AN ACT CONCERNING AN AMENDMENT TO THE MEDICAID STATE PLAN UNDER SECTION 1915(I) OF THE SOCIAL SECURITY ACT TO PROVIDE HOME CARE SERVICES.

OFFICE OF FISCAL ANALYSIS

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sSB-297

AN ACT CONCERNING AN AMENDMENT TO THE MEDICAID STATE PLAN UNDER SECTION 1915(I) OF THE SOCIAL SECURITY ACT TO PROVIDE HOME CARE SERVICES.

State Impact: See Below

Municipal Impact: None

Explanation

The bill requires the Department of Social Services (DSS) to amend the Medicaid state plan to expand home and community based services. The bill specifies that DSS may amend waivers if necessary to implement the bill.

Potential Costs

The applicable waivers include Acquired Brain Injury (ABI), Personal Care Assistant (PCA), and Katie Beckett, all of which have a waiting list. The table below identifies the costs associated with expanding services to the individuals on the waiting lists for these programs. ¹

Waiver Program	Number on Wait List	Average Annual Cost Per Person ($)	Total Annual Cost ($ Gross)
ABI	60	102,000	6,120,000
PCA	110	28,000	3,080,000
Katie Beckett	400	28,000	11,200,000
Total	570		20,400,000

The total cost for the 570 individuals on the waiting lists would be approximately $20. 4 million annually, which would result in a net state cost of $10. 2 million due to the 50% federal Medicaid reimbursement. If the state receives an enhanced Medicaid rate (52%) due to meeting the program requirements of the Balancing Incentive Payment program, the state cost would be $9. 8 million. These costs could increase if additional individuals, not currently on the waiting lists, are eligible to enroll as a result of the amended plan.

Potential Savings

The bill also applies to the Connecticut Home Care Program (CHCP). The waiver portion of this program is not capped and therefore does not have a waiting list. To the extent the bill applies to the state funded portion of the CHCP, the state could realize a savings associated with federal Medicaid reimbursement. The FY 11 expenditures of the state funded program are estimated at $55. 6 million for over 4,200 clients. For purposes of illustration, if everyone in the program qualifies under the amended plan, this would result in a savings of approximately $27. 8 million annually as state expenditures are eligible for the 50% federal Medicaid reimbursement. If the state receives an enhanced match (52%) due to meeting the program requirements of the Balancing Incentive Payment program, the state savings under CHCP would be $28. 9 million.

The bill could also result in savings associated with cost-sharing for those with incomes over 200% of the federal poverty level (FPL). The extent of these savings depends on the number of applicable individuals and the level of cost sharing imposed.

The bill requires DSS to apply to the Balancing Incentive Payment Program. The costs, federal reimbursements, and guidelines for this program are not yet known. The state could receive a two percent increase in federal matching assistance for a total reimbursement rate of 52% for home and community based services, as noted above.

The Out Years

The annualized ongoing fiscal impact identified above would continue into the future subject to the number of eligible recipients, the level of cost-sharing, and the federal reimbursement rate.