BILL NUMBER: S4622B
SPONSOR: RIVERA
 
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:
To shorten and simplify Medicaid long term care eligibility processes.
 
SUMMMARY OF 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 75
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. These provisions
would be subject to federal financial participation.
Section 4 provides for the effective date.
 
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 MTLC 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,
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 disenrollment.
In 2011, the Medicaid program recognized the problems and initiated 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.
 
LEGISLATIVE HISTORY:
2022: S4965 (Rivera) - Passed Senate
2021: S4965 (Rivera) - Passed Senate
2020: S7523 (Rivera) - Advanced to 3rd Reading
2019: S5485-A (Rivera) - Vetoed
 
FISCAL IMPLICATIONS:
None noted
 
EFFECTIVE DATE:
This act shall take effect 180 days after it becomes law. Sections 2 and
3 will be subjected to federal financial participation, therefore, these
sections will not take effect until the federal center for Medicaid and
Medicare services (CMS) approves in writing to the state commissioner
that the changes do not affect eligibility requirements and federal
participation is not affected.

Statutes affected:
S4622: 4403-f public health law, 4403-f(7) public health law, 366-a social services law, 366-a(2) social services law
S4622A: 4403-f public health law, 4403-f(7) public health law, 366-a social services law, 366-a(2) social services law
S4622B: 4403-f public health law, 4403-f(7) public health law, 366-a social services law, 366-a(2) social services law