Illinois has a similar program to pay health insurance premiums for persons with HIV and has established administrative rules for the program under 89 ILL Admin. Code 118.150. Eligibility is similar to eligibility under Wisconsin's program in that the applicant must have physician-documented HIV infection. The Illinois income guideline is at 200% of the FPL whereas Wisconsin's income limit is at 300% of FPL. Illinois considers assets but Wisconsin does not. Illinois also caps its monthly premium payment at $300. The Illinois rules do not address payment of premiums during an unpaid medical leave or require a cost share.

Iowa has a similar program operating under 441 IAC 75.22 (249A). Iowa's eligibility requirements are similar to Wisconsin's in that they require a physician to state that the applicant is HIV infected and that the applicant must reduce work hours or terminate employment due to HIV related illness. Iowa considers income and assets where Wisconsin only considers income. Both Wisconsin's and Iowa's income limit is at 300% of FPL. Iowa's rules do not address payment of premiums during an unpaid medical leave nor do they require a cost share.

Michigan has a similar program to pay health insurance premiums but does not have administrative rules that govern the program.

Minnesota has a similar program to pay health insurance premiums under Minn. Stat. s. 256.9365 but does not have administrative rules for the program.

The Department reviewed 1999 Act 103, 2007 Act 20, 2009 Act 28, and ss. 252.16 (6) (c) and 252.17 (6) (c), Stats., for this rulemaking. In addition, the Department reviewed program utilization data for SFY 2008 to determine the number of program participants who were on unpaid medical leave with an income greater than 200% FPL and less than or greater than 300% FPL. During SFY 2008, of eight program applicants or participants who were on unpaid medical leave, only two had income greater than 200% FPL.

Any business that offers employer based health insurance that is the employer or former employer of a program participant will be affected by the rule.

The proposed rules will not directly affect small businesses.

The rules are amended to establish a 3% annual premium contribution schedule for individuals on unpaid medical leave who have a family income that exceeds 200% but does not exceed 300% of the federal poverty level (FPL). The rules are also amended to include “domestic partner" in the definition of “dependent" and to allow for payment of a participant's health insurance premiums even if a domestic partner is also covered on the health insurance policy. These changes will impact only a small number of insurance program participants and will result in minimal cost increases to the Department that can be absorbed in the program budget.

During 2009 only 56 of 683 insurance program participants indicated on their application that they were living with a partner. Among these 56 individuals, only 2 (<1% of total program clients) had health insurance policies with family coverage. The increased cost to the Department for these individuals is the difference between the cost of an individual premium and the cost of a family premium. Also during 2009 only 4 of 683 (<1%) insurance program participants received program assistance while they were on an unpaid medical leave. None of them had income greater than 200% of FPL. These unpaid leaves are short-term, usually lasting 3 to 6 months and the cost associated with them is minimal compared to overall program costs.

Indeterminate. Increase costs — may be possible to absorb within agency's budget.

GPR; FED.

Section 20.435 (1) (am), Stats.

None.

None.

None known.

DHS 138.03 (2) “Department" means the Wisconsin department of health and family services.

(3) “Dependent" means a spouse, domestic partner under ch. 770, Stats., or an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.

(14) “Medicare" means coverage under part A or, part B or part D of Title XVIII of the federal social security actSocial Security Act, 42 USC 1395 to 1395zz1395hhh.

DHS 138.04 Participation in the health insurance premium subsidy program. (1) (b) 2. For a subsidy under s. 252.17, Stats., have a family income that does not exceed 200 300% of the federal poverty line for a family the size of the individual's family;

(d) Have health insurance coverage under a group health plan or, an individual health policy or Medicare part D, or is eligible for health insurance coverage under a group health plan or, an individual health policy or Medicare part D;

(2) APPLICATION PROCESS. (a) Any individual who satisfies the eligibility conditions under sub. (1) and wants to participate in the health insurance premium subsidy program shall complete and submit to the department an application form, DOH 4614F-44614, which shall provide the following information:

7. Note: To obtain a copy of DOH 4614F - 44614, write or phone the Wisconsin Division of Public Health, AIDS/HIV Program, P.O. Box 2659, Madison, WI 53701-2659, (608) 267-5287. The completed form should be returned to the same office.

(b) Any individual who does not satisfy sub. (1) (b), (d) or (e), may submit an application form, DOH 4614F - 44614, that the department will hold until the individual satisfies all the applicable requirements under sub. (1). The department may not contact the individual's employer, former employer or health insurer until the individual satisfies all the applicable requirements under sub. (1) unless the individual authorizes the department, in writing, to make that contact and to make any necessary disclosure regarding the individual's HIV infection.

DHS 138.05 (1) (a) 1. For a subsidy under s. 252.17, Stats., the department shall pay the full amount of the premium amount owed by the individual due for coverage under a group health plan during an unpaid medical leave; for an individual whose family income does not exceed 200% of the federal poverty line.

2. For a subsidy under s. 252.16, Stats., the department shall pay the full amount of the premium due for health insurance coverage for an individual whose family income does not exceed 200% of the federal poverty level; and line.

DHS 138.05 (1) (a) 4. For a subsidy under s. 252.17, Stats., the department shall pay the full amount of the premium, subject to a premium contribution assessment under par. (dm), due for health insurance coverage during an unpaid medical leave for an individual whose family income exceeds 200% but does not exceed 300% of the federal poverty line.

(dm) Upon approval of an application for a subsidy under s. 252.17, Stats., the department shall assess a premium contribution to be paid by an eligible individual whose family income exceeds 200% but does not exceed 300% of the federal poverty line. The amount of the contribution shall equal 3% of the annual policy premium prorated for the number of months that the individual is on an unpaid medical leave. The annual policy premium shall be determined by annualizing the first monthly premium that is due for the benefit year.

DHS 138.05 (1) (b) The department may not refuse to pay a premium because the health plan coverage that is available to the individual who satisfies s. DHS 138.04 (1) includes coverage of the individual's spouse or domestic partner under ch. 770, Stats., and dependents.

(e) The obligation of the department to make payments under this section is subject to the availability of funds in the appropriation account under s. 20.435 (1) (am), Stats.

NOTICE IS HEREBY GIVEN that pursuant to ss. 256.08 (4) (k), 256.15 (4) (c), (5) (b), (6) (b) 2., (9m) and (13), and 227.11 (2) (a), Stats., the Department of Health Services will hold a public hearing on proposed permanent rules to consider repealing Chapters 111, 112, 113, and 119, and repealing and recreating Chapter DHS 110, relating to emergency medical services, including first responders, emergency medical technicians (EMTs), first responder service providers, non-transporting EMT service providers, and ambulance service providers.

DHS is an equal opportunity employer and service provider. If you need accommodations because of a disability or need an interpreter or translator, or if you need this material in another language or in an alternate format, you may request assistance to participate by contacting Brian Litza at 608-261-6870. You must make your request at least 7 days before the activity.

DHS es una agencia que ofrece igualdad en las oportunidades de empleo y servicios. Si necesita algún tipo de acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta información en su propio idioma o en un formato alterno, usted puede pedir asistencia para participar en los programas comunicándose con Brian Litza al número 608-261-6870. Debe someter su petición por lo menos 7 días de antes de la actividad.

DHS yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam sib luag rau sawv daws. Yog koj xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab txhais lus los yog txhais ntaub ntawv, los yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj yuav tau thov kev pab uas yog hu rau Brian Litza ntawm 608-261-6870. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd.

A copy of the rules may be obtained from the department at no charge by downloading the documents from www.adminrules.wisconsin.gov or by contacting:

Comments may be submitted to Brian Litza, listed above, or to the Wisconsin Administrative Rules Website at www.adminrules.wisconsin.gov until August 6, 2010, 7:00 p.m.

Sections 256.01 to 256.18, Stats.

Sections 256.08 (4) (k), 256.15 (4) (c), (5) (b), (6) (b) 2., (9m) and (13), and 227.11 (2) (a), Stats.