Makes provisions regarding medical assistance presumptive eligibility program

BILL NUMBER:S1606A

Title of bill

An act to amend the social services law, in relation to the medical assistance presumptive eligibility program

Purpose

The purpose of this bill is to ensure that uninsured persons discharged from mental hospitals or released from prisons or jails have continuous access to medical care for their mental illness.

Summary of provisions

This bill would amend Section 364-i of the social services law to expand the medical Assistance Presumptive Eligibility Program to include persons without insurance who are discharged from psychiatric inpatient care from a state hospital, a prison operated by the state, county or city of New York. Under the bill, such individuals would be presumed eligible for Medicaid coverage for care, services and supplies to treat a mental illness for up to 90 days from the date of discharge. The bill would require the Department of Health to submit a report on the impact of expanding the program to include persons discharged from psychiatric inpatient care. Current law limits presumptive eligibility for medical assistance to uninsured individuals who are transferred from general hospitals to a certified home health agency or a long term home health care program, if the individual meets eligibility criteria established by a local department of social services.

Justification

The mentally ill who are released from State mental hospitals, prisons or jails seldom have health care coverage at the time of discharge or release. Without follow-up medical care, including medications they have been taking within those facilities, they decompensate and act out in the community, which causes them to be reincarcerated or rehospitalized. If medications, clinic visits, and other follow-up care that was part of their discharge plan were available to them immediately upon release, they would have a much better chance to remain stable and in our communities. Since these people are prohibited from applying for Medicaid until their release, and there is a time lapse between application and acceptance into the Medicaid program, presumptive eligibility proves its effectiveness, as was shown by a study done several years ago by the Office of Mental Health.

Legislative history

First introduced in 2001.

Fiscal implications

Under existing law, there exists retroactive eligibility for Medicaid for 3 months prior to application, thus this legislation will have minimal fiscal impact. Any increased cost due to growth of utilization or the assumption of the local share should be offset by the savings that are anticipated due to the reduced rate of recidivism. In the event that eligibility is denied, the Commissioner of Health is authorized to recoup the costs from the individual.

Effective date

Effective April 1, 2013.