OLR Bill Analysis

SB 151

AN ACT CONCERNING RETROACTIVE MEDICAID ELIGIBILITY FOR HOME-CARE SERVICES.

SUMMARY

This bill requires the Department of Social Services (DSS) commissioner to retroactively provide, in accordance with federal regulations, retroactive benefits to applicants to the Connecticut Home Care Program for Elders (CHCPE) for up to three months before the date of their application. In practice and under federal law, DSS already makes retroactive payments for certain other Medicaid-eligible 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 requires the penalty period for CHCPE residents to start on the later of the (1) first of the month in which the penalized transfer occurred or (2) date the applicant would have received services if not for the penalty. Under current practice, DSS starts the penalty period on the date the application is approved. Thus, CHCPE recipients would generally receive their benefits sooner under the bill.

EFFECTIVE DATE: October 1, 2018

BACKGROUND

Retroactive Medicaid Payments

Under federal regulations, individuals are eligible for up to three months of retroactive Medicaid coverage, provided they (1) received Medicaid-covered services during that time and (2) would have been Medicaid eligible if they had applied (42 CFR § 435.915).

Asset Transfer Penalties

In general, the penalty period (in months) is calculated by dividing the value of all assets transferred 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 services and supports during the penalty period. For example, an individual with $100,000 in transferred assets would incur a 20 month penalty period if the average private pay nursing home rate is $5,000 per month.

Connecticut Home Care Program for Elders

CHCPE is a Medicaid waiver and state-funded program that provides a range of home- and community-based services for eligible individuals age 65 and older who are at risk of institutionalization. To be eligible for CHCPE, individuals must be under income and asset limits.

COMMITTEE ACTION

Aging Committee

Joint Favorable