AN ACT CONCERNING MEDICAID FUNDING FOR SAGA AND CHARTER OAK.

This bill requires the Department of Social Services (DSS) commissioner, by January 1, 2010, to apply for a federal Medicaid 1115 demonstration waiver to provide Medicaid coverage to individuals qualifying for either the State-Administered General Assistance (SAGA) medical assistance program or the Charter Oak Health Plan (see BACKGROUND). Currently, state funds are used to pay for the SAGA program and the subsidized portion of the Charter Oak Health Plan. Medicaid coverage would provide federal matching funds for these state expenditures.

The bill requires the commissioner to submit the application to the Human Services and Appropriations committees before sending it to the federal Medicaid agency, in accordance with state law. If he fails to do so by January 1, 2010, he must submit a written report to both committees, by January 2, 2010, explaining (1) why he has not done so and (2) an estimate of the cost savings that such a waiver would provide in a single calendar year.

Under current law, the DSS commissioner, by January 1, 2008, was to have sought a waiver to cover SAGA recipients with income up to 100% of the federal poverty level. He never sought the waiver. The bill repeals this separate provision.

Federal Medicaid law (Section 1115 of the Social Security Act) allows states to request “demonstration” waivers of federal rules to expand health care coverage when those rules would otherwise not allow such, or to limit whom the program covers. These waivers are generally good for five years unless renewed.

States may still request 1115 waivers, which are research and demonstration waivers that allow states to experiment with coverage. These states must be able to demonstrate that they are “budget neutral” over the life of the demonstration, meaning they cannot be expected to cost the federal government more than it would cost without the waiver.

State law requires the DSS commissioner, when applying for a federal waiver for other than routine operational issues, to submit the application to the Human Services and Appropriations committees before sending it to the federal government. The committees have 30 days to hold a hearing and advise the commissioner of their approval, denial, or modification of it. If they deny the application, the commissioner may not submit it to the federal government. The law also sets up a process for when the committees do not agree. If the committees do not act within the 30 day period, the application is deemed approved.

In 2003, the legislature directed DSS to seek a Medicaid waiver to cover SAGA medical assistance recipients by March 1, 2004 (PA 03-3, June 30 SS). In 2007, the legislature extended the deadline from March 1, 2004 until January 1, 2008 and extended it to individuals with incomes up to 100% of the FPL (PA 07-185). Currently, SAGA medical assistance is available to individuals with income up to about 55% of the FPL.

Since August 2008, the Charter Oak Health Plan has offered state residents another health insurance option. Individuals must be uninsured for at least six months to qualify and benefits are provided by managed care organizations. The state provides both premium and deductible assistance to individuals whose incomes are under 300% of the federal poverty level.

The Senate referred the bill (File 195) to Appropriations, which removed a requirement that the waiver have a certain designation.

SHB 6402 (File 509) requires DSS to seek a federal waiver for SAGA and Charter Oak by January 1, 2010.

Yea

Nay

(03/10/2009)

Yea

Nay

(04/27/2009)