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General Assembly Raised Bill No. 913
January Session, 2021
LCO No. 3527
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT REQUIRING FAIRNESS FOR FAMILIES IN MEDICAID
ELIGIBILITY AND REIMBURSEMENT DETERM INATIONS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective July 1, 2021) The Commissioner of Social 1
Services shall set payment rates for family caregivers authorized to 2
receive compensation in programs administered by the Department of 3
Social Services equal to the rates set for nonfamily professional 4
caregivers providing the same types of services to participants in such 5
programs, including, but not limited to, providing family caregivers 6
rates received by personal care attendants negotiated pursuant to 7
section 17b-706b of the general statutes and rates received by providers 8
of home care services pursuant to section 17b-343 of the general statutes. 9
The commissioner shall also use such rates to determine the value of 10
services provided by a family caregiver to a Medicaid applicant who 11
transferred assets to the family caregiver as part of a legally enforceable 12
compensation agreement with such caregiver. 13
Sec. 2. Subsection (h) of section 17b-342 of the general statutes is 14
repealed and the following is substituted in lieu thereof (Effective July 1, 15 Raised Bill No. 913
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2021): 16
(h) An individual who is otherwise eligible for services pursuant to 17
this section shall, as a condition of participation in the program, apply 18
for medical assistance benefits pursuant to section 17b-260 when 19
requested to do so by the department and shall accept such benefits if 20
determined eligible. The Commissioner of Social Services shall provide 21
medical assistance payments for Medicaid-eligible home care services 22
retroactive to not more than three months before the date an eligible 23
individual applied for Medicaid, to the extent permissible under 42 CFR 24
435.915, as amended from time to time. Any Medicaid applicant who 25
has transferred assets for less than fair market value for purposes of 26
obtaining or maintaining Medicaid eligibility in the sixty months before 27
applying shall not be eligible for retroactive medical assistance 28
payments. If the applicant has made such a transfer, the commissioner 29
shall impose a penalty period in accordance with 42 USC 30
1396p(c)(1)(D)(ii), as amended from time to time. 31
Sec. 3. Section 17b-261 of the general statutes is repealed and the 32
following is substituted in lieu thereof (Effective July 1, 2021): 33
(a) Medical assistance shall be provided for any otherwise eligible 34
person whose income, including any available support from legally 35
liable relatives and the income of the person's spouse or dependent 36
child, is not more than one hundred forty-three per cent, pending 37
approval of a federal waiver applied for pursuant to subsection (e) of 38
this section, of the benefit amount paid to a person with no income 39
under the temporary family assistance program in the appropriate 40
region of residence and if such person is an institutionalized individual 41
as defined in Section 1917 of the Social Security Act, 42 USC 1396p(h)(3), 42
and has not made an assignment or transfer or other disposition of 43
property for less than fair market value for the purpose of establishing 44
eligibility for benefits or assistance under this section. Any such 45
disposition shall be treated in accordance with Section 1917(c) of the 46
Social Security Act, 42 USC 1396p(c). Any disposition of property made 47
on behalf of an applicant or recipient or the spouse of an applicant or 48 Raised Bill No. 913
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recipient by a guardian, conservator, person authorized to make such 49
disposition pursuant to a power of attorney or other person so 50
authorized by law shall be attributed to such applicant, recipient or 51
spouse. A disposition of property ordered by a court shall be evaluated 52
in accordance with the standards applied to any other such disposition 53
for the purpose of determining eligibility. The commissioner shall 54
establish the standards for eligibility for medical assistance at one 55
hundred forty-three per cent of the benefit amount paid to a household 56
of equal size with no income under the temporary family assistance 57
program in the appropriate region of residence. In determining 58
eligibility, the commissioner shall not consider as income Aid and 59
Attendance pension benefits granted to a veteran, as defined in section 60
27-103, or the surviving spouse of such veteran. Except as provided in 61
section 17b-277 and section 17b-292, the medical assistance program 62
shall provide coverage to persons under the age of nineteen with 63
household income up to one hundred ninety-six per cent of the federal 64
poverty level without an asset limit and to persons under the age of 65
nineteen, who qualify for coverage under Section 1931 of the Social 66
Security Act, with household income not exceeding one hundred 67
ninety-six per cent of the federal poverty level without an asset limit, 68
and their parents and needy caretaker relatives, who qualify for 69
coverage under Section 1931 of the Social Security Act, with household 70
income not exceeding one hundred fifty-five per cent of the federal 71
poverty level without an asset limit. Such levels shall be based on the 72
regional differences in such benefit amount, if applicable, unless such 73
levels based on regional differences are not in conformance with federal 74
law. Any income in excess of the applicable amounts shall be applied as 75
may be required by said federal law, and assistance shall be granted for 76
the balance of the cost of authorized medical assistance. The 77
Commissioner of Social Services shall provide applicants for assistance 78
under this section, at the time of application, with a written statement 79
advising them of (1) the effect of an assignment or transfer or other 80
disposition of property on eligibility for benefits or assistance, (2) the 81
effect that having income that exceeds the limits prescribed in this 82
subsection will have with respect to program eligibility, and (3) the 83 Raised Bill No. 913
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availability of, and eligibility for, services provided by the Nurturing 84
Families Network established pursuant to section 17b-751b. For 85
coverage dates on or after January 1, 2014, the department shall use the 86
modified adjusted gross income financial eligibility rules set forth in 87
Section 1902(e)(14) of the Social Security Act and the implementing 88
regulations to determine eligibility for HUSKY A, HUSKY B and 89
HUSKY D applicants, as defined in section 17b-290. Persons who are 90
determined ineligible for assistance pursuant to this section shall be 91
provided a written statement notifying such persons of their ineligibility 92
and advising such persons of their potential eligibility for one of the 93
other insurance affordability programs as defined in 42 CFR 435.4. 94
(b) For the purposes of the Medicaid program, the Commissioner of 95
Social Services shall consider parental income and resources as available 96
to a child under eighteen years of age who is living with his or her 97
parents and is blind or disabled for purposes of the Medicaid program, 98
or to any other child under twenty-one years of age who is living with 99
his or her parents. 100
(c) For the purposes of determining eligibility for the Medicaid 101
program, an available asset is one that is actually available to the 102
applicant or one that the applicant has the legal right, authority or 103
power to obtain or to have applied for the applicant's general or medical 104
support. If the terms of a trust provide for the support of an applicant, 105
the refusal of a trustee to make a distribution from the trust does not 106
render the trust an unavailable asset. Notwithstanding the provisions of 107
this subsection, the availability of funds in a trust or similar instrument 108
funded in whole or in part by the applicant or the applicant's spouse 109
shall be determined pursuant to the Omnibus Budget Reconciliation Act 110
of 1993, 42 USC 1396p. The provisions of this subsection shall not apply 111
to a special needs trust, as defined in 42 USC 1396p(d)(4)(A), as 112
amended from time to time. For purposes of determining whether a 113
beneficiary under a special needs trust, who has not received a disability 114
determination from the Social Security Administration, is disabled, as 115
defined in 42 USC 1382c(a)(3), the Commissioner of Social Services, or 116
the commissioner's designee, shall independently make such 117 Raised Bill No. 913
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determination. The commissioner shall not require such beneficiary to 118
apply for Social Security disability benefits or obtain a disability 119
determination from the Social Security Administration for purposes of 120
determining whether the beneficiary is disabled. 121
(d) The transfer of an asset in exchange for other valuable 122
consideration shall be allowable to the extent the value of the other 123
valuable consideration is equal to or greater than the value of the asset 124
transferred. 125
(e) The Commissioner of Social Services shall seek a waiver from 126
federal law to permit federal financial participation for Medicaid 127
expenditures for families with incomes of one hundred forty-three per 128
cent of the temporary family assistance program payment standard. 129
(f) To the extent [permitted by] permissible under federal law, 130
Medicaid eligibility shall be extended for one year to a family that 131
becomes ineligible for medical assistance under Section 1931 of the 132
Social Security Act due to income from employment by one of its 133
members who is a caretaker relative or due to receipt of child support 134
income. A family receiving extended benefits on July 1, 2005, shall 135
receive the balance of such extended benefits, provided no such family 136
shall receive more than twelve additional months of such benefits. 137
(g) An institutionalized spouse applying for Medicaid and having a 138
spouse living in the community shall be required, to the maximum 139
extent permitted by law, to divert income to such community spouse in 140
order to raise the community spouse's income to the level of the 141
minimum monthly needs allowance, as described in Section 1924 of the 142
Social Security Act. Such diversion of income shall occur before the 143
community spouse is allowed to retain assets in excess of the 144
community spouse protected amount described in Section 1924 of the 145
Social Security Act. The Commissioner of Social Services, pursuant to 146
section 17b-10, may implement the provisions of this subsection while 147
in the process of adopting regulations, provided the commissioner 148
prints notice of intent to adopt the regulations [in the Connecticut Law 149 Raised Bill No. 913
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Journal within] on the Internet web site of the Department of Social 150
Services and the eRegulations System not later than twenty days of 151
adopting such policy. Such policy shall be valid until the time final 152
regulations are effective. 153
(h) To the extent permissible under federal law, an institutionalized 154
individual, as defined in Section 1917 of the Social Security Act, 42 USC 155
1396p(h)(3), shall not be determined ineligible for Medicaid solely on 156
the basis of the cash value of a life insurance policy worth less than ten 157
thousand dollars provided the individual is pursuing the surrender of 158
the policy. 159
(i) To the extent permissible under federal law, an individual who has 160
applied for Medicaid shall not be determined ineligible solely on the 161
basis of an asset discovered by such individual after the date of 162
application, provided (1) the individual reports the discovery of the 163
asset to the Commissioner of Social Services not later than ten days after 164
the discovery, (2) the individual takes steps to liquidate such 165
individual's interest in the asset and spend down the proceeds in 166
accordance with Medicaid income and asset limits, and (3) in the event 167
the individual is unable to gain access to the asset, the Department of 168
Social Services provides assistance to the individual to gain access to the 169
asset. 170
(j) To the extent permissible under federal law, an individual who has 171
applied for Medicaid shall not be determined ineligible on the basis of a 172
single, unliquidated asset, provided such individual presents evidence 173
to the Commissioner of Social Services that such asset is inaccessible to 174
the individual because it is not possible to liquidate the asset in fewer 175
than thirty days. 176
[(i)] (k) Medical assistance shall be provided, in accordance with the 177
provisions of subsection (e) of section 17a-6, to any child under the 178
supervision of the Commissioner of Children and Families who is not 179
receiving Medicaid benefits, has not yet qualified for Medicaid benefits 180
or is otherwise ineligible for such benefits. Medical assistance shall also 181 Raised Bill No. 913
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be provided to any child in the behavioral services program operated 182
by the Department of Developmental Services who is not receiving 183
Medicaid benefits, has not yet qualified for Medicaid benefits or is 184
otherwise ineligible for benefits. To the extent practicable, the 185
Commissioner of Children and Families and the Commissioner of 186
Developmental Services shall apply for, or assist such child in qualifying 187
for, the Medicaid program. 188
[(j)] (l) The Commissioner of Social Services shall provide Early and 189
Periodic Screening, Diagnostic and Treatment program services, as 190
required and defined as of December 31, 2005, by 42 USC 1396a(a)(43), 191
42 USC 1396d(r) and 42 USC 1396d(a)(4)(B) and applicable federal 192
regulations, to all persons who are under the age of twenty-one and 193
otherwise eligible for medical assistance under this section. 194
[(k)] (m) A veteran, as defined in section 27-103, and any member of 195
his or her family, who applies for or receives assistance under the 196
Medicaid program, shall apply for all benefits for which he or she may 197
be eligible through the United States Department of Veterans Affairs or 198
the United States Department of Defense. 199
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2021 New section
Sec. 2 July 1, 2021 17b-342(h)
Sec. 3 July 1, 2021 17b-261
Statement of Purpose:
To ensure equity in payment between privately paid and family
providers of human services, equity in Medicaid reimbursement for
home care services compared to institutional care and fairness to
families who discover an asset or are unable to immediately liquidate
an asset after applying 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.]