Bill > SB131

This bill establishes a new provisional eligibility process for Medicaid nursing facility services to help individuals awaiting long-term care medical assistance applications. Under the new provisions, the Department of Health and Human Services must grant provisional eligibility within 90 calendar days of receiving a long-term care application, even if the application is not complete. Nursing facilities that agree to the contract terms will receive state payments at their standard rate for services provided to provisionally eligible individuals. This provisional eligibility will last up to 18 months, or until a final determination is made on the application. If a final approval is not entered within 12 months, the care provider can request the appointment of a special Medicaid representative. Once a final determination is made, nursing facilities must reimburse the state for all payments received during the provisional eligibility period, regardless of whether the application is ultimately approved or denied. The bill appropriates $1,500,000 for the biennium ending June 30, 2027, to fund this program and creates two new positions within the department to manage the provisional eligibility process. If expenditures exceed the appropriated amount, the department can request additional funding from the Joint Legislative Fiscal Committee and Governor and Council. The bill aims to address delays in long-term care medical assistance applications and provide interim support for nursing facility residents.