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General Assembly Raised Bill No. 5340
February Session, 2022
LCO No. 2442
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING EQUITABLE MEDICAID PAYMENTS AND
ELIGIBILITY DETERMINATIONS FOR APPLICANTS, RECIPIENTS
AND FAMILY CAREGIVERS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective July 1, 2022) 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
who provide personal care services the same rates received by personal 7
care attendants negotiated pursuant to section 17b-706b of the general 8
statutes. The commissioner shall utilize such rates to determine the 9
value of personal care services provided by a family caregiver to a 10
Medicaid applicant who transferred assets to the family caregiver as 11
part of a legally enforceable compensation agreement with such 12
caregiver. 13
Sec. 2. Subsection (h) of section 17b-342 of the 2022 supplement to the 14 Raised Bill No. 5340
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general statutes is repealed and the following is substituted in lieu 15
thereof (Effective July 1, 2022): 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. 25
Sec. 3. Section 17b-261 of the 2022 supplement to the general statutes 26
is repealed and the following is substituted in lieu thereof (Effective July 27
1, 2022): 28
(a) Medical assistance shall be provided for any otherwise eligible 29
person whose income, including any available support from legally 30
liable relatives and the income of the person's spouse or dependent 31
child, is not more than one hundred forty-three per cent, pending 32
approval of a federal waiver applied for pursuant to subsection (e) of 33
this section, of the benefit amount paid to a person with no income 34
under the temporary family assistance program in the appropriate 35
region of residence and if such person is an institutionalized individual 36
as defined in Section 1917 of the Social Security Act, 42 USC 1396p(h)(3), 37
and has not made an assignment or transfer or other disposition of 38
property for less than fair market value for the purpose of establishing 39
eligibility for benefits or assistance under this section. Any such 40
disposition shall be treated in accordance with Section 1917(c) of the 41
Social Security Act, 42 USC 1396p(c). Any disposition of property made 42
on behalf of an applicant or recipient or the spouse of an applicant or 43
recipient by a guardian, conservator, person authorized to make such 44
disposition pursuant to a power of attorney or other person so 45
authorized by law shall be attributed to such applicant, recipient or 46
spouse. A disposition of property ordered by a court shall be evaluated 47 Raised Bill No. 5340
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in accordance with the standards applied to any other such disposition 48
for the purpose of determining eligibility. The commissioner shall 49
establish the standards for eligibility for medical assistance at one 50
hundred forty-three per cent of the benefit amount paid to a household 51
of equal size with no income under the temporary family assistance 52
program in the appropriate region of residence. In determining 53
eligibility, the commissioner shall not consider as income Aid and 54
Attendance pension benefits granted to a veteran, as defined in section 55
27-103, or the surviving spouse of such veteran. Except as provided in 56
section 17b-277 and section 17b-292, the medical assistance program 57
shall provide coverage to persons under the age of nineteen with 58
household income up to one hundred ninety-six per cent of the federal 59
poverty level without an asset limit and to persons under the age of 60
nineteen, who qualify for coverage under Section 1931 of the Social 61
Security Act, with household income not exceeding one hundred 62
ninety-six per cent of the federal poverty level without an asset limit, 63
and their parents and needy caretaker relatives, who qualify for 64
coverage under Section 1931 of the Social Security Act, with household 65
income not exceeding one hundred fifty-five per cent of the federal 66
poverty level without an asset limit. Such levels shall be based on the 67
regional differences in such benefit amount, if applicable, unless such 68
levels based on regional differences are not in conformance with federal 69
law. Any income in excess of the applicable amounts shall be applied as 70
may be required by said federal law, and assistance shall be granted for 71
the balance of the cost of authorized medical assistance. The 72
Commissioner of Social Services shall provide applicants for assistance 73
under this section, at the time of application, with a written statement 74
advising them of (1) the effect of an assignment or transfer or other 75
disposition of property on eligibility for benefits or assistance, (2) the 76
effect that having income that exceeds the limits prescribed in this 77
subsection will have with respect to program eligibility, and (3) the 78
availability of, and eligibility for, services provided by the Connecticut 79
Home Visiting System, established pursuant to section 17b-751b. For 80
coverage dates on or after January 1, 2014, the department shall use the 81
modified adjusted gross income financial eligibility rules set forth in 82 Raised Bill No. 5340
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Section 1902(e)(14) of the Social Security Act and the implementing 83
regulations to determine eligibility for HUSKY A, HUSKY B and 84
HUSKY D applicants, as defined in section 17b-290. Persons who are 85
determined ineligible for assistance pursuant to this section shall be 86
provided a written statement notifying such persons of their ineligibility 87
and advising such persons of their potential eligibility for one of the 88
other insurance affordability programs as defined in 42 CFR 435.4. 89
(b) For the purposes of the Medicaid program, the Commissioner of 90
Social Services shall consider parental income and resources as available 91
to a child under eighteen years of age who is living with his or her 92
parents and is blind or disabled for purposes of the Medicaid program, 93
or to any other child under twenty-one years of age who is living with 94
his or her parents. 95
(c) For the purposes of determining eligibility for the Medicaid 96
program, an available asset is one that is actually available to the 97
applicant or one that the applicant has the legal right, authority or 98
power to obtain or to have applied for the applicant's general or medical 99
support. If the terms of a trust provide for the support of an applicant, 100
the refusal of a trustee to make a distribution from the trust does not 101
render the trust an unavailable asset. Notwithstanding the provisions of 102
this subsection, the availability of funds in a trust or similar instrument 103
funded in whole or in part by the applicant or the applicant's spouse 104
shall be determined pursuant to the Omnibus Budget Reconciliation Act 105
of 1993, 42 USC 1396p. The provisions of this subsection shall not apply 106
to a special needs trust, as defined in 42 USC 1396p(d)(4)(A), as 107
amended from time to time. For purposes of determining whether a 108
beneficiary under a special needs trust, who has not received a disability 109
determination from the Social Security Administration, is disabled, as 110
defined in 42 USC 1382c(a)(3), the Commissioner of Social Services, or 111
the commissioner's designee, shall independently make such 112
determination. The commissioner shall not require such beneficiary to 113
apply for Social Security disability benefits or obtain a disability 114
determination from the Social Security Administration for purposes of 115
determining whether the beneficiary is disabled. 116 Raised Bill No. 5340
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(d) The transfer of an asset in exchange for other valuable 117
consideration shall be allowable to the extent the value of the other 118
valuable consideration is equal to or greater than the value of the asset 119
transferred. 120
(e) The Commissioner of Social Services shall seek a waiver from 121
federal law to permit federal financial participation for Medicaid 122
expenditures for families with incomes of one hundred forty-three per 123
cent of the temporary family assistance program payment standard. 124
(f) To the extent [permitted by] permissible under federal law, 125
Medicaid eligibility shall be extended for one year to a family that 126
becomes ineligible for medical assistance under Section 1931 of the 127
Social Security Act due to income from employment by one of its 128
members who is a caretaker relative or due to receipt of child support 129
income. A family receiving extended benefits on July 1, 2005, shall 130
receive the balance of such extended benefits, provided no such family 131
shall receive more than twelve additional months of such benefits. 132
(g) An institutionalized spouse applying for Medicaid and having a 133
spouse living in the community shall be required, to the maximum 134
extent permitted by law, to divert income to such community spouse in 135
order to raise the community spouse's income to the level of the 136
minimum monthly needs allowance, as described in Section 1924 of the 137
Social Security Act. Such diversion of income shall occur before the 138
community spouse is allowed to retain assets in excess of the 139
community spouse protected amount described in Section 1924 of the 140
Social Security Act. The Commissioner of Social Services, pursuant to 141
section 17b-10, may implement the provisions of this subsection while 142
in the process of adopting regulations, provided the commissioner 143
[prints] posts notice of intent to adopt the regulations [in the 144
Connecticut Law Journal within] on the eRegulations System not later 145
than twenty days [of] after adopting such policy. Such policy shall be 146
valid until the time final regulations are effective. 147
(h) To the extent permissible under federal law, an institutionalized 148 Raised Bill No. 5340
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individual, as defined in Section 1917 of the Social Security Act, 42 USC 149
1396p(h)(3), shall not be determined ineligible for Medicaid solely on 150
the basis of the cash value of a life insurance policy worth less than ten 151
thousand dollars provided the individual is pursuing the surrender of 152
the policy. 153
(i) To the extent permissible under federal law, an individual who has 154
applied for Medicaid shall not be determined ineligible solely on the 155
basis of an asset discovered by such individual after the date of 156
application, provided (1) the individual reports the discovery of the 157
asset to the Commissioner of Social Services not later than ten days after 158
the discovery, (2) the individual takes steps within thirty days to 159
liquidate such individual's interest in the asset and spend down the 160
proceeds in accordance with Medicaid income and asset limits, and (3) 161
in the event the individual is unable to gain access to the asset, the 162
Department of Social Services provides assistance to the individual to 163
gain access to the asset. 164
(j) To the extent permissible under federal law, an individual who has 165
applied for Medicaid shall not be determined ineligible on the basis of a 166
single, unliquidated asset, provided such individual presents evidence 167
to the Commissioner of Social Services that such asset is inaccessible to 168
the individual because it is not possible to liquidate the asset in fewer 169
than thirty days. 170
[(i)] (k) Medical assistance shall be provided, in accordance with the 171
provisions of subsection (e) of section 17a-6, to any child under the 172
supervision of the Commissioner of Children and Families who is not 173
receiving Medicaid benefits, has not yet qualified for Medicaid benefits 174
or is otherwise ineligible for such benefits. Medical assistance shall also 175
be provided to any child in the behavioral services program operated 176
by the Department of Developmental Services who is not receiving 177
Medicaid benefits, has not yet qualified for Medicaid benefits or is 178
otherwise ineligible for benefits. To the extent practicable, the 179
Commissioner of Children and Families and the Commissioner of 180
Developmental Services shall apply for, or assist such child in qualifying 181 Raised Bill No. 5340
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for, the Medicaid program. 182
[(j)] (l) The Commissioner of Social Services shall provide Early and 183
Periodic Screening, Diagnostic and Treatment program services, as 184
required and defined as of December 31, 2005, by 42 USC 1396a(a)(43), 185
42 USC 1396d(r) and 42 USC 1396d(a)(4)(B) and applicable federal 186
regulations, to all persons who are under the age of twenty-one and 187
otherwise eligible for medical assistance under this section. 188
[(k)] (m) A veteran, as defined in section 27-103, and any member of 189
his or her family, who applies for or receives assistance under the 190
Medicaid program, shall apply for all benefits for which he or she may 191
be eligible through the United States Department of Veterans Affairs or 192
the United States Department of Defense. 193
[(l)] (n) On and after January 1, 2023, the Commissioner of Social 194
Services shall, within available appropriations, provide state-funded 195
medical assistance to any child eight years of age and younger, 196
regardless of immigration status, whose household income does not 197
exceed two hundred one per cent of the federal poverty level without 198
an asset limit and who does not otherwise qualify for Medicaid, the 199
Children's Health Insurance Program, or an offer of affordable, 200
employer-sponsored insurance as defined in the Affordable Care Act, as 201
an employee or a dependent of an employee. 202
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2022 New section
Sec. 2 July 1, 2022 17b-342(h)
Sec. 3 July 1, 2022 17b-261
Statement of Purpose:
To (1) provide the same Medicaid payment rates to family caregivers
providing the same services as professional caregivers, (2) authorize
retroactive Medicaid coverage for home care if federally permissible,
and (3) not delay a Medicaid eligibility determination due to an asset Raised Bill No. 5340
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discovered after the application or an asset that cannot be liquidated
within thirty days.
[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.]