This bill introduces provisional eligibility for Medicaid nursing facility services as part of the long-term care application process, allowing individuals to receive care 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 provisional eligibility will last for up to 18 months, with payments made at the same rate as fully eligible individuals. Additionally, the bill stipulates that if a final determination on the application is not made within 12 months, the care provider may initiate an action for a special Medicaid representative. The bill also includes provisions for reimbursement to the department by providers who received payments for services rendered to provisionally eligible individuals.

Furthermore, the bill appropriates $1.5 million for the FY26/27 biennium to fund these provisional eligibility expenses and establishes two positions within the Department of Health and Human Services to manage the program. It also amends existing law to clarify that counties will not be liable for provisional eligibility appropriations and payments related to Medicaid recipients in state institutions. The effective date for this 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