•  Summary 
  •  Actions 
  •  Committee Votes 
  •  Floor Votes 
  •  Memo 
  •  Text 
  •  LFIN 
  •  Chamber Video/Transcript 

A09017 Summary:

Amd 4403-f, Pub Health L; amd 366-a, Soc Serv L
Provides for automatic enrollment and recertification simplification for Medicaid managed care plans and long term care plans.
Go to top    

A09017 Actions:

01/10/2020referred to health
Go to top

A09017 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law and the social services law, in relation to automatic enrollment and recertification simplification for Medicaid eligible recipients   PURPOSE OR GENERAL IDEA OF BILL: To shorten and simplify Medicaid long term care eligibility processes.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends Public Health Law § 4403-f to enable auto-assignment in a managed long term care plan when a person determined to be eligible has not chosen a plan within the first 75 days of eligibility, and extends that eligibility if auto-assignment is not completed within 75th days. Sections 2 and 3 amend Social Services Law § 366-a to make the Medicaid recertification process less burdensome and error-prone by allowing attestation of resources that are unchanged or have diminished, and providing automatic recertification for Managed Long Term Care (MLTC) enrollees, mainstream managed care members receiving personal care services, enrollees in the Aged, Blind, and Disabled Category without excess income and Medicare Savings Program recipients.   JUSTIFICATION: People who have successfully applied for Medicaid in order to enroll in a MLTC plan face many hurdles and delays before they are effectively enrolled. First, an in-home eligibility assessment by a nurse can take several weeks to schedule and this assessment is valid for only 75 days. After that assessment is completed, the Medicaid recipient will schedule in-home assessments with prospective MLTC plans to determine the level of care each will provide. It can take several weeks to schedule and complete those visits. Once the recipient agrees to a plan, the plan will process enrollment, which is effective either the first of the following month, or, if it is already after the 18th, effective the first of the month after the following month. If 75 days have lapsed at this point, the process restarts at the beginning, resulting in care delays. Currently, Medicaid recipients complete a mail renewal form, attesting to their income, once a year in order to continue to receive health care coverage. This is true even if the recipient is on a fixed income. The recertification process is so prone to errors that it frequently results in a discontinuance of eligibility. The recipient may not receive the discontinuance notice on time or at all, or may not be able to request a fair hearing within 10 days, which automatically triggers dis-enroll- ment. In 2011, the Medicaid program recognized the problems and initi- ated a demonstration program to automate renewals for Aged, Blind and Disabled Medicaid recipients with fixed incomes. This bill extends the benefits of that demonstration to the rest of the program.   PRIOR LEGISLATIVE HISTORY: 2019: A.7578A -- Vetoed   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: 180 days after enactment.
Go to top

A09017 Text:

                STATE OF NEW YORK
                   IN ASSEMBLY
                                    January 10, 2020
        Introduced  by M. of A. GOTTFRIED, DINOWITZ -- read once and referred to
          the Committee on Health
        AN ACT to amend the public health law and the social  services  law,  in
          relation  to  automatic  enrollment and recertification simplification
          for Medicaid eligible recipients
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Paragraph  (b)  of subdivision 7 of section 4403-f of the
     2  public health law is amended by adding a new subparagraph (iii) to  read
     3  as follows:
     4    (iii)  Where  a  person  determined  eligible  for Medicaid ("Medicaid
     5  recipient") has been determined by the commissioner or his or her desig-
     6  nee to require community-based long term care services for more  than  a
     7  continuous period of one hundred twenty days, and the Medicaid recipient
     8  has  not selected and enrolled in a managed long term care plan prior to
     9  any expiration date of such determination of need for  long  term  care,
    10  after  being  provided  with information to make an informed choice, the
    11  commissioner shall assign the recipient to  a  managed  long  term  care
    12  plan,  taking  into  account  consistency with any prior community-based
    13  direct care  workers  having  recently  served  the  recipient,  quality
    14  performance  criteria,  capacity,  and  geographic  accessibility.   The
    15  commissioner may assign participants pursuant  to  such  criteria  on  a
    16  weighted  basis.   A recipient assigned to a managed long term care plan
    17  under this subparagraph shall be deemed to have been determined to be in
    18  need of long term care services for more than a continuous period of one
    19  hundred twenty days and eligible to be enrolled in a managed  long  term
    20  care plan.
    21    §  2.  Paragraph  (b)  of subdivision 2 of section 366-a of the social
    22  services law, as added by section 51 of part A of chapter 1 of the  laws
    23  of 2002, is amended to read as follows:
    24    (b)  Notwithstanding  the provisions of paragraph (a) of this subdivi-
    25  sion, an applicant or recipient may attest to the amount of his  or  her
    26  accumulated  resources,  unless  such  applicant or recipient is seeking
    27  medical assistance payment for long term care  services  for  the  first
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 9017                             2
     1  time.  A  recipient  who has already provided documentation of resources
     2  may attest to the amount of accumulated resources if it has remained the
     3  same or is less than the amount originally documented.  For purposes  of
     4  this  paragraph,  long  term  care  services shall mean care, treatment,
     5  maintenance, and services described in paragraph (b) of subdivision  [1]
     6  one  of  section  three  hundred  sixty-seven-f  of this title, with the
     7  exception of short term rehabilitation, as defined by  the  commissioner
     8  of health.
     9    §  3.  Paragraph  (d)  of subdivision 5 of section 366-a of the social
    10  services law, as amended by section 12 of part D of chapter  56  of  the
    11  laws  of 2013, is relettered paragraph (e) and three new paragraphs (f),
    12  (g) and (h) are added to read as follows:
    13    (f) Notwithstanding paragraph (b) of subdivision two of  this  section
    14  and  paragraphs (a), (b), (c) and (d) of this subdivision, the following
    15  recipients will be recertified automatically, unless there  has  been  a
    16  finding of lack of eligibility for Medicaid:
    17    (i)  enrollees  in Medicaid managed long term care plans as defined in
    18  section forty-four hundred three-f of the public health law;
    19    (ii) enrollees in Medicaid managed care plans as  defined  in  section
    20  three  hundred  sixty-four-j  of  this  title  who receive personal care
    21  services pursuant to paragraph (e) of subdivision two of  section  three
    22  hundred sixty-five-a of this title or consumer directed personal assist-
    23  ance  services  pursuant  to  section three hundred sixty-five-f of this
    24  title;
    25    (iii) enrollees receiving Medicaid in the  Aged,  Blind  and  Disabled
    26  category  who  receive  fixed  income  from the Social Security Adminis-
    27  tration (SSA); and
    28    (iv) Medicare Savings Program (MSP) recipients who have a fixed income
    29  from the Social Security Administration (SSA).
    30    (g) Nothing in paragraph (e) of this subdivision should  be  construed
    31  to  alter a Medicaid recipient's obligation to inform the public welfare
    32  district of changes in income or other factors that might impact  eligi-
    33  bility pursuant to subdivision four of this section.
    34    (h)  Upon  a  finding of lack of eligibility, recipients identified in
    35  paragraph (e) of this subdivision will be entitled to notice and hearing
    36  rights as provided in section twenty-two of this chapter.
    37    § 4. This act shall take effect on the one hundred eightieth day after
    38  it shall have become a law; provided that the  amendments  to  paragraph
    39  (b)  of subdivision 7 of section 4403-f of the public health law made by
    40  section one of this act shall be subject to the expiration and reversion
    41  of such paragraph and shall expire and be deemed repealed therewith  and
    42  provided  further  that  such  amendments shall not affect the repeal of
    43  such section and shall expire and be deemed repealed  therewith.  Effec-
    44  tive  immediately, the commissioner of health shall make regulations and
    45  take other actions reasonably necessary to implement this  act  on  that
    46  date.
Go to top