Eligibility Redetermination for Medicaid Members

The bill authorizes the department of health care policy and financing (state department) to seek federal authorization to:

• Extend the timeline for member reenrollment in the state medical assistance program based on the financial eligibility for a member whose income is based solely on a fixed income source; and
• Verify Determine a member's eligibility for reenrollment based on income and need at the same time without checking federally approved electronic data sources or requesting additional information if the member's income consists solely of social security income or another source of stable income or assets or if the member's income or assets have not changed since the initial verification during the application process .

The bill requires the state department to modify the questions asked to medical professionals when verifying a member's need for long-term services and supports and allows any licensed medical professional a treating licensed medical professional who has a bona fide physician-patient relationship with a member to complete sign the documentation necessary to verify a member's need for long-term services and supports. The bill prohibits the state department from requiring new documentation for a member who transitions from receiving services in an institutional setting to receiving services in a home- and community-based setting and vice versa.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)