OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
sSB-418
AN ACT INCREASING THE PERSONAL NEEDS ALLOWANCE FOR
CERTAIN LONG-TERM CARE FACILITY RESIDENTS AND
AUTHORIZING A DEDUCTION FOR CONSERVATOR EXPENSES
FROM THE AMOUNT OF INCOME A MEDICAID RECIPIENT
APPLIES TO THE COST OF CARE.
Primary Analyst: ES 3/15/21
Contributing Analyst(s): LD, PR
OFA Fiscal Note
State Impact:
Agency Affected Fund-Effect FY 22 $ FY 23 $
Social Services, Dept. GF - Cost 2,650,000 2,150,000
Social Services, Dept. GF - Revenue Gain 375,000 -
Probate Court PCAF - Savings 950,000 950,000
Note: GF=General Fund; PCAF=Probate Court Administration Fund
Municipal Impact: None
Explanation
The bill results in the impact described below due to (1) increasing
the Personal Needs Allowance, and (2) requiring the state to deduct
certain conservatorship expenses when calculating the amount of
income an institutionalized Medicaid enrollee must contribute towards
his or her care, to the extent allowed under federal law.
Sections 1 and 2 result in a state Medicaid cost of approximately
$1.2 million annually ($2.4 million gross after considering both the
state and federal share) by increasing the personal needs allowance
(PNA) by $12.75 from $60 to $72.75.
Sections 3 and 4 result in increased state Medicaid costs of
approximately $950,000 in FY 22 and $1.9 million in FY 23 ($950,000 in
FY 23 after a transfer from the Probate Court Administration Fund) by 2021SB-00418-R000060-FN.DOCX Page 2 of 3
requiring the Department of Social Services (DSS) to deduct certain
conservator expenses when calculating a Medicaid-eligible nursing
home resident’s applied income. This assumes a start date of January
1, 2022. In addition, DSS will incur one-time Other Expenses costs of
approximately $500,000 in FY 22 to enhance the state's eligibility
system in order to implement the applied income deductions specified
in the bill. The system enhancement costs are anticipated to result in a
federal grants revenue gain of $375,000, which reflects federal
reimbursement for such costs under Medicaid.
These provisions also result in a net savings to the Probate Court
Administration Fund (PCAF) of $950,000 in FY 22 and FY 23 associated
with requiring the Probate Court to transfer funds to DSS equal to one-
half the amount deducted for conservator expenses in the prior fiscal
year, beginning in FY 23. In FY 20, the Probate Court supported
conservator expenses for approximately 2,500 Medicaid individuals in
long-term care. The estimated impact to the PCAF and DSS is detailed
in the tables below.
Probate Court PCAF $
FY 22 FY 23 FY 24
Reduction in Conservator
Reimbursement/Fee Waivers 950,000 1,900,000 1,900,000
Transfer to DSS - (950,000) (1,900,000)
Net Impact to PCAF 950,000 950,000 -
DSS Medicaid $
FY 22 FY 23 FY 24
Gross cost 1,900,000 3,800,000 3,800,000
State Share 950,000 1,900,000 1,900,000
Transfer from Probate - (950,000) (1,900,00)
Net Impact to DSS 950,000 950,000 -
DSS Other Expense/Federal Grants $
FY 22 FY 23 FY 24
Impact System Enhancements 500,000 - -
Federal Grants Rev 375,000 - -
Net Impact to State 125,000 - -
2021SB-00418-R000060-FN.DOCX Page 3 of 3
The actual cost to DSS will depend on (1) the amount of the
conservator expenses (including conservator compensation), Probate
Court filing fees/expenses, and premiums for any Probate Court
bonds counted as a deduction from a beneficiary’s income, and (2) the
commensurate shift to the state for Medicaid costs which would have
been paid by the beneficiary.
Section 5 will result in a cost to the state Medicaid program to the
extent the penalty period that would have been imposed on an
individual, making them temporarily ineligible for Medicaid long term
care services, is either reduced or eliminated. The cost to the state
Medicaid program will depend on the reduction or elimination of the
penalty period which would have been imposed on the individual and
the scope of services that otherwise would not be eligible for Medicaid
coverage.
The Out Years
The annualized ongoing fiscal impact for increasing the PNA is
subject to the number of Medicaid residents in long-term care facilities.
The annualized ongoing fiscal impact related to sections 3 and 4 is
described in the tables above.