Revision: March 27, 2014, midnight
HB 461-FN – AS AMENDED BY THE HOUSE
22Jan2014… 2337h
5Mar2014… 0426h
2013 SESSION
01/10
HOUSE BILL 461-FN
AN ACT relative to long-term care services.
SPONSORS: Rep. Donovan, Sull 4
COMMITTEE: Health, Human Services and Elderly Affairs
This bill clarifies long-term care eligibility for the purpose of receiving Medicaid-funded nursing home services.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
22Jan2014… 2337h
5Mar2014… 0426h
13-0756
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Thirteen
AN ACT relative to long-term care services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Long-Term Care; Eligibility. Amend RSA 151-E:3 by inserting after paragraph II the following new paragraph:
II-a. Subject to written approval by the Center for Medicare and Medicaid Services, financial eligibility rules in paragraph II shall include eligibility if the person’s countable income is at or below the nursing facility special income standard, as defined in 42 C.F.R. 435.236, for the Medicaid program or the person incurs allowable medical expenses each month, including the anticipated cost of waiver services, which when deducted from the individual’s income would reduce the individual’s income to an amount that is no higher than the nursing facility special income standard. The department shall submit a request for such approval within 30 days of the effective date of this paragraph.
2 Effective Date. This act shall take effect upon its passage.
LBAO
13-0756
Amended 03/12/14
HB 461-FN FISCAL NOTE
AN ACT relative to long-term care services.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as amended by the House (Amendment #2014-0426h), will have an indeterminable fiscal impact on state revenue and expenditures in FY 2015 and each year thereafter. There will be no fiscal impact on county or local revenues and expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill would alter the financial eligibility rules for individuals applying for or receiving Choices for Independence (CFI) services subject to written approval from the Centers for Medicare and Medicaid Services (CMS). The Department states individuals must be clinically and financially eligible for CFI services. Financial eligibility is determined first. Currently, eligibility for these services is determined at the beginning of the each month as follows:
• Individuals with monthly gross income no higher than $2,163 are eligible as categorically needy. ($2,163 is the monthly special income limit for long term care programs.)
• If an individual’s gross income exceeds $2,163:
• The individual’s net income is determined.
• The $591 medically needy income limit is subtracted from the individual’s net income. The excess income is equal to the amount the individual must “spend down” in medical costs, including the cost of room and board for residential care, in order to become or remain eligible for services.
• If an individual’s medical costs exceed the excess income, the person is determined to be eligible.
• After an individual is determined to be financially eligibility, clinical eligibility is determined.
CFI program participants are required to notify the Department within 10 days of any change in income or resources. The Department indicates under the proposed bill, financial eligibility would be determined on an annual basis. The Department assumes the bill would not increase the number of CFI recipients or result in additional costs since there would be no change in clinical or financial eligibility standards. Absent the time required to do a more detailed analysis of the remaining 17 cases, the Department randomly selected and reviewed a sample of 17 of the total of 34 case files for medically needy CFI recipients. In each case, the recipients consistently met their required spend down amount on the first day of each month. The Department assumes the remaining 17 medically needy CFI recipients also satisfy their required spend down each month. Individuals would still be required to notify the department within 10 days of any change in income or resources.
The bill would allow current and future CFI medically needy recipients with gross monthly income in excess of the special income limit for long term care programs, and with medical costs above their excess income to remain eligible for Medicaid without the monthly verification and without having their cases opened and closed each month. The Department indicates bill would simplify administration of the eligibility determination process as staff would no longer need to process each CFI medically needy recipient on a monthly basis. The administrative savings related to this change cannot be determined. There would be additional one-time costs to modify the New HEIGHTS eligibility system. The Department is not able to estimate this cost but expects it will be minimal.
The New Hampshire Association of Counties states this bill will have no determinable fiscal impact on county revenue and expenditures.