49.43 Definitions. As used in ss. 49.43 to 49.497 unless the context indicates otherwise: (1e) “Accommodated person” means any person in a hospital or in a skilled nursing facility or intermediate care facility, as defined in Title XIX of the social security act, who would have been eligible for benefits under s. 49.19 or 49.77 […]
49.45 Medical assistance; administration. (1) Purpose. To provide appropriate health care for eligible persons and obtain the most benefits available under Title XIX of the federal social security act, the department shall administer medical assistance, rehabilitative and other services to help eligible individuals and families attain or retain capability for independence or self-care as hereinafter […]
49.452 Counting promissory notes as assets for certain Medical Assistance programs. (1) In this section, “promissory note” means a written, unconditional agreement, given in return for goods, money loaned, or services rendered, under which one party promises to pay another party a specified sum of money at a specified time or on demand. (2) If […]
49.453 Divestment of assets. (1) Definitions. In this section and in s. 49.454: (a) “Assets” has the meaning given in 42 USC 1396p (h) (1). (am) “Covered individual” means an individual who is an institutionalized individual or a noninstitutionalized individual. (ar) “Community spouse” means the spouse of either the institutionalized person or the noninstitutionalized person. […]
49.454 Treatment of trust amounts. (1) Applicability. (a) Except as provided in sub. (4), this section applies to an individual with respect to a trust if assets of the individual or the individual’s spouse were used to form all or part of the corpus of the trust and if any of the following persons established […]
49.455 Protection of income and resources of couple for maintenance of community spouse. (1) Definitions. In this section: (a) “Community spouse” means an individual who is married to an institutionalized spouse. (b) “Consumer price index” means the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor. […]
49.46 Medical assistance; recipients of social security aids. (1) Eligibility. (a) The following shall receive medical assistance under this section: 1. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual’s resources, would qualify for a grant of aid to families with dependent children under s. 49.19. 1g. Notwithstanding s. 49.19 (20), any […]
49.463 Ineligibility for noncompliance with child support determinations and obligations. (1) Definitions. In this section: (a) “Able-bodied adult” means an adult who is not elderly, as defined in s. 49.468 (1) (a) 2., or disabled, as defined in s. 49.471 (1) (cm), who is not pregnant, and who is able-bodied, as defined by the department. […]
49.465 Presumptive medical assistance eligibility. (1) In this section, “qualified provider” means a provider which satisfies the requirements under 42 USC 1396r-1 (b) (2), as determined by the department. (2) A pregnant woman is eligible for medical assistance benefits, as provided under sub. (3), during the period beginning on the day on which a qualified […]
49.468 Expanded medicare buy-in. (1) (a) In this subsection and sub. (1m): 1. “Disabled” means blind, as defined under 42 USC 1382c (a) (2) and disabled, as defined under 42 USC 1382c (a) (3). 2. “Elderly” means 65 years of age or older. 3. “Entitled to coverage under part A of medicare” means eligible for […]
49.47 Medical assistance; medically indigent. (1) Purpose. Medical assistance as set forth herein shall be provided to persons over 65, if eligible under this section, all disabled children under 18, if eligible under this section, and persons who are blind or disabled, if eligible under this section. (2) Definitions. As used in this section, unless […]
49.471 BadgerCare Plus. (1) Definitions. In this section, unless the context requires otherwise: (a) “BadgerCare Plus” means the Medical Assistance program described in this section. (b) “Caretaker relative” means an individual who is maintaining a residence as a child’s home, who exercises primary responsibility for the child’s care and control, including making plans for the […]
49.472 Medical assistance purchase plan. (1) Definitions. In this section: (a) “Earned income” has the meaning given in 42 USC 1382a (a) (1). (am) “Family” means an individual, the individual’s spouse and any dependent child, as defined in s. 49.141 (1) (c), of the individual. (b) “Health insurance” means surgical, medical, hospital, major medical or […]
49.473 Medical assistance; women diagnosed with breast or cervical cancer or precancerous conditions. (1) In this section: (a) “County department” means a county department under s. 46.215, 46.22, or 46.23. (b) “Qualified entity” has the meaning given in 42 USC 1396r-1b (b) (2). (2) A woman is eligible for medical assistance as provided under sub. […]
49.475 Information about assistance program beneficiaries; electronic submission of claims. (1) Definitions. In this section: (ar) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). (b) “Insurer” has the meaning given in s. 600.03 (27). (c) “Pharmacy benefits management” means the administration or management of prescription drug benefits provided by an insurer […]
49.48 Denial, nonrenewal and suspension of certification of service providers based on certain delinquency in payment. (1) Except as provided in sub. (1m), the department shall require each applicant to provide the department with the applicant’s social security number, if the applicant is an individual, as a condition of issuing or renewing a certification under […]
49.485 False claims. Whoever knowingly presents or causes to be presented to any officer, employee, or agent of this state a false claim for medical assistance shall forfeit not less than $5,000 nor more than $10,000, plus 3 times the amount of the damages that were sustained by the state or would have been sustained […]
49.49 Medical assistance offenses. (1d) Damages. If any person is convicted under s. 946.91 (2), the state shall have a cause of action for relief against such person in an amount 3 times the amount of actual damages sustained as a result of any excess payments made in connection with the offense for which the […]
49.493 Benefits under uninsured health plans. (1) In this section: (a) “Department or contract provider” means the department, the county providing the medical benefits or assistance or a health maintenance organization that has contracted with the department to provide the medical benefits or assistance. (b) “Medical benefits or assistance” means medical benefits under s. 49.02 […]
49.496 Recovery of correct medical assistance payments. (1) Definitions. In this section: (af) “Decedent” means a deceased recipient or a deceased nonrecipient surviving spouse, whichever is applicable. (ah) “Disabled” has the meaning given in s. 49.468 (1) (a) 1. (b) “Home” means property in which a person has an ownership interest consisting of the person’s […]
