SB144,3,52 49.45 (6m) (m) To hold a bed in a facility, the department may pay the full
3payment rate under this subsection for up to 30 days for services provided to a person
4during the pendency of an undue hardship determination, as provided in s. 49.453
5(8) (b) 3.

SB144,3,77 49.453 (1) (a) "Assets" has the meaning given in 42 USC 1396p (e) (h) (1).

SB144,3,109 49.453 (1) (ar) "Community spouse" means the spouse of either the
10institutionalized person or the noninstitutionalized person.

SB144,3,1212 49.453 (1) (d) "Income" has the meaning given in 42 USC 1396p (e) (h) (2).

SB144,3,1514 49.453 (1) (e) "Institutionalized individual" has the meaning given in 42 USC
151396p (e) (h) (3).

SB144,3,1817 49.453 (1) (f) (intro.) "Look-back date" means for a covered individual, either
18of the following:

SB144,4,2 191m. For transfers made before February 8, 2006, the date that is 36 months
20before, or with respect to payments from a trust or portions of a trust that are treated

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1as assets transferred by the covered individual under s. 49.454 (2) (c) or (3) (b) the
2date that is 60 months before:

SB144,4,76 49.453 (1) (f) 2m. For all transfers made on or after February 8, 2006, the date
7that is 60 months before the dates specified in subd. 1m. a. and b.

SB144,4,109 49.453 (1) (fm) "Noninstitutionalized individual" has the meaning given in 42
10USC 1396p (e) (h) (4).

SB144,4,1212 49.453 (1) (i) "Resources" has the meaning given in 42 USC 1396p (e) (h) (5).

SB144,4,1615 49.453 (3) (a) (intro.) The period of ineligibility under this subsection begins
16on either of the following:

SB144,4,20 171. In the case of a transfer of assets made before February 8, 2006, the first day
18of the first month beginning on or after the look-back date during or after which
19assets have been transferred for less than fair market value and that does not occur
20in any other periods of ineligibility under this subsection.

SB144,5,422 49.453 (3) (a) 2. In the case of a transfer of assets made on or after February
238, 2006, the first day of a month beginning on or after the look-back date during or
24after which assets have been transferred for less than fair market value, or the date
25on which the individual is eligible for medical assistance and would otherwise be

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1receiving institutional level care described in sub. (2) (a) 1. to 3. based on an approved
2application for the care but for the application of the penalty period, whichever is
3later, and that does not occur during any other period of ineligibility under this
4subsection.

SB144,5,76 49.453 (3) (b) (intro.) The Subject to par. (bc), the department shall determine
7the number of months of ineligibility as follows:

SB144,5,129 49.453 (3) (bc) In determining the number of months of ineligibility under par.
10(b), with respect to asset transfers that occur after February 8, 2006, the department
11may not round down the quotient, or otherwise disregard any fraction of a month,
12obtained in the division under par. (b) 3.

SB144,5,1715 49.453 (4) (ac) In this subsection, "transaction" means any action taken by an
16individual that changes the course of payments to be made under an annuity or the
17treatment of the income or principal of an annuity, including all of the following:

SB144,5,1818 1. An addition of principal.

SB144,5,1919 2. An elective withdrawal.

SB144,5,2020 3. A request to change the distribution of the annuity.

SB144,5,2121 4. An election to annuitize the contract.

SB144,5,2222 5. A change in ownership.

SB144,6,3

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149.453 (4) (am) Paragraph (a) (ag) 1. does not apply to a variable annuity that
2is tied to a mutual fund that is registered with the federal securities and exchange
3commission.

SB144,6,75 49.453 (4) (b) The amount of assets that is transferred for less than fair market
6value under par. (a) (ag) is the amount by which the transferred amount exceeds the
7expected value of the benefit.

SB144,6,189 49.453 (4) (c) The department shall promulgate rules specifying the method to
10be used in calculating the expected value of the benefit, based on 26 CFR 1.72-1 to
111.72-18, and specifying the criteria for adjusting the expected value of the benefit
12based on a medical condition diagnosed by a physician before the assets were
13transferred to the annuity, or transferred by promissory note or similar instrument.
14In calculating the amount of the divestment when a transfer to an annuity, or a
15transfer by promissory note or similar instrument, is made, payments made to the
16transferor in any year subsequent to the year in which the transfer was made shall
17be discounted to the year in which the transfer was made by the applicable federal
18rate specified under par. (a) (ag) on the date of the transfer.

SB144,6,2120 49.453 (4) (cm) Paragraphs (ag) to (c) apply to annuities purchased before
21February 8, 2006, for which no transaction has occurred on or after February 8, 2006.

SB144,7,223 49.453 (4) (d) For purposes of sub. (2), the purchase of an annuity by an
24institutionalized individual or his or her community spouse, or anyone acting on

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1their behalf, shall be treated as a transfer of assets for less than fair market value
2unless any of the following applies:

SB144,7,53 1. The state is designated as the remainder beneficiary in the first position for
4at least the total amount of medical assistance paid on behalf of the institutionalized
5individual.

SB144,7,96 2. The state is named as a beneficiary in the 2nd position after the community
7spouse or a minor or disabled child and is named in the first position if the community
8spouse or a representative of the minor or disabled child disposes of any remainder
9for less than fair market value.

SB144,7,1010 3. The annuity satisfies the requirements under par. (e) 1. or 2.

SB144,7,1512 49.453 (4) (e) For purposes of sub. (2), the purchase of an annuity by or on behalf
13of an annuitant who has applied for medical assistance for nursing facility services
14or other long-term care services described in sub. (2) is a transfer of assets for less
15than fair market value unless either of the following applies:

SB144,7,17161. The annuity is either an annuity described in section 408 (b) or (q) of the
17Internal Revenue Code of 1986 or purchased with proceeds from any of the following:

SB144,7,1918a. An account or trust described in section 408 (a), (c), or (p) of the Internal
19Revenue Code of 1986.

SB144,7,2120b. A simplified employee pension, within the meaning of section 408 (k) of the
21Internal Revenue Code of 1986.

SB144,7,2222c. A Roth IRA described in section 408A of the Internal Revenue Code of 1986.

SB144,7,2323 2. All of the following apply with respect to the annuity:

SB144,7,2424 a. The annuity is irrevocable and nonassignable.

SB144,8,2

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1b. The annuity is actuarily sound, as determined in accordance with actuarial
2publications of the office of the chief actuary of the social security administration.

SB144,8,43 c. The annuity provides for payments in equal amounts during the term of the
4annuity, with no deferral and no balloon payments made.

SB144,8,66 49.453 (4) (em) Paragraphs (d) and (e) apply to all of the following:

SB144,8,77 1. Annuities purchased on or after February 8, 2006.

SB144,8,98 2. Annuities purchased before February 8, 2006, for which a transaction has
9occurred on or after February 8, 2006.

SB144,8,1411 49.453 (4c) Purchase of note, loan, or mortgage. (a) For purposes of sub. (2),
12the purchase by an individual or his or her spouse of a promissory note, loan, or
13mortgage after February 8, 2006, is a transfer of assets for less than fair market
14value unless all of the following apply with respect to the note, loan, or mortgage:

SB144,8,1515 1. The repayment term is actuarially sound.

SB144,8,1716 2. The payments are to be made in equal amounts during the term of the loan,
17with no deferral and no balloon payment.

SB144,8,1818 3. Cancellation of the balance upon the death of the lender is prohibited.

SB144,8,2219 (b) The value of a promissory note, loan, or mortgage that does not satisfy the
20requirements under par. (a) 1. to 3. is the outstanding balance due on the date that
21the individual applies for medical assistance for nursing facility services or other
22long-term care services described in sub. (2).

SB144,9,224 49.453 (4m) Purchase of life estate. For purposes of sub. (2), the purchase
25by an individual or his or her spouse of a life estate in another individual's home after

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1February 8, 2006, is a transfer of assets for less than fair market value unless the
2purchaser resides in the home for at least one year after the date of the purchase.

SB144,9,65 49.453 (8) (a) (intro.) Subsections (2) and (3) do not apply to transfers of assets
6if the any of the following applies:

SB144,9,7 71. The assets are exempt under 42 USC 1396p (c) (2) or if the (A), (B), or (C).

SB144,9,10 82. The department determines under the process under par. (b) that application
9of this section would work an undue hardship. The department shall promulgate
10rules concerning the transfer of assets exempt under 42 USC 1396p (c) (2).

SB144,9,1312 49.453 (8) (b) The department shall establish a hardship waiver process that
13includes all of the following:

SB144,9,1714 1. The department determines that undue hardship exists if the application of
15subs. (2) and (3) would deprive the individual of medical care to the extent that the
16individual's health or life would be endangered, or would deprive the individual of
17food, clothing, shelter, or other necessities of life.

SB144,9,2118 2. A facility in which an institutionalized individual who has transferred assets
19resides is permitted to file an application for undue hardship on behalf of the
20individual with the consent of the individual or the individual's authorized
21representative.

SB144,9,2522 3. The department may, during the pendency of an undue hardship
23determination, pay the full payment rate under s. 49.45 (6m) for nursing facility
24services for up to 30 days for the individual who transferred assets, to hold a bed in
25the facility in which the individual resides.

SB144,10,42 49.47 (4) (a) (intro.) Any individual who meets the limitations on income and
3resources under pars. (b) and to (c) and who complies with par. pars. (cm) and (cr)
4shall be eligible for medical assistance under this section if such individual is:

SB144,10,86 49.47 (4) (b) 1. A Subject to par. (bc), a home and the land used and operated
7in connection therewith or in lieu thereof a mobile home if the home or mobile home
8is used as the person's or his or her family's place of abode.

SB144,10,1410 49.47 (4) (bc) 1. Subject to subd. 2., a person shall be ineligible under this
11section for medical assistance for nursing facility services or other long-term care
12services described in s. 49. 453 (2) if the equity in his or her home and the land used
13and operated in connection with the home exceeds $750,000. This subdivision does
14not apply if any of the following persons lawfully resides in the home:

SB144,10,1515 a. The person's spouse.