This bill amends the eligibility criteria for Medicaid services related to nursing facilities and home and community-based care. Key changes include the addition of "mobility" to the list of activities of daily living for which assistance is required, and a correction to the federal reference for the definition of "skilled professional medical personnel" from 42 C.F.R. section 432.50(d)(1)(ii) to 432.2. The bill also mandates that the Department of Health and Human Services (DHHS) must consider information from the applicant's primary care physician or nurse practitioner when determining clinical eligibility. Furthermore, it clarifies that the responsibility for making medical eligibility determinations lies with skilled professional medical personnel, and allows the department to obtain necessary medical information for decision-making.

Additionally, the bill stipulates that no applicant undergoing annual redetermination can be denied eligibility without the agreement of their primary care physician or nurse practitioner that they no longer meet the required level of care. This change aims to ensure that clinical assessments are thorough and take into account the recommendations of healthcare providers. The bill does not provide funding or authorize new positions but is expected to incur costs exceeding $2.5 million annually, shared between general and federal funds. The Department of Health and Human Services has expressed concerns that the new requirements could lead to delays in processing applications and potentially jeopardize federal financial participation for Medicaid if eligibility determinations are not made within the mandated timeframe.

Statutes affected:
Introduced: 151-E:3
As Amended by the Senate (2nd): 151-E:3
As Amended by the Senate: 151-E:3