract in the amounts and according to the procedures specified by
17the department.

SB518,4,2219 49.45 (18) (b) 2. Any service provided to a person who is less than 18 years old.
20This subdivision does not apply if the person's family income exceeds 100 percent of
21the poverty line and he or she is eligible for the benefits under s. 49.46 (2) (a) and (b)
22under s. 49.471.

SB518,5,18

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149.471 (2) Waiver and state plan amendments. The department shall request
2a waiver from, and submit amendments to the state Medical Assistance plan to, the
3secretary of the federal department of health and human services to implement
4BadgerCare Plus. If the state plan amendments are approved and a waiver that is
5substantially consistent with the provisions of this section, excluding sub. (2m), is
6granted and in effect, the department shall implement BadgerCare Plus beginning
7on January 1, 2008, the effective date of the state plan amendments, or the effective
8date of the waiver, whichever is latest. If the state plan amendments are approved
9but the terms of approval do not allow for federal funding of the cost of benefits for
10all or any part of one or more of the eligibility categories under sub. (4) (b), the
11department may at its discretion pay for the cost of benefits for all or any part of any
12group for which federal funding was denied exclusively with moneys from the
13appropriation under s. 20.435 (4) (b). If the state plan amendments are not approved
14or if a waiver that is substantially consistent with the provisions of this section,
15excluding sub. (2m), is not granted, BadgerCare Plus may not be implemented. If
16the state plan amendments are approved but approval is not continued or if a waiver
17that is substantially consistent with the provisions of this section, excluding sub.
18(2m), is granted but not continued in effect, BadgerCare Plus shall be discontinued.

SB518,6,321 49.471 (3) (a) 1. Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4),
22if the amendments to the state plan under sub. (2) are approved and a waiver under
23sub. (2) that is substantially consistent with all of the provisions of this section,
24excluding sub. (2m), is granted and in effect, an individual described in sub. (4) (a)
25or (b) or (5) is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical

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1Assistance or BadgerCare health program benefits. The eligibility of an individual
2described in sub. (4) (a) or (b) or (5) for Medical Assistance benefits shall be
3determined under this section.

SB518,6,126 49.471 (3) (b) 1. (intro.) If an individual over 18 years of age who is eligible for
7and receiving Medical Assistance benefits under s. 49.46, 49.47, or 49.665 in the
8month before BadgerCare Plus is implemented loses that eligibility solely due to the
9implementation of BadgerCare Plus and, because of his or her income, is not eligible
10for BadgerCare Plus, the individual shall continue receiving for 18 12 consecutive
11months the medical assistance he or she was receiving before the implementation of
12BadgerCare Plus if all of the following are satisfied:

SB518,6,1715 49.471 (3) (b) 1. c. The individual continues to meet meets all nonfinancial
16eligibility requirements for the coverage that he or she had in the month before the
17implementation of BadgerCare Plus under this section.

SB518,6,2320 49.471 (3) (b) 2. Notwithstanding subd. 1., if at any time during an individual's
2118-month 12-month eligibility extension under subd. 1. any criterion under subd.
221. a. to d. is not satisfied, the individual's eligibility for the extended coverage is
23terminated and any time remaining in the eligibility period is lost.

SB518,7,6

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149.471 (4) (a) 4. a. The individual is a parent or caretaker relative of a child who
2is living in the home with the parent or caretaker relative or who is temporarily
3absent from the home for not more than 6 months or, if the child has been removed
4from the home for more than 6 months, the parent or caretaker relative is working
5toward unifying the family by complying with a permanency plan under s. 48.38 or
6938.38.

SB518,7,108 49.471 (4) (a) 7. Individuals who qualify for a medical assistance eligibility
9extension under s. 49.46 (1) (c), (cg), or (co) when their income increases above the
10poverty line.

SB518,7,1813 49.471 (4) (b) 4. a. The individual is a parent or caretaker relative of a child who
14is living in the home with the parent or caretaker relative or who is temporarily
15absent from the home for not more than 6 months or, if the child has been removed
16from the home for more than 6 months, the parent or caretaker relative is working
17toward unifying the family by complying with a permanency plan under s. 48.38 or
18938.38.

SB518,7,2521 49.471 (5) (b) 1. Except as provided in sub. (6) (a) 1., a pregnant woman is
22eligible for the benefits specified in par. (c) during the period beginning on the day
23on which a qualified provider determines, on the basis of preliminary information,
24that the woman's family income does not exceed 300 percent of the poverty line and
25ending on the applicable day specified in subd. 3.

SB518,8,73 49.471 (5) (b) 2. Except as provided in sub. (6) (a) 2., a child who is not an unborn
4child is eligible for the benefits described in s. 49.46 (2) (a) and (b) during the period
5beginning on the day on which a qualified entity determines, on the basis of
6preliminary information, that the child's family income does not exceed 150 percent
7of the poverty line and ending on the applicable day specified in subd. 3.

SB518,8,1310 49.471 (5) (c) 2. On behalf of a woman under par. (b) 1. whose family income
11exceeds 200 percent of the poverty line, the department shall audit and pay allowable
12charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory prenatal
13care services under the benefits under sub. (11).

SB518,8,1815 49.471 (5) (c) 1. On behalf of a woman under par. (b) 1. whose family income
16does not exceed 200 percent of the poverty line, the department shall audit and pay
17allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory
18prenatal care services under the benefits described in s. 49.46 (2) (a) and (b).

SB518,9,221 49.471 (6) (a) 2. Any pregnant woman, including a pregnant woman under sub
22(5) (b) 1., child who is not an unborn child, including a child under sub. (5) (b) 2.,
23parent, or caretaker relative whose family income is less than 150 percent of the
24poverty line is eligible for medical assistance under this section for any of the 3
25months prior to the month of application if the individual met the eligibility criteria

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1under this section and had a family income of less than 150 percent of the poverty
2line in that month.

SB518,9,74 49.471 (6) (a) 1. Any pregnant woman, including a pregnant woman under sub.
5(5) (b) 1., is eligible for medical assistance under this section for any of the 3 months
6prior to the month of application if she met the eligibility criteria under this section
7in that month.

SB518,9,2312 49.471 (7) (b) 1. A pregnant woman, or an unborn child, whose family income
13exceeds 300 percent of the poverty line may become eligible for coverage under this
14section if the difference between the pregnant woman's or unborn child's family
15income and the applicable income limit under sub. (4) (b) is obligated or expended
16for any member of the pregnant woman's or unborn child's family for medical care
17or any other type of remedial care recognized under state law or for personal health
18insurance premiums or for both. Eligibility obtained under this subdivision
19continues without regard to any change in family income for the balance of the
20pregnancy and, for a pregnant woman but not for an unborn child, to the last day of
21the month in which the 60th day after the last day of the woman's pregnancy falls.
22Eligibility obtained by a pregnant woman under this subdivision extends to all
23pregnant women in the pregnant woman's family.

SB518,10,9

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149.471 (7) (b) 2. A child who is not an unborn child and, whose family income
2exceeds 150 percent of the poverty line, and who is ineligible under this section solely
3because of sub. (8) (b) may obtain eligibility under this section if the difference
4between the child's family income and 150 percent of the poverty line is obligated or
5expended on behalf of the child or any member of the child's family for medical care
6or any other type of remedial care recognized under state law or for personal health
7insurance premiums or for both. Eligibility obtained under this subdivision during
8any 6-month period, as determined by the department, continues for the remainder
9of the 6-month period and extends to all children in the family.

SB518,10,2012 49.471 (7) (b) 3. For a pregnant woman or an unborn child to obtain eligibility
13under subd. 1., the amount that must be obligated or expended in any 6-month
14period is equal to the sum of the differences in each of those 6 months between the
15pregnant woman's or unborn child's monthly family income and the monthly family
16income that is 300 percent of the poverty line. For a child to obtain eligibility under
17subd. 2., the amount that must be obligated or expended in any 6-month period is
18equal to the sum of the differences in each of those 6 months between the child's
19monthly family income and the monthly family income that is 150 percent of the
20poverty line.

SB518,10,2523 49.471 (7) (c) 1. Deduct from family the individual's income, up to the amount
24of the individual's income, any payments made by amount the individual is obligated
25to pay for court-ordered child or family support or maintenance.

SB518,11,22 49.471 (8) (d) 1. f. An individual described in sub. (4) (a) 7.

SB518,11,125 49.471 (8) (d) 2. c. One or more members of the individual's family were eligible
6for other health insurance coverage or Medical Assistance under s. 49.46 or 49.47 at
7the time the employee failed to enroll in the health insurance coverage under par. (b)
81. and no member of the family was eligible for coverage under this section at that
9time or, if one or more members of the individual's family were eligible for coverage
10under this section at that time, family income did not exceed 150 percent of the
11poverty line or the individual qualified for a medical assistance eligibility extension
12as provided in sub. (4) (a) 7.

SB518,11,1815 49.471 (10) (a) Copayments. Except as provided in s. 49.45 (18) (am) 2. and (b)
162., all cost-sharing provisions under s. 49.45 (18) apply to a recipient with coverage
17of the benefits described in s. 49.46 (2) (a) and (b) to the same extent as they apply
18to a person eligible for medical assistance under s. 49.46, 49.468, or 49.47.

SB518,11,2020 49.471 (10) (b) 4. g. An individual described in sub. (4) (a) 7.

SB518,12,423 49.471 (10) (b) 5. If a recipient who is required to pay a premium under this
24paragraph or under sub. (2m) or (4) (c) either does not pay a premium when due or
25requests that his or her coverage under this section be terminated, the recipient's

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1coverage terminates and the recipient is not eligible for BadgerCare Plus for 6
2consecutive calendar months following the date on which the recipient's coverage
3terminated, except for any month during that 6-month period when the recipient's
4family income does not exceed 150 percent of the poverty line.

SB518,12,117 49.471 (12) (b) If the amendments to the state plan submitted under sub. (2)
8are approved and a waiver that is substantially consistent with all of the provisions
9of this section is granted and in effect, the department shall publish a notice in the
10Wisconsin Administrative Register that states the date on which BadgerCare Plus
11is implemented.