Aging Committee
JOINT FAVORABLE REPORT
Bill No.: SB-418
AN ACT INCREASING THE PERSONAL NEEDS ALLOWANCE FOR CERTAIN
LONG-TERM CARE FACILITY RESIDENTS AND AUTHORIZING A
DEDUCTION FOR CONSERVATOR EXPENSES FROM THE AMOUNT OF
Title: INCOME A MEDICAID RECIPIENT APPLIES TO THE COST OF CARE.
Vote Date: 3/2/2021
Vote Action: Joint Favorable Substitute
PH Date: 2/23/2021
File No.:
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
Aging Committee
REASONS FOR BILL:
Currently the personal needs allowance for Medicaid patients is $60 per month. This monthly
allowance has remained the same since 2011. This bill would increase the monthly personal
needs allowance to $72 a month which would better the quality of life for these residents. In
many cases the current personal needs allowance does not cover the bare necessities
required by the residents. The bill will increase the amount of personal income a long-term
facility resident may keep and authorize a deduction for conservator expenses from the
amount of income a Medicaid recipient must apply toward the cost of their care.
RESPONSE FROM ADMINISTRATION/AGENCY:
Senator Paul Formica, Connecticut General Assembly: His testimony was offered in
support of this legislation. The personal needs allowance has not changed since 2011 when it
was reduced from $69 to $60 and the cost of living adjustment indexing was eliminated. He
believes that this is about the quality of life of someone at their most vulnerable and it is time
to provide relief to our long-term care facility residents.
Mairead Painter, Long-Term Care Ombudsman, Dept. of Aging and Disability Services:
She supports this bill and points out that the legislature voted temporarily to decrease the
resident's monthly personal needs allowance and eliminate the COLA. She acknowledges the
current challenges faced by the state's financial state, but she asks the General Assembly to
consider that residents have done their part and to increase the personal needs allowance to
$72.50. She also supports the ability to deduct conservator expenses from the amount of
income a Medicaid recipient applies to the cost of care. She understands that due to the
reimbursement restrictions that many conservators who previously did this work are no longer
taking on cases. It is important that the Probate Court has access to persons willing to serve
as conservators.
Dept. of Social Services: They submitted testimony opposition to this proposal pointing out
that the $60 is above the average for the States in the Northeast and is $30 above the federal
minimum. Increasing the personal needs allowance would have a negative fiscal impact on
the state budget. Also, Section 4 requires that DSS approve fees above the baseline amount
if approved by the Probate Court. This would place additional administrative and fiscal
burdens on DSS by requiring staff to recalculate a recipient's applied income at various times
during the year. Finally, the bill would increase the percentage of costs the state would be
liable to pay for nursing home services provided to a Medicaid recipient. We anticipate that
this increase would result in a significant cost that is not provide for within the current budget.
Michael Werner, Attorney, The Commission on Women, Children, Seniors, Equity and
Opportunity: They offered testimony in support of this bill. Medicaid patients in long-term
care often have outside income, such as Social Security or pension, but Medicaid take most
of the money to defray care costs, which leaves little to spend on personal items. Personal
Needs Allowance also covers co-pays for prescriptions, clothing, adult diapers, a phone, or
whatever else the recipient needs. This bill would increase the personal needs allowance
from $60 to $72 a month.
Beverly Streit-Kefalas, Probate Court Administrator, Connecticut Probate Court: She
submitted testimony in support of this proposal. The legislation will enable our state to begin
receiving federal Medicaid reimbursement for monies expended in providing conservators for
indigent conserved persons. Federal reimbursement will save the state and estimated
$885,000 annually. Our state looks to the Probate courts to find conservators for conserved
persons who have no family or close friends and to pay for the services of the conservator
when the conserved person is indigent. The annual expenditure was $5.5 million in 2020
representing 12% of the system's annual expenses. Several states have already secured the
necessary federal approval to implement this structure, including Massachusetts, Rhode
Island and Vermont.
NATURE AND SOURCES OF SUPPORT:
Mag Morelli, President, LeadingAge Connecticut: Her testimony is in support of this bill
with some qualifications. Section 1 of the bill would increase the Personal Needs Allowance
for nursing home residents from $60 to $72 and they are supportive. The PNA can enhance a
person's quality of life as a resident of a nursing home. They are concerned about Section 2
of the bill because it is unclear how the deduction would be funded, and we would object if
the intent is to reduce the total amount paid to the nursing home by the amount of the
deduction. It may be that the intent is to have the Medicaid payment to the nursing home
increase by the amount of the applied income deduction, which would make the nursing
home payment whole. They request that clear assurances be placed in the language of the
bill that the deduction from the applied income calculation will not reduce payments to the
nursing home.
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Joelen Gates, Attorney, Connecticut Legal Services, Willimantic: They submitted
testimony in support of Section 1&2, Conditional Support of Section 3 and no comment on
Section 4&5. They believe that the Personal Needs Allowance be increased from $60 to $72.
Section 3 of the bill would require the DSS to seek federal approval to amend the state
Medicaid plan to allow deduction from the income of conserved nursing home residents.
While they don't object to this concept it is important that deductions for probate court fees
and expenses be deducted only after the other currently permissible federal deductions.
Nursing home residents are required to pay all their income towards the cost of their care in
the nursing home except for a personal needs allowance, for residents with a minor child, a
family allowance, for married residents, unpaid medical expenses and a community
allowance to maintain a home if the resident is expected to return home within 6 months. If
the conserved nursing home resident has an income remaining after deducting theses
expenses, the probate court fees could be deducted.
Anna Doroghazi, AARP Connecticut: Their comments were in support of Sections 1 & 2.
They point out that since 2011 when the Personal Needs Allowance was reduced to $60 by
the legislature there has been no changes made. They believe that increasing the level to
$72 would help nursing home residents to maintain a level of independence and dignity.
Matt Barrett, President and CEO, Connecticut Assoc. of Health Care Facilities: They are
in support of Section 1 & 2 of this bill in that it would provide a long-time overdue increase of
the nursing home resident personal needs allowance. Section 3 of the bill alters the applied
income arrangement by requiring that a deduction of the conservation expenses be deducted
from the applied income amount. The effect of these deductions would be to reduce the
amount of applied income going toward the cost of nursing home care for Medicaid
recipients. To assure that the Medicaid payment to the nursing home is increased as the
applied income is reduced which is the apparent intended outcome of the bill, they request
that the language be amended as follows (on line 36) after "are permissible under federal
law." be added "Whenever such conservator fees and other expenses are deducted from the
applied income, the Medicaid payment to the nursing home shall be increased in an amount
equal to the reduced applied income."
Patty Bausch, Newtown Rehabilitation Center: She submitted testimony in support of this
bill. She believes the Personal Needs Allowance should be increased from $60 to $72 a
month.
Deb Arel, Resident Council Board at Branford Hills Health Care Center: They submitted
testimony in favor of this proposal. While the increase is not much it would make a difference
for their dignity and quality of life.
James Young, Attorney, The Connecticut Chapter' The National Academy of Elder Law
Attorneys: His testimony was in support of this legislation. He points out that the
Connecticut rate was set in 1998 at $50 and it rose to $69 in 2011 when it was reduced to
$60, additionally the COLA was eliminated at the same time. We know that the cost of living
has increased significantly since that time. He advises that it appears that approximately 15
states have PNA amounts higher than Connecticut. He believes that if this bill were enacted
the burden to the state would be insignificant but that it would mean a lot to the thousands of
persons living in nursing homes.
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NATURE AND SOURCES OF OPPOSITION:
Jeryl Gray, Constituent, Stratford Connecticut: The testimony submitted by were in
opposition to this bill. His comments did not touch on Sections 1 or 2. Her comments were
directed toward Section 3 and 4 that concerned the Connecticut Probate Court System which
she does not hold in high regard. She is opposed to "any direction of action that would serve
to increase any of the powers of what he sees as the already grossly over-powered, above-
the-law Connecticut Probate Court System, a system which may be better characterized as
being a rampantly corrupt, self-servicing, predatory, rapacious, human trafficking racketeering
enterprise."
Reported by: Richard Ferrari, Assistant Clerk Date: 3/12/21
Richard ONeil, Assistant Clerk
Joseph Perkus, Clerk
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Statutes affected:
Committee Bill:
AGE Joint Favorable Substitute:
File No. 60: