This bill introduces provisional eligibility for Medicaid nursing facility services as part of the long-term care application process, allowing applicants to receive services while their applications are being processed. Specifically, it mandates that the Department of Health and Human Services grant provisional eligibility within 90 days of receiving an application, regardless of whether the application is complete. The bill also stipulates that provisional eligibility will last for 18 months unless a final determination is made sooner, and it requires facilities to comply with contractual terms to receive payments for care provided to provisionally eligible individuals. Additionally, it includes provisions for reimbursement to the department if a final determination denies the application.

The bill makes several amendments to existing law, including the insertion of language that exempts counties from liability for provisional eligibility appropriations and payments related to Medicaid recipients in state institutions. It also establishes two positions within the Department of Health and Human Services to manage the provisional eligibility program and appropriates $1 for the biennium ending June 30, 2027, to fund these expenses. The effective date of the act is set for July 1, 2026.

Statutes affected:
Introduced: 167:8, 167:18-a
As Amended by the Senate: 167:8, 167:18-a
SB543 text: 167:8, 167:18-a