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repealed and the following is substituted in lieu thereof (Effective July 1, 12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