Requires the state to pay medicare part A premiums for certain persons and requires local social services to appeal denial of medicare for long term care

Title of bill

An act to amend the social services law, in relation to requiring the state to pay medicare part A premiums for persons eligible for medicare part A and medical assistance and to require local commissioners of social services to appeal denial of medicare coverage before approving medical assistance coverage for long term care

Purpose of the bill

This bill would require the State to pay for Medicare Part A premiums for those persons dually eligible for Medicare Part A and Medicaid and requires local commissioners of social services to appeal denials of Medicare coverage before approving Medicaid coverage for long term care.

Summary of specific provisions

§1 & §2- Amends subdivisions 1 and 2 of 364-i of the Social Services Law, as amended by Chapter 693 of the Laws of 1996, and as amended by Chapter 626 of the Laws of 1987, respectively, to remove "long-term home health care program" from the subdivisions.

§3, §4, §5, §6, §7, and § 11- Amends various sections of the Social Services Law to require: that persons receiving or seeking long-term care and who are eligible for Medicare must fully utilize those benefits, and if such person's application is denied, he or she must appeal such denial or permit the local social services official to do so on his or her behalf.

§ 8- Amends subdivision 3 of 367 -a of the Social Services Law by adding a new paragraph (e) to provide that the State pay for Medicare Part A premiums for those persons dually eligible for Medicare Part A and Medicaid.

§9- Amends subdivision 7 of 367-c of the Social Services Law to require that in the instance when a person receives Medicare coverage and then such person's Medicare coverage is terminated, such person must appeal such denial or permit the local social services official to do so on his or her behalf.

§ 10- Amends subdivision 3 of 367-e of the Social Services Law to direct the Commissioner of Health to apply for any waivers needed to implement these provisions.

§ 12- Effective date.

Justification

It is an established fact that New York State receives less than its fair share of federal financial assistance for its Medicaid program. While the federal government pays greater than 70% of the cost of some states' Medicaid programs, it pays only 50% of New York's. Additionally, the cost of Medicare premiums and the complexity of Medicare long term care reimbursement applications have discouraged people who are eligible for Medicare from seeking this assistance. This has allowed the federal government, which funds Medicare, to avoid paying for these services that Medicare eligibles are entitled to receive. Instead, when these individuals are unable to afford long-term care, state taxpayers are forced to pay for this care through Medicaid. While the State has so far been unable to secure a higher federal Medicaid share. This bill will at least help to ensure that the federal government meets its obligation to Medicare recipients.

Prior legislative history

2007-2008: A4692 2005-2006: A.5462/S.3444

Fiscal implications

Yet to be determined. Cost savings to both counties and the State are expected.

Effective date

This act shall take effect on the one hundred twentieth day after it shall have become a law.