What's happening
This bill streamlines Medicaid enrollment and recertification processes, including automatic plan assignments and simplified renewals for certain recipients.
Why it matters
Reduces administrative burden for vulnerable populations. by allowing many Medicaid recipients—especially those who are elderly, disabled, or have fixed Social Security income—to be automatically recertified for coverage, minimizing the risk of losing benefits due to paperwork lapses.
Ensures continuity of care for those needing long-term services. by automatically assigning eligible individuals to managed long term care plans if they do not select one themselves, and by considering factors like previous caregivers, plan quality, and geographic access in the assignment process.
Maintains safeguards and accountability. by requiring recipients to continue reporting changes that could affect eligibility, and by guaranteeing notice and hearing rights if someone is found ineligible during the automatic renewal process.
Potentially accelerates access to needed services. for new and existing recipients by simplifying resource documentation requirements, especially for those whose financial situation has not changed, thus expediting eligibility determinations and recertifications.
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Who cares
Headline styles
Simplify Medicaid Enrollment Process
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Vetoed memo.183
- Delivered to governor
- Returned to senate
- Passed assembly
- Ordered to third reading rules cal.552
- Substituted for A7578A
- Referred to ways and means
- Delivered to assembly
- Passed senateVote 62–0
- Amended on third reading 5485a
- Advanced to third reading
- 2nd report cal.
Show 2 earlier actions
- 1st report cal.1107
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Simplify Medicaid Enrollment
Assembly Floor Calendar · Sponsor Richard Gottfried
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5485--A Cal. No. 1107
2019-2020 Regular Sessions
IN SENATE
May 2, 2019
Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- reported favorably from said committee, ordered to first and second report, ordered to a third reading, amended and ordered reprinted, retaining its place in the order of third reading
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
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph (b) of subdivision 7 of section 4403-f of the public health law is amended by adding a new subparagraph (iii) to read as follows:
(iii) Where a person determined eligible for Medicaid ("Medicaid recipient") has been determined by the commissioner or his or her designee to require community-based long term care services for more than a continuous period of one hundred twenty days, and the Medicaid recipient has not selected and enrolled in a managed long term care plan prior to any expiration date of such determination of need for long term care, after being provided with information to make an informed choice, the commissioner shall assign the recipient to a managed long term care plan, taking into account consistency with any prior community-based direct care workers having recently served the recipient, quality performance criteria, capacity, and geographic accessibility. The commissioner may assign participants pursuant to such criteria on a weighted basis. A recipient assigned to a managed long term care plan under this subparagraph shall be deemed to have been determined to be in need of long term care services for more than a continuous period of one hundred twenty days and eligible to be enrolled in a managed long term care plan.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11182-04-9
S. 5485--A 2
§ 2. Paragraph (b) of subdivision 2 of section 366-a of the social services law, as added by section 51 of part A of chapter 1 of the laws of 2002, is amended to read as follows:
(b) Notwithstanding the provisions of paragraph (a) of this subdivision, an applicant or recipient may attest to the amount of his or her accumulated resources, unless such applicant or recipient is seeking medical assistance payment for long term care services for the first time. A recipient who has already provided documentation of resources may attest to the amount of accumulated resources if it has remained the same or is less than the amount originally documented. For purposes of this paragraph, long term care services shall mean care, treatment, maintenance, and services described in paragraph (b) of subdivision [1] one of section three hundred sixty-seven-f of this title, with the exception of short term rehabilitation, as defined by the commissioner of health.
§ 3. Paragraph (d) of subdivision 5 of section 366-a of the social services law, as amended by section 12 of part D of chapter 56 of the laws of 2013, is relettered paragraph (e) and three new paragraphs (f), (g) and (h) are added to read as follows:
(f) Notwithstanding paragraph (b) of subdivision two of this section and paragraphs (a), (b), (c) and (d) of this subdivision, the following recipients will be recertified automatically, unless there has been a finding of lack of eligibility for Medicaid:
(i) enrollees in Medicaid managed long term care plans as defined in section forty-four hundred three-f of the public health law;
(ii) enrollees in Medicaid managed care plans as defined in section three hundred sixty-four-j of this title who receive personal care services pursuant to paragraph (e) of subdivision two of section three hundred sixty-five-a of this title or consumer directed personal assistance services pursuant to section three hundred sixty-five-f of this title;
(iii) enrollees receiving Medicaid in the Aged, Blind and Disabled category who receive fixed income from the Social Security Administration (SSA); and
(iv) Medicare Savings Program (MSP) recipients who have a fixed income from the Social Security Administration (SSA).
(g) Nothing in paragraph (e) of this subdivision should be construed to alter a Medicaid recipient's obligation to inform the public welfare district of changes in income or other factors that might impact eligibility pursuant to subdivision four of this section.
(h) Upon a finding of lack of eligibility, recipients identified in paragraph (e) of this subdivision will be entitled to notice and hearing rights as provided in section twenty-two of this chapter.
§ 4. This act shall take effect on the one hundred eightieth day after it shall have become a law; provided that the amendments to paragraph (b) of subdivision 7 of section 4403-f of the public health law made by section one of this act shall be subject to the expiration and reversion of such paragraph and shall expire and be deemed repealed therewith and provided further that such amendments shall not affect the repeal of such section and shall expire and be deemed repealed therewith. Effective immediately, the commissioner of health shall make regulations and take other actions reasonably necessary to implement this act on that date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
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 or general idea of bill
to shorten and simplify Medicaid long term care eligibility processes.
Summary of specific provisions
Section 1 amends Public Health Law § 4403-f to enable auto-assignment in a managed long term care 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 auto-assignment is not completed within 75th days.
Sections 2 and 3 amend Social Services Law § 366-a 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 Managed Long Term Care (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.
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 MLTC 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 at this point, 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 dis-enroll- ment. In 2011, the Medicaid program recognized the problems and initi- ated 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.
Prior legislative history
New bill
Fiscal implications
None
Effective date
180 days after enactment.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.