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

---

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

---

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.

SB144,10,1716 b. The person's child who is under age 21 or who is disabled, as defined in s.
1749.468 (1) (a) 1.

SB144,10,1818 2. Subdivision 1. applies to all of the following:

SB144,10,2119 a. At the time of application, to a person who applies for medical assistance for
20nursing facility services or other long-term care services described in s. 49.453 (2)
21after the effective date of this subd. 2. a. .... [revisor inserts date].

SB144,11,222 b. At the time of the person's first recertification after the effective date of this
23subd. 2. b. .... [revisor inserts date], to a person not specified in subd. 2. a. who applied
24for medical assistance for nursing facility services or other long-term care services
25described in s. 49.453 (2) on or after January 1, 2006, and who was eligible for medical

---

1assistance for those services on the effective date of this subd. 2. b. .... [revisor inserts
2date].

SB144,11,84 49.47 (4) (bm) For purposes of determining eligibility or benefits amount for
5a person described in par. (a) 3. or 4. who resides in a continuing care retirement
6community or a life care community, any entrance fee paid on admission to the
7community shall be considered a resource available to the person to the extent that
8all of the following apply:

SB144,11,119 1. The person has the ability to use the entrance fee, or the contract provides
10that the entrance fee may be used, to pay for care if the person's other resources or
11income are insufficient to pay for the care.

SB144,11,1412 2. The person is eligible for a refund of any remaining entrance fee when the
13person dies or terminates the continuing care retirement community or life care
14community contract and leaves the community.

SB144,11,1615 3. The entrance fee does not confer an ownership interest in the continuing care
16retirement community or life care community.

SB144,12,318 49.47 (4) (cr) 1. As a condition of receiving medical assistance for long-term
19care services described in s. 49.453 (2) (a), an applicant for or recipient of the
20long-term care services shall disclose on the application or recertification form a
21description of any interest the individual or his or her community spouse, as defined
22in s. 49.453 (1) (ar), has in an annuity, regardless of whether the annuity is
23irrevocable or is treated as an asset. The application or recertification form shall
24include a statement that the state becomes a remainder beneficiary under any
25annuity in which the individual or his or her spouse has an interest by virtue of the

---

1provision of the medical assistance. The applicant or recipient shall, no later than
230 days after the department receives the application or recertification form, take
3any action required by the annuity issuer to make the state a remainder beneficiary.

SB144,12,74 2. The department shall notify the issuer of an annuity disclosed under subd.
51. of the state's right as a remainder beneficiary and shall request that the issuer
6notify the department of any changes to or payments made under the annuity
7contract.

SB144,12,88 3. This paragraph applies to all of the following:

SB144,12,99 a. Annuities purchased on or after February 8, 2006.

SB144,12,1110 b. Annuities purchased before February 8, 2006, for which a transaction, as
11defined in s. 49.453 (4) (ac), has occurred on or after February 8, 2006.

SB144,12,1713 632.48 (3) Notice of changes. An insurer that receives a request from the
14department of health and family services under s. 49.47 (4) (cr) 2. for notification
15shall comply with the request and notify the department of any changes to or
16payments made under the annuity contract to which the request for notification
17relates.

SB144,12,2219 647.02 (2) (g) The figure to be used by the provider as the actual or projected
20length of a resident's stay in the facility in the formula in the contract provision
21required under s. 647.05 (9) (1m) (i) and supporting information showing how the
22figure was determined.

SB144,13,324 647.04 (5) Inform the commissioner of any change in the figure used by the
25provider as the actual or projected length of a resident's stay in the facility in the

---

1formula in the contract provision required under s. 647.05 (9) (1m) (i) within 30 days
2after the change is made and submit supporting information showing how the
3change was determined.

SB144,13,96 647.05 (1m) (g) Provides that if a resident dies or the continuing care contract
7is terminated after the first 30 days of occupancy, but within the first 90 days of
8occupancy, the provider will refund at least 90% of the amount computed under sub.
9(6) par. (f).

SB144,13,1311 647.05 (2m) Subject to s. 49.455, a continuing care contract may require that,
12before a resident applies for medical assistance, the resident must spend on his or
13her care the resources declared for purposes of admission to the facility.