PA 15-69—sHB 6946

Human Services Committee

AN ACT CONCERNING HUSKY PROGRAMS

SUMMARY: This act makes numerous substantive, technical, and conforming changes to statutes related to the Department of Social Services' (DSS) HUSKY programs. By law, DSS must provide medical assistance in accordance with the state Medicaid plan, the state Children's Health Insurance Program, and federal law.

Among other things, the act creates the term “HUSKY Health” to refer to HUSKY A, HUSKY B, HUSKY C, and HUSKY D and makes a number of conforming changes. The act:

1. expands the definition of HUSKY A, which provides Medicaid to children, caretaker relatives, and pregnant women, to conform to federal law and agency practice by including postpartum women;

2. makes several changes to HUSKY B, the state children's health insurance program (S-CHIP);

3. defines HUSKY C as Medicaid provided to individuals who are age 65 or older or who are blind or have a disability, conforming to agency practice; and

4. defines HUSKY D or Medicaid Coverage for the Lowest Income Populations program as Medicaid provided to nonpregnant low-income adults who are age 18 to 64, conforming to agency practice.

The act makes several changes to conform to current DSS practice on federal Affordable Care Act (ACA) requirements for income eligibility determinations, household definitions, and presumptive eligibility.

The act eliminates requirements for DSS to publish notice of intent to adopt regulations on various topics in the Connecticut Law Journal, and instead requires DSS to publish such notice on its website and the eRegulations system. This conforms to existing law (CGS 4-168) and current practice.

Lastly, the act eliminates obsolete references to the single point of entry servicer used when Medicaid programs were offered through a managed care delivery system. ACA requirements related to interaction between states' Medicaid eligibility determinations and health insurance exchanges made many of these provisions obsolete.

EFFECTIVE DATE: Upon passage, except two technical changes are effective July 1, 2016 ( 11 & 23).

17, 25, 26, 27, & 45 — MAGI RULES

The ACA requires state Medicaid agencies (e. g. , DSS) to use a Modified Adjusted Gross Income (MAGI) methodology to determine eligibility for several Medicaid coverage groups. DSS has been phasing in MAGI methodology since expanding Medicaid in 2010. For coverage dates beginning January 1, 2014, the act requires DSS to use MAGI eligibility rules to determine eligibility for HUSKY A, B, and D. The act codifies DSS practices consistent with federal law regarding MAGI eligibility rules and federal definitions.

Thus, to conform to federal law and current agency practice, the act adjusts program income limits in order to convert to the MAGI rules, which do not include as many income disregards (see BACKGROUND). The act adjusts the income limits for (1) medical assistance for those age 19 and under and their parents or caretaker relatives, (2) subsidized HUSKY B coverage for children, (3) unsubsidized HUSKY B coverage for children, (4) the federal poverty level (FPL) below which the HUSKY Plus program gives priority, and (5) the FPL above which DSS may impose a premium requirement for HUSKY B. (PA 15-5, June Special Session, 374, eliminates unsubsidized HUSKY B coverage. )

To conform to federal law and agency practice, the act adopts the federal definition of “household” and “household income” in place of “family” for purposes of eligibility determinations (see BACKGROUND).

45 — ELIGIBILITY FOR OTHER PROGRAMS

The act eliminates a requirement that DSS, when redetermining eligibility for HUSKY A and B, also determine eligibility for supplemental nutrition assistance, a child care subsidy program, and benefits under any other DSS-administered program. Federal regulations require DSS, for those Medicaid groups whose eligibility is determined through MAGI rules, to redetermine eligibility without requiring additional information from the applicant if possible, which may preclude determining eligibility for additional programs (42 CFR 435. 916).

20 & 25 — PRESUMPTIVE ELIGIBILITY

Hospitals

To conform to federal regulations, the act allows qualified hospitals to determine presumptive Medicaid eligibility. It requires them, when making such a determination, to assist individuals with completing and submitting their Medicaid applications (see BACKGROUND). DSS must provide Medicaid during a presumptive eligibility period to those determined eligible by a qualified hospital.

Qualified Entities

By law, DSS must establish standards and procedures to designate qualified entities that may grant presumptive eligibility for HUSKY A and HUSKY B. Prior law required qualified entities to ensure that a completed application for benefits was submitted to DSS when making a presumptive eligibility determination. The act instead requires them to provide assistance to applicants with completion and submission of the application.

By law, DSS must provide qualified entities with necessary forms for HUSKY A applications and information on how to help parents, guardians, and others complete and file such forms. As an alternative to providing forms, the act allows DSS to provide the entities with information on filing an application electronically.

12, 18, 20, 29, 38, & 45 — HUSKY HEALTH

Under the act, HUSKY Health is the combined HUSKY A, HUSKY B, HUSKY C, and HUSKY D programs that provide medical coverage to eligible children, parents, relative caregivers, people age 65 or older, individuals with disabilities, low-income adults, and pregnant women. The act expands HUSKY A, which provides Medicaid to children, caretaker relatives, and pregnant women, to also include postpartum women, conforming to federal law and current agency practice (see BACKGROUND). (PA 15-5, June Special Session, 370, decreases HUSKY A coverage for nonpregnant adults. )

The act defines (1) HUSKY C as Medicaid provided to people who are age 65 or older or who are blind or have a disability and (2) HUSKY D or “Medicaid Coverage for the Lowest Income Populations” program as Medicaid provided to nonpregnant low-income adults who are age 18 to 64.

The act replaces references to HUSKY programs throughout the statutes with HUSKY Health. It removes explicit references to Medicaid funded programs not included in HUSKY Health from (1) the Behavioral Health Partnership and (2) a requirement that DSS provide coverage for isolation care and emergency services provided by the state's mobile field hospital. It appears that these are conforming changes, as in practice, DSS considers other Medicaid programs (including programs administered through waivers) to be included in HUSKY Health. Similarly, the act also removes an explicit reference to Medicaid from the animal population control program's determination of low-income status. (The program provides sterilization and vaccination services to dogs and cats owned by low-income individuals. ) But, by law, the agriculture commissioner may designate other public assistance programs to be included in this determination.

Prior law required the state Department of Education to establish procedures to allow applicants for free and reduced price meals under the National School Lunch Program to apply for HUSKY A and HUSKY B. The act expands this requirement to also include HUSKY C and D.

Outreach

The act eliminates a requirement that DSS develop mechanisms to increase outreach and maximize enrollment of eligible children and adults in HUSKY A and HUSKY B, and report annually on the implementation and results of these outreach programs. The act also eliminates related provisions including (1) a requirement that DSS contract with severe need schools and community–based organizations to, among other things, distribute applications and information on enrolling in HUSKY A and HUSKY B and (2) a requirement that DSS consult with the Latino and Puerto Rican Affairs Commission, the African-American Affairs Commission, and representatives from minority community-based organizations to develop and implement outreach efforts to increase enrollment of medically underserved children and adults. In practice, outreach activities conducted through the ACA may target these groups.

20 — DURABLE MEDICAL EQUIPMENT

To conform to agency practice, the act defines durable medical equipment as equipment that:

1. can withstand repeated use,

2. is primarily and customarily used to serve a medical purpose,

3. generally is not useful to a person in the absence of an illness or injury, and

4. is nondisposable.

This definition replaces an erroneous federal reference, which presumably referred to a federal definition that included iron lungs, oxygen tents, hospital beds, and wheelchairs used in the patient's home (including certain institutions) whether furnished on a rental basis or purchased, and also included blood-testing strips and blood glucose monitors for individuals with diabetes (42 USC 1395x(n)).

17, 20, 25, 26, & 45 — HUSKY B

State Plan

DSS provides HUSKY B services through S-CHIP, a federal program. Prior law required DSS to submit revisions to the S-CHIP plan to the Appropriations, Human Services, Insurance, and Public Health committees for approval, denial, or modification. The act eliminates this requirement. By law, and in practice, the Council on Medical Assistance Program Oversight (MAPOC) advises DSS on, among other things, the planning and implementation of the health care delivery system for HUSKY B.

Eligible Beneficiary

In addition to converting income limits for eligibility to conform to MAGI rules, the act changes eligibility requirements by redefining “eligible beneficiary” for HUSKY B. The act removes an exclusion for certain children of municipal employees who are eligible for employer-sponsored insurance beginning October 30, 1997. Federal law excludes, with certain exceptions, children of families who are eligible for health benefits coverage under a state health benefits plan based on a family member's employment with a public agency.

The act eliminates the term “enrollee” to describe eligible beneficiaries who receive HUSKY B services and instead defines “member” as an eligible beneficiary who receives services under HUSKY A, B, C, or D, although “eligible beneficiaries” under law unchanged by the act only refers to children receiving HUSKY B benefits.

HUSKY Plus

By law, HUSKY Plus provides supplemental health coverage for HUSKY B members whose needs cannot be accommodated within HUSKY B's basic benefit package. Under prior law, HUSKY Plus was two programs: one providing coverage for HUSKY B recipients with intensive physical needs and one providing coverage for such recipients with intensive behavioral health needs. The act eliminates the HUSKY Plus program for behavioral health. In practice, DSS has instead been providing behavioral health services through the Behavioral Health Partnership since 2006.

The act eliminates a requirement that DSS report annually to the governor and the General Assembly on the HUSKY Plus Programs.

Other Coverage

The act eliminates a requirement that DSS review HUSKY B applications to determine whether applicants or their employers have discontinued employer-sponsored dependent coverage in order to qualify for HUSKY B, and disapprove such applications in certain cases. The act instead requires, in cases where a HUSKY B member has limited benefit insurance coverage for services also covered under HUSKY B, DSS to require the other coverage to pay for the goods or services before any HUSKY B payment.

Referrals to the Exchange

Under prior law, DSS had to provide those people it determined ineligible for coverage under Medicaid-funded programs a written statement notifying them of their ineligibility and advising them of the availability of HUSKY B. The act instead requires DSS to provide those ineligible for HUSKY Health programs a written statement notifying them of their potential eligibility for other insurance affordability programs (e. g. , federal tax credits and subsidies available through the state's health insurance exchange).

BACKGROUND

Household and Household Income

Federal law generally requires state Medicaid agencies to make financial eligibility determinations based on a tax-based concept of family size and household income (i. e. , MAGI-based definitions).

As of January 1, 2014, states can no longer use traditional income disregards for many Medicaid applicants. (Disregards enable applicants to have higher incomes and still qualify for assistance because states disregard a portion of the income. ) Instead, states must determine eligibility based on the applicant's modified adjusted gross income, which is an individual's (or couple's) total income reported to the IRS plus tax-exempt interest and foreign earned income (42 CFR 435. 603).

Hospital Presumptive Eligibility

Federal law requires state Medicaid agencies (e. g. , DSS) to provide Medicaid during a presumptive eligibility period to those determined eligible by a qualified hospital. Under federal law, a qualified hospital is one that:

1. participates as a Medicaid provider;

2. notifies the agency of its election to make presumptive eligibility determinations;

3. agrees to make such determinations consistent with state policies and procedures;

4. at the state's option, helps individuals to complete and submit the full application and understand its requirements; and

5. has not been disqualified by the agency.

Qualified hospitals may make such eligibility determinations for various groups including children, pregnant women, parents and caretaker relatives, and individuals age 19 and older. State agencies may limit such determinations to those based on income (42 CFR 435. 1110).

Medicaid Coverage of Postpartum Women

Federal law requires state Medicaid programs to provide categorical eligibility to any woman receiving Medicaid services during her pregnancy for a period from the last day of pregnancy through the end of the month in which a 60-day period, beginning on the last day of pregnancy, ends (42 CFR 435. 170).

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