OLR Bill Analysis
AN ACT CONCERNING PRESUMPTIVE MEDICAID ELIGIBILITY FOR THE CONNECTICUT HOME-CARE PROGRAM FOR THE ELDERLY.
This bill requires the Department of Social Services (DSS) commissioner to implement presumptive eligibility for individuals applying to the Medicaid-funded portion of the Connecticut Home Care Program for Elders (CHCPE). He must do this in consultation with the aging commissioner (who has not been appointed) by October 1, 2013.
Presumptive eligibility allows an applicant to be determined immediately eligible for enrollment in CHCPE without initially requiring a full Medicaid-eligibility determination. Under the bill, the state will pay for up to 90 days of care for applicants who (1) require a skilled nursing home level of care and (2) are determined presumptively eligible for Medicaid.
During the 90-day presumptive eligibility period, state costs must be offset by (1) available federal Medicaid reimbursements and (2) savings realized from providing home- and community-based care instead of institutional care that would have been necessary without presumptive eligibility.
The bill requires the DSS commissioner to adopt regulations to implement and administer the new system.
EFFECTIVE DATE: October 1, 2013
PRESUMPTIVE ELIGIBILITY SYSTEM
By law, DSS contracts with “access” agencies (currently three) to determine CHCPE participants' service needs and develop individualized care plans. The bill requires the commissioner to develop a screening tool for these agencies to use to determine if a presumptive eligibility applicant is (1) functionally able to live in a home or community setting and (2) likely to be financially eligible for Medicaid. The commissioner must authorize these agencies to initiate home care services within five days of making this determination. DSS must then make a presumptive financial eligibility determination within 72 hours after the functional eligibility determination is completed.
The bill requires applicants to sign a written agreement attesting to the accuracy of the information they provide. The agreement must also acknowledge that applicants will (1) receive state-funded services within 90 days of applying for Medicaid coverage and (2) complete a Medicaid application on the day they are screened for functional eligibility, or no later than 10 days after the screening.
DSS must make a final Medicaid-eligibility determination for presumptive eligibility applicants within 45 days of receiving a completed Medicaid application.
Offsetting State Costs
For presumptive eligibility applicants deemed Medicaid-eligible, the bill requires the DSS commissioner to retroactively apply the final eligibility determination and request all available federal matching funds to cover state costs during the presumptive eligibility period.
For applicants deemed Medicaid-ineligible, the DSS commissioner must consult with the aging commissioner and identify federal Older Americans Act funding that may be allocated to subsidize state costs during this period.
CHCPE is a Medicaid waiver and state-funded program that provides home- and community-based services for qualifying individuals ages 65 and older who are institutionalized or at risk of institutionalization. Services include care management, adults day and foster care, personal care assistance, homemaker services, transportation, meals-on-wheels, minor home modifications, and certain assisted living services.