Researcher: JP Page 1 3/24/21
OLR Bill Analysis
sSB 913
AN ACT REQUIRING FAIRNESS FOR FAMILIES IN MEDICAID
ELIGIBILITY AND REIMBURSEMENT DETERMINATIONS.
SUMMARY
This bill generally requires, to the extent permissible under federal
Medicaid law, (1) payment parity for family caregivers, (2) retroactive
coverage for home care services, and (3) a process for resolving
undisclosed assets discovered during the application process.
Additionally, the bill replaces an obsolete reference to the
Connecticut Law Journal with the Department of Social Services’ (DSS)
website and the eRegulations system for posting required notices of
intention to adopt regulations. It also makes technical and conforming
changes.
EFFECTIVE DATE: July 1, 2021
§ 1 — FAMILY CAREGIVER PAYMENT RATES
The bill requires, to the extent permissible under federal law,
payment rates for authorized family caregivers in DSS-administered
programs to equal the rates for non-family professional caregivers
providing the same types of services to program participants. By law,
the DSS commissioner must determine whether a Medicaid applicant
transferred assets in violation of federal law. Under the bill, the
commissioner must use the fair market value of the family caregiver’s
provided services when making this determination with regard to a
legally enforceable compensation agreement for the services.
§ 2 — RETROACTIVE MEDICAID BENEFITS
The bill requires the DSS commissioner to provide, in accordance
with federal regulations, retroactive benefits to applicants of the
Connecticut Home Care Program for Elders (CHCPE, see 2021SB-00913-R000131-BA.DOCX
Researcher: JP Page 2 3/24/21
BACKGROUND) for up to three months before the date of their
application, as long as they were otherwise eligible during that time
period. In practice and under federal law, DSS already makes
retroactive payments for certain other Medicaid services, including
long-term care services.
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. The bill makes any
CHCPE applicant who has made such a transfer ineligible for the
retroactive Medicaid payments and requires the commissioner to
impose a penalty period in accordance with federal regulations.
§ 3 — LATE-DISCOVERED ASSET S
The bill prohibits, to the extent permissible under federal law,
Medicaid coverage denial solely on the basis of an asset discovered by
an applicant during the application process, as long as the applicant (1)
reports the discovery to DSS within ten days of the discovery and (2)
takes steps to liquidate it and spend-down the proceeds in accordance
with Medicaid income and asset limits. The bill directs the department
to assist these applicants to gain access to their assets if they are unable
to do so.
BACKGROUND
Retroactive Medicaid Payments
Under federal regulations, individuals are eligible for up to three
months of retroactive Medicaid coverage, as long as they (1) received
Medicaid services during that time and (2) would have been Medicaid
eligible if they had applied (42 C.F.R. § 435.915).
Asset Transfer Penalties
Generally, the penalty period (in months) is calculated by dividing
the value of all assets transferred for less than fair market value during
the 60 months before application by the average monthly cost of
private nursing home care in the state or community. Medicaid does
not pay for long-term care services and supports during the penalty
period. 2021SB-00913-R000131-BA.DOCX
Researcher: JP Page 3 3/24/21
Connecticut Home Care Program for Elders
CHCPE is a Medicaid-waiver and a state-funded program that
provides a range of home- and community-based services for eligible
individuals age 65 or older who are at risk of inappropriate
institutionalization (e.g., nursing home placement). To be eligible for
CHCPE, individuals must meet income and asset limits.
COMMITTEE ACTION
Human Services Committee
Joint Favorable Substitute
Yea 19 Nay 0 (03/09/2021)