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OLR Bill Analysis
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.
SUMMARY
This bill requires the Department of Social Services (DSS)
commissioner to increase, from $60 to $72.75 per month, the personal
needs allowance (PNA) provided to long-term care facility residents
who receive Medicaid or certain other federal or state assistance (see
BACKGROUND).
The bill also requires the commissioner to amend the Medicaid state
plan by December 31, 2021, to allow the deduction of certain
conservator expenses when calculating a Medicaid-eligible nursing
home resident’s applied income. In general, these residents must
spend any income they have on their care, except for certain
allowances (i.e., applied income).
The bill also:
1. requires DSS to increase a nursing home’s Medicaid payment by
the amount of the reduced applied income;
2. requires the DSS commissioner to annually notify the probate
court administrator of the total conservatorship expenses
deducted from the applied income in the preceding fiscal year;
3. requires the probate court administrator to annually transfer
from the Probate Court Administration Fund to DSS an amount
equal to half of such conservatorship expenses for Medicaid-
eligible nursing home residents for that year; 2021SB-00418-R000060-BA.DOCX
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4. requires the DSS commissioner to deduct a baseline of $125 in
conservatorship expenses from a nursing home resident’s
applied income and approve deductions that exceed this
amount under certain conditions; and
5. prohibits DSS from treating any probate court-approved
conservator or fiduciary fees as an improper asset transfer for
purposes of imposing a penalty period.
EFFECTIVE DATE: July 1, 2021, except the provisions on Medicaid
applied income take effect upon passage.
APPLIED INCOME
Medicaid State Plan Amendment
The bill requires the DSS commissioner to amend the Medicaid state
plan by December 31, 2021, to allow the deduction of the following
conservatorship expenses:
1. compensation for the individual’s conservator, in amounts
approved by the probate court;
2. probate court filing fees and expenses, including
conservatorship fees, fiduciary accounting fees, and
miscellaneous fees (see BACKGROUND);
3. premiums for any bond the probate court requires; and
4. any other fiduciary expenses the probate court approved that
are permissible under federal law.
Under the bill, whenever these conservator fees and expenses are
deducted from the applied income, DSS must increase the nursing
home’s Medicaid payment by the amount of the reduced applied
income.
The DSS commissioner must seek approval from the federal Centers
for Medicare and Medicaid Services (CMS) for the state plan
amendment. The bill applies to conservator expenses incurred on or
after October 1, 2021, or the date CMS approves the state plan 2021SB-00418-R000060-BA.DOCX
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amendment, whichever is later.
Notification and Transfer of Funds
The bill requires the DSS commissioner, by December 31, 2022, and
annually thereafter, to calculate the total conservatorship expenses
deducted from a nursing home resident’s applied income in the
preceding fiscal year and inform the probate court administrator in
writing of the amount.
Within 30 days after receiving the commissioner’s calculation, the
probate court administrator must transfer from the Probate Court
Administration Fund to DSS funds equal to half of the conservatorship
expenses for that year.
Deduction Amount
Under the bill, DSS must deduct from a conserved nursing home
resident’s applied income a baseline of $125 per month in
conservatorship expenses. The DSS commissioner must approve
deductions above this amount if they are approved by the probate
court (1) when the conserved nursing home resident is initially granted
Medicaid benefits and (2) upon eligibility redeterminations.
PENALTY PERIOD
Under federal law, DSS must impose a penalty period when
individuals transfer assets for less than fair market value in the 60
months before applying for Medicaid coverage (i.e., improper asset
transfer). The bill prohibits DSS from treating any probate court-
approved conservator or fiduciary fees as an improper asset transfer.
By law, the penalty period (in months) is generally calculated by
dividing the value of all assets transferred during the 60 months before
application by the average monthly cost to a private patient of nursing
facility services in the state or community. Medicaid does not pay for
long-term care services and supports during the penalty period.
BACKGROUND
Medicaid Personal Needs Allowance 2021SB-00418-R000060-BA.DOCX
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Covered facilities include nursing homes, chronic disease hospitals,
intermediate care facilities for individuals with intellectual disabilities,
and state humane institutions. Residents of these facilities who receive
Medicaid apply their monthly income (e.g., Social Security) towards
the cost of their care. But federal law allows them to keep a portion of
this income (the PNA) to pay for incidental items, such as haircuts,
telephone expenses, newspapers, or hobbies. Facilities deposit the
PNA into residents’ personal fund accounts.
Probate Court Fees
By law, the general fee for most probate court matters related to
conservatorship is $250 (CGS § 45a-106a). This includes filing motions
to (1) appoint a conservator, (2) change residence or placement in a
long-term care facility, and (3) terminate a conservatorship.
The basic fee for a fiduciary to file an account in the probate court in
any matter other than estate settlement is at least $50 and up to $500
per year, based on a formula (CGS § 45a-108a).
The law also allows the probate court to charge fees for
miscellaneous expenses (i.e., filing or copying certain documents)
(CGS § 45a-109).
The law allows an indigent petitioner or applicant to the probate
court to apply for a fee waiver (CGS § 45a-111).
COMMITTEE ACTION
Aging Committee
Joint Favorable Substitute
Yea 15 Nay 0 (03/02/2021)