This bill introduces provisional eligibility for Medicaid nursing facility services as part of the long-term care application process. It mandates that the Department of Health and Human Services grant provisional eligibility within 90 days of receiving a long-term care medical assistance application, regardless of whether the application is complete, provided that the nursing facility agrees to comply with the contract terms. Provisional eligibility will last for 18 months unless a final determination is made on the application or other specified conditions occur. The bill also stipulates that the department will make payments to providers for care at the same rate as fully eligible individuals during this provisional period, and any provider receiving such payments must reimburse the department if the application is ultimately denied.

Additionally, the bill appropriates $1,500,000 for the biennium ending June 30, 2027, to fund 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 certain state institutions. The effective date for this act is set for July 1, 2026.

Statutes affected:
Introduced: 167:8, 167:18-a
SB543 text: 167:8, 167:18-a