BILL NUMBER: S1617
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.
 
SUMMARY OF PROVISIONS:
Section 1 amends Public Health Law (PHL) section 4403-f, as it relates
to Health Maintenance Organizations (HMOs), to enable auto-assignment in
a Managed Long Term Care (MLTC) 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 that person does not complete auto-as-
signment within 75 days.
Sections 2 and 3 amend Social Services Law section 366-a, as it relates
to applications for assistance; investigations; reconsideration, 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 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:
2023-24: S4622-B Rivera/A5980-A Paulin - Passed Senate
2021-22: S4965 Rivera/A155 Gottfried - Passed Senate
2020: S7523 Rivera/A9017 Gottfried - Advanced to 3rd Reading
2019: S5485-A Rivera/A7578-A Gottfried - Vetoed Memo. 183
 
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:
S1617: 4403-f public health law, 4403-f(7) public health law, 366-a social services law, 366-a(2) social services law