us-wi/statute/49.45/23b — Childless adults demonstration project reform waiver implementation required.

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us-wi/statute/49.45/23b — Childless adults demonstration project reform waiver implementation required. · Axiom

In this subsection: 1. “Community engagement activity” includes any of the following: a. Work in exchange for money, goods, or services. b. Unpaid work, such as volunteer work or community service. c. Self-employment. d. Participation in a work, job training, or job search program, as approved by the department, including the employment and training program under s. 49.79 (9), the Wisconsin Works program under ss. 49.141 to 49.161, programs under the federal workforce innovation and opportunity act, and tribal work programs. 2. “Exempt individual” means an individual who is any of the following: a. Receiving temporary or permanent disability benefits from the federal or state government or a private source. b. Determined by the department to be physically or mentally unable to work. c. Verified as unable to work in a statement from a social worker or other health care professional. d. Experiencing chronic homelessness. e. Serving as primary caregiver for a person who cannot care for himself or herself. f. Receiving or applying for unemployment compensation and complying with the work requirements for unemployment compensation. g. Participating regularly in an alcohol or other drug abuse treatment or rehabilitation program, except for alcoholics anonymous or narcotics anonymous but including cultural interventions specific to American Indian tribes or bands. h. Attending high school at least half time or enrolled in an institution of higher education, including vocational programs or high school equivalency programs, at least half time. i. Exempt from work requirements under the food stamp program under s. 49.79.

(a)(1)#

“Community engagement activity” includes any of the following: a. Work in exchange for money, goods, or services. b. Unpaid work, such as volunteer work or community service. c. Self-employment. d. Participation in a work, job training, or job search program, as approved by the department, including the employment and training program under s. 49.79 (9), the Wisconsin Works program under ss. 49.141 to 49.161, programs under the federal workforce innovation and opportunity act, and tribal work programs.

(a)(1)(a)#

Work in exchange for money, goods, or services.

(a)(1)(b)#

Unpaid work, such as volunteer work or community service.

(a)(1)(c)#

Self-employment.

(a)(1)(d)#

Participation in a work, job training, or job search program, as approved by the department, including the employment and training program under s. 49.79 (9), the Wisconsin Works program under ss. 49.141 to 49.161, programs under the federal workforce innovation and opportunity act, and tribal work programs.

(a)(2)#

“Exempt individual” means an individual who is any of the following: a. Receiving temporary or permanent disability benefits from the federal or state government or a private source. b. Determined by the department to be physically or mentally unable to work. c. Verified as unable to work in a statement from a social worker or other health care professional. d. Experiencing chronic homelessness. e. Serving as primary caregiver for a person who cannot care for himself or herself. f. Receiving or applying for unemployment compensation and complying with the work requirements for unemployment compensation. g. Participating regularly in an alcohol or other drug abuse treatment or rehabilitation program, except for alcoholics anonymous or narcotics anonymous but including cultural interventions specific to American Indian tribes or bands. h. Attending high school at least half time or enrolled in an institution of higher education, including vocational programs or high school equivalency programs, at least half time. i. Exempt from work requirements under the food stamp program under s. 49.79.

(a)(2)(a)#

Receiving temporary or permanent disability benefits from the federal or state government or a private source.

(a)(2)(b)#

Determined by the department to be physically or mentally unable to work.

(a)(2)(c)#

Verified as unable to work in a statement from a social worker or other health care professional.

(a)(2)(d)#

Experiencing chronic homelessness.

(a)(2)(e)#

Serving as primary caregiver for a person who cannot care for himself or herself.

(a)(2)(f)#

Receiving or applying for unemployment compensation and complying with the work requirements for unemployment compensation.

(a)(2)(g)#

Participating regularly in an alcohol or other drug abuse treatment or rehabilitation program, except for alcoholics anonymous or narcotics anonymous but including cultural interventions specific to American Indian tribes or bands.

(a)(2)(h)#

Attending high school at least half time or enrolled in an institution of higher education, including vocational programs or high school equivalency programs, at least half time.

(a)(2)(i)#

Exempt from work requirements under the food stamp program under s. 49.79.

(b)#

Beginning as soon as practicable after October 31, 2018, and ending no sooner than December 31, 2023, the department shall do all of the following with regard to the childless adults demonstration project under sub. (23): 1. Require in each month persons, except exempt individuals, who are eligible to receive Medical Assistance under sub. (23) and who are at least 19 years of age but have not attained the age of 50 to participate in, document, and report 80 hours per calendar month of community engagement activities. The department, after finding good cause, may grant a temporary exemption from the requirement under this subdivision upon request of a Medical Assistance recipient. 2. Require persons with incomes of at least 50 percent of the poverty line to pay premiums in accordance with par. (c) as a condition of eligibility for Medical Assistance under sub. (23). 3. Require as a condition of eligibility for Medical Assistance under sub. (23) completion of a health risk assessment. 4. Charge recipients of Medical Assistance under sub. (23) an $8 copayment for nonemergency use of the emergency department in accordance with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54. 5. Disenroll from Medical Assistance under sub. (23) for 6 months any individual who does not pay a required premium under subd. 2. and any individual who is required under subd. 1. to participate in a community engagement activity but who does not participate for 48 aggregate months in the community engagement activity.

(b)(1)#

Require in each month persons, except exempt individuals, who are eligible to receive Medical Assistance under sub. (23) and who are at least 19 years of age but have not attained the age of 50 to participate in, document, and report 80 hours per calendar month of community engagement activities. The department, after finding good cause, may grant a temporary exemption from the requirement under this subdivision upon request of a Medical Assistance recipient.

(b)(2)#

Require persons with incomes of at least 50 percent of the poverty line to pay premiums in accordance with par. (c) as a condition of eligibility for Medical Assistance under sub. (23).

(b)(3)#

Require as a condition of eligibility for Medical Assistance under sub. (23) completion of a health risk assessment.

(b)(4)#

Charge recipients of Medical Assistance under sub. (23) an $8 copayment for nonemergency use of the emergency department in accordance with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.

(b)(5)#

Disenroll from Medical Assistance under sub. (23) for 6 months any individual who does not pay a required premium under subd. 2. and any individual who is required under subd. 1. to participate in a community engagement activity but who does not participate for 48 aggregate months in the community engagement activity.

(c)#

1. Persons who are eligible for the demonstration project under sub. (23) and who have monthly household income that exceeds 50 percent of the poverty line shall pay a monthly premium amount of $8 per household. A person who is eligible to receive an item or service furnished by an Indian health care provider is exempt from the premium requirement under this subdivision. 2. The department may disenroll under par. (b) 5. a person for nonpayment of a required monthly premium only at annual eligibility redetermination after providing notice and reasonable opportunity for the person to pay. If a person who is disenrolled for nonpayment of premiums pays all owed premiums or becomes exempt from payment of premiums, he or she may reenroll in Medical Assistance under sub. (23). 3. The department shall reduce the amount of the required household premium by up to half for a recipient of Medical Assistance under sub. (23) who does not engage in certain behaviors that increase health risks or who attests to actively managing certain unhealthy behaviors.

(c)(1)#

Persons who are eligible for the demonstration project under sub. (23) and who have monthly household income that exceeds 50 percent of the poverty line shall pay a monthly premium amount of $8 per household. A person who is eligible to receive an item or service furnished by an Indian health care provider is exempt from the premium requirement under this subdivision.

(c)(2)#

The department may disenroll under par. (b) 5. a person for nonpayment of a required monthly premium only at annual eligibility redetermination after providing notice and reasonable opportunity for the person to pay. If a person who is disenrolled for nonpayment of premiums pays all owed premiums or becomes exempt from payment of premiums, he or she may reenroll in Medical Assistance under sub. (23).

(c)(3)#

The department shall reduce the amount of the required household premium by up to half for a recipient of Medical Assistance under sub. (23) who does not engage in certain behaviors that increase health risks or who attests to actively managing certain unhealthy behaviors.