General Assembly Raised Bill No. 776
January Session, 2017 LCO No. 3468
*03468_______HS_*
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
General Assembly
Raised Bill No. 776
January Session, 2017
LCO No. 3468
*03468_______HS_*
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT REQUIRING FAIRNESS FOR FAMILIES IN MEDICAID ELIGIBILITY AND REIMBURSEMENT DETERMINATIONS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective July 1, 2017) The Commissioner of Social Services shall set payment rates for family caregivers authorized to receive compensation in programs administered by the Department of Social Services equal to the rates set for non-family professional caregivers providing the same types of services to participants in such programs, including rates for personal care attendants negotiated pursuant to section 17b-706b of the general statutes and rates for home care services set pursuant to section 17b-343 of the general statutes. The commissioner shall also use such rates to determine the value of services provided by a family caregiver to a Medicaid applicant who transferred assets to the family caregiver as part of a legally enforceable compensation agreement with such caregiver.
Sec. 2. Subsection (h) of section 17b-342 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2017):
(h) An individual who is otherwise eligible for services pursuant to this section shall, as a condition of participation in the program, apply for medical assistance benefits pursuant to section 17b-260 when requested to do so by the department and shall accept such benefits if determined eligible. The commissioner, in accordance with 42 CFR 435.915, shall provide payments for Medicaid-eligible services under the medical assistance program provided not more than three months prior to the date an eligible individual applied for such assistance, provided such applicant has not made a transfer of assets for less than fair market value in the sixty months prior to the date of applying for such assistance. If the applicant has made such a transfer, the commissioner, in accordance with 42 USC 1396p(c)(1)(D)(ii), as amended from time to time, shall begin any penalty period on the later of (1) the first day of the month during or after the date of the transfer that resulted in the penalty period, or (2) the date an otherwise eligible applicant applied for medical assistance and would have been receiving such assistance but for the imposition of a penalty period. For purposes of this subsection, "penalty period" has the same meaning as provided in section 17b-261q.
Sec. 3. Section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2017):
(a) Medical assistance shall be provided for any otherwise eligible person whose income, including any available support from legally liable relatives and the income of the person's spouse or dependent child, is not more than one hundred forty-three per cent, pending approval of a federal waiver applied for pursuant to subsection (e) of this section, of the benefit amount paid to a person with no income under the temporary family assistance program in the appropriate region of residence and if such person is an institutionalized individual as defined in Section 1917 of the Social Security Act, 42 USC 1396p(h)(3), and has not made an assignment or transfer or other disposition of property for less than fair market value for the purpose of establishing eligibility for benefits or assistance under this section. Any such disposition shall be treated in accordance with Section 1917(c) of the Social Security Act, 42 USC 1396p(c). Any disposition of property made on behalf of an applicant or recipient or the spouse of an applicant or recipient by a guardian, conservator, person authorized to make such disposition pursuant to a power of attorney or other person so authorized by law shall be attributed to such applicant, recipient or spouse. A disposition of property ordered by a court shall be evaluated in accordance with the standards applied to any other such disposition for the purpose of determining eligibility. The commissioner shall establish the standards for eligibility for medical assistance at one hundred forty-three per cent of the benefit amount paid to a household of equal size with no income under the temporary family assistance program in the appropriate region of residence. In determining eligibility, the commissioner shall not consider as income Aid and Attendance pension benefits granted to a veteran, as defined in section 27-103, or the surviving spouse of such veteran. Except as provided in section 17b-277 and section 17b-292, the medical assistance program shall provide coverage to persons under the age of nineteen with household income up to one hundred ninety-six per cent of the federal poverty level without an asset limit and to persons under the age of nineteen, who qualify for coverage under Section 1931 of the Social Security Act, with household income not exceeding one hundred ninety-six per cent of the federal poverty level without an asset limit, and their parents and needy caretaker relatives, who qualify for coverage under Section 1931 of the Social Security Act, with household income not exceeding one hundred fifty per cent of the federal poverty level without an asset limit. Such levels shall be based on the regional differences in such benefit amount, if applicable, unless such levels based on regional differences are not in conformance with federal law. Any income in excess of the applicable amounts shall be applied as may be required by said federal law, and assistance shall be granted for the balance of the cost of authorized medical assistance. The Commissioner of Social Services shall provide applicants for assistance under this section, at the time of application, with a written statement advising them of (1) the effect of an assignment or transfer or other disposition of property on eligibility for benefits or assistance, (2) the effect that having income that exceeds the limits prescribed in this subsection will have with respect to program eligibility, and (3) the availability of, and eligibility for, services provided by the Nurturing Families Network established pursuant to section 17b-751b. For coverage dates on or after January 1, 2014, the department shall use the modified adjusted gross income financial eligibility rules set forth in Section 1902(e)(14) of the Social Security Act and the implementing regulations to determine eligibility for HUSKY A, HUSKY B and HUSKY D applicants, as defined in section 17b-290. Persons who are determined ineligible for assistance pursuant to this section shall be provided a written statement notifying such persons of their ineligibility and advising such persons of their potential eligibility for one of the other insurance affordability programs as defined in 42 CFR 435.4.
(b) For the purposes of the Medicaid program, the Commissioner of Social Services shall consider parental income and resources as available to a child under eighteen years of age who is living with his or her parents and is blind or disabled for purposes of the Medicaid program, or to any other child under twenty-one years of age who is living with his or her parents.
(c) For the purposes of determining eligibility for the Medicaid program, an available asset is one that is actually available to the applicant or one that the applicant has the legal right, authority or power to obtain or to have applied for the applicant's general or medical support. If the terms of a trust provide for the support of an applicant, the refusal of a trustee to make a distribution from the trust does not render the trust an unavailable asset. Notwithstanding the provisions of this subsection, the availability of funds in a trust or similar instrument funded in whole or in part by the applicant or the applicant's spouse shall be determined pursuant to the Omnibus Budget Reconciliation Act of 1993, 42 USC 1396p. The provisions of this subsection shall not apply to a special needs trust, as defined in 42 USC 1396p(d)(4)(A), as amended from time to time. For purposes of determining whether a beneficiary under a special needs trust, who has not received a disability determination from the Social Security Administration, is disabled, as defined in 42 USC 1382c(a)(3), the Commissioner of Social Services, or the commissioner's designee, shall independently make such determination. The commissioner shall not require such beneficiary to apply for Social Security disability benefits or obtain a disability determination from the Social Security Administration for purposes of determining whether the beneficiary is disabled.
(d) The transfer of an asset in exchange for other valuable consideration shall be allowable to the extent the value of the other valuable consideration is equal to or greater than the value of the asset transferred.
(e) The Commissioner of Social Services shall seek a waiver from federal law to permit federal financial participation for Medicaid expenditures for families with incomes of one hundred forty-three per cent of the temporary family assistance program payment standard.
(f) To the extent [permitted by] permissible under federal law, Medicaid eligibility shall be extended for one year to a family that becomes ineligible for medical assistance under Section 1931 of the Social Security Act due to income from employment by one of its members who is a caretaker relative or due to receipt of child support income. A family receiving extended benefits on July 1, 2005, shall receive the balance of such extended benefits, provided no such family shall receive more than twelve additional months of such benefits.
(g) An institutionalized spouse applying for Medicaid and having a spouse living in the community shall be required, to the maximum extent permitted by law, to divert income to such community spouse in order to raise the community spouse's income to the level of the minimum monthly needs allowance, as described in Section 1924 of the Social Security Act. Such diversion of income shall occur before the community spouse is allowed to retain assets in excess of the community spouse protected amount described in Section 1924 of the Social Security Act. The Commissioner of Social Services, pursuant to section 17b-10, may implement the provisions of this subsection while in the process of adopting regulations, provided the commissioner prints notice of intent to adopt the regulations [in the Connecticut Law Journal] on the Internet web site of the Department of Social Services and the eRegulations system within twenty days of adopting such policy. Such policy shall be valid until the time final regulations are effective.
(h) To the extent permissible under federal law, an institutionalized individual, as defined in Section 1917 of the Social Security Act, 42 USC 1396p(h)(3), shall not be determined ineligible for Medicaid solely on the basis of the cash value of a life insurance policy worth less than ten thousand dollars provided the individual is pursuing the surrender of the policy.
(i) To the extent permissible under federal law, an individual who has applied for Medicaid shall not be determined ineligible solely on the basis of an asset discovered by such individual after the date of application, provided (1) the individual reports the discovery of the asset to the Commissioner of Social Services not later than ten days after the discovery, (2) the individual takes steps to liquidate such individual's interest in the asset and spend down the proceeds in accordance with Medicaid income and asset limits, and (3) in the event the individual is unable to gain access to the asset, the Department of Social Services provides assistance to the individual to gain access to the asset.
(j) To the extent permissible under federal law, an individual who has applied for Medicaid shall not be determined ineligible on the basis of a single, unliquidated asset, provided such individual presents evidence to the Commissioner of Social Services that such asset is inaccessible to the individual because it is not possible to liquidate the asset in fewer than thirty days.
[(i)] (k) Medical assistance shall be provided, in accordance with the provisions of subsection (e) of section 17a-6, to any child under the supervision of the Commissioner of Children and Families who is not receiving Medicaid benefits, has not yet qualified for Medicaid benefits or is otherwise ineligible for such benefits. Medical assistance shall also be provided to any child in the behavioral services program operated by the Department of Developmental Services who is not receiving Medicaid benefits, has not yet qualified for Medicaid benefits or is otherwise ineligible for benefits. To the extent practicable, the Commissioner of Children and Families and the Commissioner of Developmental Services shall apply for, or assist such child in qualifying for, the Medicaid program.
[(j)] (l) The Commissioner of Social Services shall provide Early and Periodic Screening, Diagnostic and Treatment program services, as required and defined as of December 31, 2005, by 42 USC 1396a(a)(43), 42 USC 1396d(r) and 42 USC 1396d(a)(4)(B) and applicable federal regulations, to all persons who are under the age of twenty-one and otherwise eligible for medical assistance under this section.
[(k)] (m) A veteran, as defined in section 27-103, and any member of his or her family, who applies for or receives assistance under the Medicaid program, shall apply for all benefits for which he or she may be eligible through the Veterans' Administration or the United States Department of Defense.
This act shall take effect as follows and shall amend the following sections:
Section 1 July 1, 2017 New section
Sec. 2 July 1, 2017 17b-342(h)
Sec. 3 July 1, 2017 17b-261
This act shall take effect as follows and shall amend the following sections:
Section 1
July 1, 2017
New section
Sec. 2
July 1, 2017
17b-342(h)
Sec. 3
July 1, 2017
17b-261
Statement of Purpose:
To equalize compensation rates between family and non-family professional caregivers in programs administered by the Department of Social Services, use the same Medicaid reimbursement criteria for home care clients as is used for institutional clients and prohibit determinations of ineligibility for Medicaid based on an inaccessible asset or an asset discovered after a person applies for Medicaid.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]