SB 3 — AN ACT CONCERNING HEALTH CARE AFFORDABILITY.

3 (b) The working group shall consist of:

sSB3(10) /The Filechief No.executive officer of Access Health Connecticut;

447 9 sSB3 File No.

447 (10) The chief executive officer of Access Health Connecticut;

and (12)LCO Any9 otherof members37 theSubstitute chairpersonsBill deemNo. necessary.

3 (12) Any other members the chairpersons deem necessary.

(g) The members of the working group shall serve without compensation, but shall, within the limits of available funds and subject sSB3to /the Fileapproval No.of the working group's chairpersons, be reimbursed for expenses necessarily incurred in the performance of their duties.

447(h) Not later than December 1, 2026, the working group shall submit a report to the joint standing committees of the General Assembly having cognizance ofmattersrelatingtoappropriationsandthebudgets LCO 10 sSB3of File37 Substitute Bill No.

4473 toof thestate approvalagencies, ofhuman theservices workingand group'sinsurance chairpersons,and bereal reimbursedestate forconcerning expensesthe necessarilygroup's incurredrecommendations infor the performancedesign ofand theirimplementationoftheConnecticut duties.Optionprogramandthebasichealth program.

(h) Not later than December 1, 2026, the working group shall submit a report to the joint standing committees of the General Assembly having cognizance ofmattersrelatingtoappropriationsandthebudgets of state agencies, human services and insurance and real estate concerning the group's recommendations for the design and implementationoftheConnecticut Optionprogramandthebasichealth program.

sSB3(2) /hospital Fileexpenses No.rendered the husband or wife or minor child while residing in the family of his or her parents;

447 11 sSB3 File No.

447 (2) hospital expenses rendered the husband or wife or minor child while residing in the family of his or her parents;

and (4) any article purchased by either which has in fact gone to the support of the family, orLCO for11 theof joint37 benefitSubstitute ofBill both.No.

3 or for the joint benefit of both.

(NEW) (Effective October 1, 2026) (a) As used in this section, (1) "hospital" has the same meaning as provided in section 19a-490 of the general statutes, (2) "hospital financial assistance" means any program administered by a hospital or health system, including a bed fund, as defined in section 19a-509b of the general statutes, that reduces, in whole or in part, a patient's liability for the cost of inpatient or outpatient care, and (3) "hospital financial assistance program" means a sSB3program /in Filewhich No.a participating hospital provides inpatient and outpatient care:

447 12 sSB3 File No.

447 program in which a participating hospital provides inpatient and outpatient care:

(B)LCO Subsidized12 by hospital financial assistance for an uninsured patient with income exceeding two hundred per cent of the37 federalSubstitute povertyBill levelNo. but not exceeding three hundred per cent of the federal poverty level;

3 (B) Subsidized by hospital financial assistance for an uninsured patient with income exceeding two hundred per cent of the federal poverty level but not exceeding three hundred per cent of the federal poverty level;

sSB3(A) /A Filecopy No.of the patient's most recent tax return;

447 13 sSB3 File No.

447 (A) A copy of the patient's most recent tax return;

or (D)LCO Written13 incomeof verification37 fromSubstitute anBill employerNo. if the patient is paid in cash.

(c)3 A(D) participatingWritten hospitalincome shallverification exemptfrom patientsan whoemployer areif experiencingthe homelessnesspatient oris arepaid atin imminentcash. risk of homelessness fromproviding documentationpursuant to subsection(b)ofthissection but may require such patients to provide self-attested information for both a hospital financial assistance screening and hospital financial assistance application.

(c) A participating hospital shall exempt patients who are experiencing homelessness or are at imminent risk of homelessness fromproviding documentation pursuant to subsection(b)ofthissection but may require such patients to provide self-attested information for both a hospital financial assistance screening and hospital financial assistance application.

(b) The Commissioner of Social Services shall establish criteria for a sSB3participating /hospital Fileto No.document hospital financial assistance and receive timely payment for such assistance.

447(c) A hospital aggrieved by a final decision of the commissioner on the validity of such hospital's bills for hospital financial assistance may LCO 14 sSB3of File37 Substitute Bill No.

4473 participatingfile hospitalan toappeal documentin hospitalaccordance financialwith assistancethe andprovisions receiveof timelysection payment17b-238 forof suchthe assistance.general statutes, as amended by this act.

(c) A hospital aggrieved by a final decision of the commissioner on the validity of such hospital's bills for hospital financial assistance may file an appeal in accordance with the provisions of section 17b-238 of the general statutes, as amended by this act.

(4) One person with expertise in health and human services policy administration, one person with expertise in data science, analytics or interagency data integration and one person with expertise in user experience or person-centered design of such programs, all appointed sSB3jointly /by Fileand No.serving at the pleasure of the chairpersons of the working group;

447(5) The chief executive officer of Access Health Connecticut, as LCO 15 sSB3of File37 Substitute Bill No.

4473 jointlydefined byin andsection serving4 at the pleasure of thethis chairpersonsact; of the working group;

(5) The chief executive officer of Access Health Connecticut, as defined in section 4 of this act;

sSB3(1) /An Fileestimate of the number and percentage of Medicaid and supplemental nutrition assistance program beneficiaries in the state LCO 16 of 37 Substitute Bill No.

4473 16who sSB3may Filequalify No.for exemptions from work or community engagement requirements imposed by the federal Fiscal Responsibility Act of 2023, P.L.

447 (1) An estimate of the number and percentage of Medicaid and supplemental nutrition assistance program beneficiaries in the state who may qualify for exemptions from work or community engagement requirements imposed by the federal Fiscal Responsibility Act of 2023, P.L.

sSB3(2) /The Filenumber of beneficiaries who have lost and are expected to LCO 17 of 37 Substitute Bill No.

4473 17lose sSB3eligibility Filefor No.the supplemental nutrition assistance and Medicaid programssince implementationofsuch requirementsunder P.L.119-21;

447 (2) The number of beneficiaries who have lost and are expected to lose eligibility for the supplemental nutrition assistance and Medicaid programssince implementationofsuch requirementsunder P.L.119-21;

(1) "HUSKY Health program" means the Medicaid and Children's sSB3LCO /18 Fileof 37 Substitute Bill No.

4473 18Health sSB3Insurance FileProgram No.administered by the Department of Social Services pursuant to sections 17b-261 and 17b-292 of thegeneral statutes and any related state plan amendments or waivers approved by the federal Centers for Medicare and Medicaid Services.

447 Health Insurance Program administered by the Department of Social Services pursuant to sections 17b-261 and 17b-292 of thegeneral statutes and any related state plan amendments or waivers approved by the federal Centers for Medicare and Medicaid Services.

(1) Determining whether an individual qualifies for an exemption sSB3LCO /19 Fileof 37 Substitute Bill No.

4473 19from sSB3work Filerequirements No.under SNAP or from Medicaid community engagement requirements;

447 from work requirements under SNAP or from Medicaid community engagement requirements;

sSB3LCO /20 Fileof 37 Substitute Bill No.

4473 20(d) sSB3The FileDepartment No.of Social Services shall use any such data received pursuant to this section solely for the purposes of:

447 (d) The Department of Social Services shall use any such data received pursuant to this section solely for the purposes of:

(f) To the extent permissible under federal law, the Department of sSB3LCO /21 Fileof 37 Substitute Bill No.

4473 21Social sSB3Services Filemay No.establish a system under which applicants and beneficiaries of the HUSKY Health program and SNAP are asked, at the time of application or renewal, to provide consent for the department to access and use data maintained by other agencies in order to determine or renew eligibility.

447 Social Services may establish a system under which applicants and beneficiaries of the HUSKY Health program and SNAP are asked, at the time of application or renewal, to provide consent for the department to access and use data maintained by other agencies in order to determine or renew eligibility.

(b) The commissioner shall take into consideration existing definitions in state statutes and regulations relating to similar physical conditions, definitions of medical frailty in other states, related medical codes needed to diagnose such classification and ways to streamline sSB3LCO /22 Fileof 37 Substitute Bill No.

4473 22such sSB3classification Fileacross No.programs administered by the commissioner that enroll medically frail individuals.

447 such classification across programs administered by the commissioner that enroll medically frail individuals.

At least one member appointed from each joint standing committee shall sSB3LCO /23 Fileof 37 Substitute Bill No.

4473 23be sSB3a Filemember No.of the minority party.

447 be a member of the minority party.

and (2) any additional written comments submitted to such joint standing committees at such sSB3LCO /24 Fileof 37 Substitute Bill No.

4473 24proceedings. sSB3 File No.

447 proceedings.

(B) After a health carrier notifies a covered person, a covered person's sSB3LCO /25 Fileof 37 Substitute Bill No.

4473 25authorized sSB3representative Fileor No.a covered person's health care professional of an initial adverse determination that was based, in whole or in part, on medical necessity, of a concurrent or prospective utilization review or of a benefit request, the health carrier shall offer a covered person's health care professional the opportunity to confer, at the request of the covered person's health care professional, with a clinical peer of such health carrier, provided such covered person, covered person's authorized representative or covered person's health care professional has not filed a grievance of such initial adverse determination prior to such conference.

447 authorized representative or a covered person's health care professional of an initial adverse determination that was based, in whole or in part, on medical necessity, of a concurrent or prospective utilization review or of a benefit request, the health carrier shall offer a covered person's health care professional the opportunity to confer, at the request of the covered person's health care professional, with a clinical peer of such health carrier, provided such covered person, covered person's authorized representative or covered person's health care professional has not filed a grievance of such initial adverse determination prior to such conference.

(C) If a health carrier notifies a covered person, authorized representativeLCO or26 health care provider pursuant to subparagraph (B) of sSB337 /Substitute FileBill No.

4473 26representative sSB3or Filehealth No.care provider pursuant to subparagraph (B) of this subdivision that additional information is necessary, the health carrier shall approve or deny the prior authorization request not later than twenty-four hours after receipt of such information.

447 this subdivision that additional information is necessary, the health carrier shall approve or deny the prior authorization request not later than twenty-four hours after receipt of such information.

(i)LCO Specifically27 describe in the notice of extension37 theSubstitute requiredBill informationNo. necessary to complete the request;

and3 sSB3(i) /Specifically Filedescribe No.in the notice of extension the required information necessary to complete the request;

447and 27(ii) sSB3Provide Filethe No.covered person and, if applicable, the covered person'sauthorizedrepresentative withnot lessthan forty-five calendar days after the date of receipt of the notice to provide the specified information.

447 (ii) Provide the covered person and, if applicable, the covered person'sauthorizedrepresentative withnot lessthan forty-five calendar days after the date of receipt of the notice to provide the specified information.

(B) Unless the covered person or the covered person's authorized representative hasfailedto provideinformationnecessary for thehealth carrier to make a determination, for an urgent care request specified under subparagraph (B) or (C) of subdivision (38) of section 38a-591a, the health carrier shall make a determination as soon as possible, taking intoLCO account28 theof covered37 person'sSubstitute medicalBill condition, but not later than twenty-four hours after the health carrier receives such request, provided, if the urgent care request is a concurrent review request to sSB3 / File No.

4473 28into sSB3account Filethe No.covered person's medical condition, but not later than twenty-four hours after the health carrier receives such request, provided, if the urgent care request is a concurrent review request to extend a course of treatment beyond the initial period of time or the number of treatments, such request is made not less than twenty-four hours prior to the expiration of the prescribed period of time or number of treatments.

447 extend a course of treatment beyond the initial period of time or the number of treatments, such request is made not less than twenty-four hours prior to the expiration of the prescribed period of time or number of treatments.

(d) (1) If a health carrier fails, within the time periods specified in subsectionsLCO (b)29 and (c) of this37 section,Substitute toBill approve or deny a completed priorauthorizationrequest,acknowledge receipt oftherequestornotify the covered person, authorized representative or health care provider that additional information is required, the prior authorization request sSB3 / File No.

4473 29subsections sSB3(b) Fileand No.(c) of this section, to approve or deny a completed priorauthorizationrequest,acknowledge receipt oftherequestornotify the covered person, authorized representative or health care provider that additional information is required, the prior authorization request shall be deemed approved.

447 shall be deemed approved.

(e) (1) Any service for which prior authorization was required and received, including deemed approvals, shall be paid in accordance with stateandfederalpromptpaymentlaws.Ahealthcarriershallpayclaims for health care services for which prior authorization was required by and received from the health carrier, including any prior authorization deemed approved pursuant to subsection (d) of this section, except where:LCO 30 of 37 Substitute Bill No.

3 where:

(D) the health carrier has a reasonable belief sSB3that /fraud Fileor No.intentional misconduct occurred;

447 30 sSB3 File No.

447 that fraud or intentional misconduct occurred;

(E)Adescriptionofthehealthcarrier'sinternalgrievanceprocessthat includes (i) the health carrier's expedited review procedures, (ii) any time limits applicable to such process or procedures, (iii) the contact informationLCO for31 the organizational unit designated to coordinate the review on behalf of the37 healthSubstitute carrier,Bill and (iv) a statement that the covered person or, if applicable, the covered person's authorized representative is entitled, pursuant to the requirements of the health sSB3 / File No.

4473 31information sSB3for Filethe No.organizational unit designated to coordinate the review on behalf of the health carrier, and (iv) a statement that the covered person or, if applicable, the covered person's authorized representative is entitled, pursuant to the requirements of the health carrier's internal grievance process, to receive from the health carrier, free of charge upon request, reasonable access to and copies of all documents, records, communications and other information and evidence regarding the covered person's benefit request;

447 carrier's internal grievance process, to receive from the health carrier, free of charge upon request, reasonable access to and copies of all documents, records, communications and other information and evidence regarding the covered person's benefit request;

and (I)LCO A32 statement, expressed in language approved by the Healthcare Advocate and prominently displayed on the first page or cover sheet of the37 noticeSubstitute usingBill a call-out box and large or bold text, that if the covered person or the covered person's authorized representative chooses to file a grievance of an adverse determination, (i) such appeals are sometimes sSB3 / File No.

4473 32(I) sSB3A Filestatement, No.expressed in language approved by the Healthcare Advocate and prominently displayed on the first page or cover sheet of the notice using a call-out box and large or bold text, that if the covered person or the covered person's authorized representative chooses to file a grievance of an adverse determination, (i) such appeals are sometimes successful, (ii) such covered person or covered person's authorized representative may benefit from free assistance from the Office of the Healthcare Advocate, which can assist such covered person or covered person's authorized representative with the filing of a grievance pursuant to 42 USC 300gg-93, as amended from time to time, (iii) such covered personor coveredperson'sauthorizedrepresentative isentitled and encouraged to submit supporting documentation for the health carrier's consideration during the review of an adverse determination, including narratives from such covered person or covered person's authorized representative and letters and treatment notes from such covered person's health care professional, and (iv) such covered person or covered person's authorized representative has the right to ask such covered person's health care professional for such letters or treatment notes.

447 successful, (ii) such covered person or covered person's authorized representative may benefit from free assistance from the Office of the Healthcare Advocate, which can assist such covered person or covered person's authorized representative with the filing of a grievance pursuant to 42 USC 300gg-93, as amended from time to time, (iii) such covered personor coveredperson'sauthorizedrepresentative isentitled and encouraged to submit supporting documentation for the health carrier's consideration during the review of an adverse determination, including narratives from such covered person or covered person's authorized representative and letters and treatment notes from such covered person's health care professional, and (iv) such covered person or covered person's authorized representative has the right to ask such covered person's health care professional for such letters or treatment notes.

(3) A disclosure that the covered person or the covered person's authorizedrepresentativeLCO may33 fileimmediately,without waiting for the date such advance notice of the37 proposedSubstitute rescissionBill ends,No. a grievance with the health carrier to request a review of the adverse determination to rescind coverage, pursuant to sections 38a-591e and 38a-591f;

sSB33 /authorizedrepresentative Filemay No.fileimmediately,without waiting for the date such advance notice of the proposed rescission ends, a grievance with the health carrier to request a review of the adverse determination to rescind coverage, pursuant to sections 38a-591e and 38a-591f;

447(4) 33A sSB3description Fileof No.the health carrier's grievance procedures established under sections 38a-591e and 38a-591f, including any time limits applicable to those procedures;

447 (4) A description of the health carrier's grievance procedures established under sections 38a-591e and 38a-591f, including any time limits applicable to those procedures;

(b) Any institution or agency to which payments are to be made under sections 17b-239 to 17b-246, inclusive, and sections 17b-340, [and] 17b-343 and section 11 of this act which is aggrieved by any decision of said commissioner may, within ten days after written notice thereof fromLCO the34 commissioner,of obtain,37 bySubstitute writtenBill requestNo. to the commissioner, a rehearing on all items of aggrievement.

3 from the commissioner, obtain, by written request to the commissioner, a rehearing on all items of aggrievement.

The rehearing shall be sSB3held /within Filethirty No.days of the filing of the detailed written description of each specific item of aggrievement.

447 34 sSB3 File No.

447 held within thirty days of the filing of the detailed written description of each specific item of aggrievement.

On and after July 1, 1996, a rehearingLCO shall35 be held by the commissioner or his designee, provided a detailed written description of all37 suchSubstitute itemsBill isNo. filed within ninety days of written notice of the commissioner's decision.

3 rehearing shall be held by the commissioner or his designee, provided a detailed written description of all such items is filed within ninety days of written notice of the commissioner's decision.

The commissioner shall issue a sSB3final /decision Filewithin No.sixty days of the close of evidence or the date on which final briefs are filed, whichever occurs later.

447 35 sSB3 File No.

447 final decision within sixty days of the close of evidence or the date on which final briefs are filed, whichever occurs later.

(a)(1)Uponrequestpursuanttosubparagraph(E)ofsubdivision [(1)] (2) of subsection (e) of section 38a-591d, as amended by this act, the health carrier shall provide free of charge to a covered person or a covered person's authorized representative, as applicable, copies of all documents, communications, information and evidence, including citationsLCO to36 any medical journals, regarding the covered person's benefit request that is the subject of the37 adverseSubstitute determinationBill thatNo. were not submitted by the covered person or the covered person's authorized representative and were available to the health carrier or the utilization review entity that made the adverse determination at the time such adverse determination was made.

sSB33 /citations Fileto No.any medical journals, regarding the covered person's benefit request that is the subject of the adverse determination that were not submitted by the covered person or the covered person's authorized representative and were available to the health carrier or the utilization review entity that made the adverse determination at the time such adverse determination was made.

447This 36act sSB3shall Filetake No.effect as follows and shall amend the following sections:

447 This act shall take effect as follows and shall amend the following sections:

5 from passage New section July 1, 2026 Sec.

6 July 1, 2026 New section Sec.

12 from passage New section from passage Sec.

13 from passage New section Sec.

22 January 1, 2027 38a-591n(a)(1) StatementHS ofJoint LegislativeFavorable Commissioners:Subst.

In-LCO SectionAPP 1(e),Joint "healthFavorable program"LCO was37 changedof to37 "health care program" for consistency;

in Section 4(b) "program" was changed to "Connecticut Option program" for clarity;

in Section 4(e), the last sentence was redrafted for clarity;

in Section 5(f), the last sentence was redrafted for clarity;

in Section 6, the effective date was changed for accuracy;

in Sections 7 and 12, references to "cochairperson" and "cochairpersons" were changed to "chairperson" and "chairpersons" for clarity and consistency;

in Section 7(b)(8), "along with the Secretary of the Office of Policy and Management, or the secretary's designee," was added for clarity;

in Section 9(d)(1) and 9(d)(2), "that were rendered to a deceased spouse" wasdeleted for clarity;Section10(b)(2)and10(c)were redrafted for clarity;

in Section 11(c), "17b-60" was changed to "17b-238" for accuracy;

in Section 12(c)(3), "federal action" was changed to "changes" for consistency;

in Section 13(2), "the programs" was changed to the sSB3 / File No.

447 37 sSB3 File No.

447 "supplemental nutrition assistance and Medicaid programs" for clarity;

in Section 14(b), "requirements or administrative operations of" was changed to "requirements for or administrative operations of" for clarity;

in Section 15(a)(2), "where" was changed to "when" for clarity;

Section 15(e) was redrafted for clarity;

Section 15(h) was redrafted for clarity;

and Sections 19, 20, 21 and 22 were added for accuracy and statutory consistency.

HS Joint Favorable Subst.

-LCO sSB3 / File No.

447 38 sSB3 File No.

447 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 27 $ FY 28 $ Resources of the CAHCT Fund CAHCT Fund - See Below See Below See Below Resources of the Federal Cuts SF - Transfer 200 million None Response Fund from Resources of the CAHCT Fund SF - Transfer to 200 million None Policy & Mgmt., Off.

GF - Cost 765,200 260,940 Social Services, Dept.

GF - Potential See Below See Below Cost State Comptroller - Fringe GF - Cost 108,730 108,730 Benefits1 State Comptroller - Fringe Various - Significant Significant Benefits Potential Cost UConn Health Ctr.

OF - Potential See Below See Below Revenue Gain Social Services, Dept.

GF - Cost See Below See Below Note:

CAHCT Fund = Connecticut Affordable Health Care Trust Fund;

SF=Special Fund (Non-appropriated);

GF=General Fund;

Various=Various Municipal Impact:

Municipalities Effect FY 27 $ FY 28 $ Various Municipalities Potential Significant Significant Cost Explanation Sections 1–4 create and fund the Connecticut Affordable Health Care Trust (CAHCT) fund to, in part, support thedesign and implementation 1The fringe benefit costs for most state employees are budgeted centrally in accounts administered by the Comptroller.

The estimated active employee fringe benefit cost associated with most personnel changes is 41.82% of payroll in FY 27.

sSB3 / File No.

447 39 sSB3 File No.

447 of a Connecticut Option healthcare program.

Revenues of the CAHCT Fund Section 3 requires the Office of Policy and Management (OPM) to transfer $200 million from the Federal Cuts Response Fund to the CAHCT Fund in FY 27.

The bill also requires the resources of the CAHCT fund be invested by the Treasurer separate and apart from other state investments, but in the same manner as several other state investment funds.

Investment revenues are indeterminate, as they are dependent on available resources, market returns, and future investment decisions.

Expenses of the CAHCT Fund To the extent amounts on deposit in the fund meets or exceeds the amount needed to fund the program, there will be ongoing annual administrative and investment costs associated with the CAHCT fund as a result of the bill starting no earlier than FY 27.

Administrative expenses include a one-time cost to the State Treasurer associated with the establishment of the CAHCT fund of up to $100,000.

The bill allows the CAHCT fund to enter into contracts for various administrative, legal, and investment services.

The bill specifies the ongoing costs of administering the CAHCT Fund are to be covered by the resources of the fund.

As such, there is not anticipated to be a cost to appropriated funds or municipalities due to these sections.

Section 4 establishes a Connecticut Option affordable health care program within OPM.

This results in a cost of $500,000 in FY 27 to OPM for a consultant to develop the health care program.

There is also a cost of $132,600 in FY 27 and anannual cost of $130,470 beginning in FY 28 to OPM and corresponding fringe benefit costs beginning in FY 27 to the Office of the State Comptroller for a Policy Development Coordinator position.

This position will support an annual reporting requirement in the bill beginning January 1, 2027, work with the consultant in the design and development of the health sSB3 / File No.

447 40 sSB3 File No.

447 care program and serve as the OPM designee for a working group established in section 7 of the bill.

Sections 5 and 6 result in a cost to the Department of Social Services (DSS) associated with establishing a basic health program, which is guided by the recommendations of the working group established in section7.Whiletheimpactofimplementingsuchaprogramisunknown at thistime anddependent onhowtheprogramisultimately structured, DSSwillincurinitialcontractingcostsof$750,000todevelopandsubmit the required waiver as well as costs for additional staff and resources to perform an actuarial analysis, procure a managed care organization, and set up other potentially necessary operational mechanisms to implement the program.

Section 7 establishes a working group within OPM to design the Connecticut Option program established in section 4 of the bill.

These requirements outlined in the section contribute to the cost to OPM in section 4 for a Policy Development Coordinator position.

Section 8 requires OPM to hold public hearings and stakeholder engagement meetings.

This results in a cost to OPM beginning in FY 27 to hold each of these meetings.

This cost is dependent on the number of meetings held and the cost associated with each meeting.

Section 10 results in a potential revenue gain to the UConn Health Center (UCHC) annually beginning in FY 27.

It allows any hospital, including UCHC, to participate in a financial assistance program established by the bill for patients who meet certain income and other criteria.

Presumably, UCHC would only choose to participate if the program increased net patient revenue, and the bill's reimbursement from DSS offset the cost of participating in this program.

Any revenue gain would depend on:

(1) the number of qualifying patients who participate;

and (2) how the program's changes in qualifying patient payments compare to the reimbursement UCHC would receive from DSS.

In the past 12 months, UConn Health has served at least 5,299 sSB3 / File No.

447 41 sSB3 File No.

447 uninsured patients and 749 insured patients who met the bill's income parameters.

On average, the uninsured patients who met the bill's income parameters owed $810 out-of-pocket, and they ultimately paid 63% to 72% of that amount (i.e., $227 to $300 is left unpaid).

The insured patients owed $301, and they ultimately paid69% to 81%of that amount (i.e., $57 to $93 left unpaid).

Section 11 results in a Medicaid cost to DSS associated with disproportionate share hospital payments (DSH).

The bill requires DSS to make DSH payments to hospitals as compensation for participating inthehospitalfinancialassistance programestablished by thebill, using criteria to be identifiedby DSS.

The extent of the cost to DSS is unknown and will be based on participating hospitals, criteria developed, and relevant costs.

For context, DSH payments must meet federal requirements in order for states to receive a 50% federal share and are subject to both hospital and state specific limits.

Section 12 establishes a safety net mitigation working group within OPM to advise the state's response to significant changes in federal law or policy that impact certain program and requires the group to report annually beginning February 1, 2027.

This results in a cost of $132,600 in FY 27 and an annual cost of $130,470 beginning in FY 28 to OPM and corresponding fringe benefit costsbeginning inFY 27to theOffice of the State Comptroller for a Policy Development Coordinator position.

This position will also be responsible for requirements outlined in section 14 of the bill.

Section 14 requires OPM to notify the certain committees on federal statutes, regulations, rules, or administrative guidance that is likely to impact federal health funding levels and provide recommendations.

This results in a cost to OPM for a Policy Development Coordinator 2These numbers represent the number of insured and uninsured patients at UCHC who have applied for financial assistance in the past 12 months and otherwise meet the bill's eligibility parameters.

These figures do not include patients who may be eligible to participate in the bill's financial assistance program due to participation in SNAP or WIC.

sSB3 / File No.

447 42 sSB3 File No.

447 position that is outlined in section 12.

Section 15 results in a potential cost to DSS to establish a program for collecting information from employers or other entities to support Medicaid and SNAP eligibility determinations.

To the extent DSS establishes a program outside of the current scope of practice, DSS may incur system modification costs to support the new program.

Section 17 requires DSS to submit any proposal to change the fee-for- service Medicaid payment model to a managed care payment model to the Appropriations and Human Services committees before implementing or seeking any necessary federal approval to implement such change.

To the extent this delays or prevents a change that otherwise would have occurred, the state could experience a fiscal impact that cannot be determined at this time.

Section 18 shortens the timeframe for prior authorization and deems requests approved if health carriers fail to meet these standards.

The state and fully insured municipalities may experience significant cost increases in medical and pharmacy spend beginning in FY 27 if the changes outlined in the bill result in greater number of authorizations deemed approved.

The state plan currently saves approximately $84 million annually under current prior authorization procedures.

Sections 19 and 20 result in potential increased administrative costs to DSS to the extent participating hospitals utilize the appeals process authorized by the bill as referenced in Section 11.

The bill makes other clarifying, conforming and technical changes that do not result in a fiscal impact.

The Out Years The annualized ongoing fiscal impact will continue into the future subject to inflation, the allowable scope of DSH payments, and any future changes to the Medicaid payment model.

sSB3 / File No.

447 43 sSB3 File No.

447 OLR Bill Analysis sSB 3 AN ACT CONCERNING HEALTH CARE AFFORDABILITY.

TABLE OF CONTENTS:

SUMMARY §§ 1-3 — CONNECTICUT AFFORDABLE HEALTH CARE TRUST FUND Creates the Connecticut Affordable Health Care Trust Fund to fund the Connecticut Option (see § 4) and transfers $200 million to it from the Federal Cuts Response Fund § 4 — CONNECTICUT OPTION AFFORDABLE HEALTH CARE PROGRAM Establishes the Connecticut Option program within OPM for affordable health insurance coverage;

requires it to provide premium subsidies until December 31, 2027, for QHPs for households with certain incomes who are ineligible for Covered Connecticut or who are ineligible for ACA subsidies;

allows the program to include other plans and subsidy options §§ 5 & 6 — BASIC HEALTH PROGRAM Requires DSS to establish a BHP to provide subsidized health insurance to eligible individuals with certain household incomes who are not eligible for state medical assistance but are eligible to buy QHPs through Access Health CT § 7 — CONNECTICUT OPTION AND BHP WORKING GROUP Establishes a working group to oversee design of the Connecticut Option program and BHP and requires it to report recommendations for these programs by December 1, 2026 § 8 — CONNECTICUT OPTION PROGRAM AND BHP PUBLIC HEARINGS AND STAKEHOLDER MEETINGS Requires OPM to hold at least one public hearing and a series of stakeholder engagement meetings before each program’s implementation sSB3 / File No.

447 44 sSB3 File No.

447 § 9 — SPOUSAL MEDICAL DEBT Prevents surviving spouses from being liable for certain medical debt of a deceased spouse §§ 10, 11, 19 & 20 — HOSPITAL FINANCIAL ASSISTANCE PROGRAM Establishes a voluntary hospital financial assistance program, sets requirements for the program, and authorizes hospitals to be reimbursed through DSH payments § 12 — SAFETY NET MITIGATION WORKING GROUP Establishes a safety net mitigation working group and requires it to report annually to the Appropriations, Human Services, Housing, and Insurance and Real Estate committees § 13 — MONTHLY DSS REPORTS ON WORK AND COMMUNITY ENGAGEMENT REQUIREMENTS Requires DSS to report monthly on implementation and effects of federal work and community engagement requirements in Medicaid and SNAP § 14 — OPM NOTICE TO LEGISLATORS ON HUSKY HEALTH AND SNAP Requires the OPM secretary to notify and make recommendations to the Appropriations and Human Services committees when he determines federal changes may affect SNAP or HUSKY Health and allows the committees to hold a public hearing § 15 — DSS DATA ACCESS AND EMPLOYMENT VERIFICATION Requires DSS to have access to data fromother state agencies to verify SNAP work requirements and Medicaid community engagement requirements and sets related requirements;

allows DSS to establish a program to facilitate enrollment and automatic eligibility renewal for Medicaid or SNAP § 16 — “MEDICAL FRAILTY” DEFINITION Requires DSS to develop a state definition of “medical frailty” and report the proposed definition to the Human Services Committee within 60 days after the bill passes § 17 — LEGISLATIVE REVIEW OF MEDICAID PAYMENT MODEL CHANGES Requires DSS to submit to the Appropriations and Human Services committees any proposal to change the Medicaid payment model from fee-for-service to managed care sSB3 / File No.

447 45 sSB3 File No.

447 §§ 18, 21 & 22 — UTILIZATION REVIEW REQUESTS AND PRIOR AUTHORIZATION Shortens maximum response times for decisions on non-urgent prospective or concurrent review requests;

establishes deadlines and related requirements for prior authorization determinations for urgent and non-urgent care requests and deems prior authorization requests approved if health carriers fail to act within set time frames;

makes prior authorization approval a binding payment and coverage determination SUMMARY This bill establishes new health care programs, trust funds, and working groups, and a makes other changes in laws related to health care, Medicaid, and other programs, as described in the section-by- section analysis below.

It also makes technical and conforming changes.

EFFECTIVE DATE:

Various, see below.

§§ 1-3 — CONNECTICUT AFFORDABLE HEALTH CARE TRUST FUND Creates the Connecticut Affordable Health Care Trust Fund to fund the Connecticut Option (see § 4) and transfers $200 million to it from the Federal Cuts Response Fund The bill establishes the Connecticut Affordable Health Care Trust Fund and requires that it be used to implement the Connecticut Option affordable health care program (see § 4).

The bill requires the Office of Policy and Management (OPM) to transfer $200 million to the trust fund from the Federal Cuts Response Fund for FY 27.

The bill authorizes it to hold all payments and contributed deposits;

gifts;bequests;endowments;federal,state,orlocalgrants;andanyother funds from any public or private source and all earnings until they are disbursed.

The trust exists as long as it has deposits or obligations and until terminated by law.

Funds in the trust are not state property;

they cannot be combined with state funds and the state has no claim on them.

Similarly, contracts and obligations associated with the trust are not state debts or obligations.

Under the bill, the state has no obligation to any person on sSB3 / File No.

447 46 sSB3 File No.

447 account of the trust.

Also, amounts obligated to be paid from the trust are limited to what is deposited in it.

Regardless of existing law’s requirements for the treasurer on investments of the state’s trust funds, the bill requires the treasurer to (1) invest funds in the trust in a reasonable and appropriate way to achieve the fund’s objectives, using a similarly situated prudent person’sdiscretionandcareand(2)dulyconsidertherateofreturn,risk, term or maturity, diversification of the fund’s total portfolio, liquidity, projected disbursements and expenditures, and expected payments, deposits, contributions, and future gifts.

The bill prohibits the treasurer from requiring the fund to invest directly in state or political subdivision obligations or in any investment or other endowment the treasurer administers.

It requires the fund’s assets to be continuously invested and reinvested, consistent with its objectives, until expended.

It otherwise extends to the fund the same requirements that state law sets for other state trust funds, including the Teachers’ Pension Fund, the State Employees Retirement Fund, and the Connecticut Municipal Employees’ Retirement Fund.

The bill requires the treasurer to ensure that sufficient liquidity exists within the fund to allow for expenditures in each fiscal year.

It allows him, on the fund’s behalf, to:

1.

receive and invest money in the fund in any instruments, obligations, securities, or property;

2.

enter into contracts for services for the fund (such as legal, actuarial, accounting, advisory, and management) and pay for services from the fund’s assets;

3.

obtain insurance in connection with the fund’s property, assets, activities, or deposits;

4.

apply for and accept gifts, grants, or donations;

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447 5.

adopt regulations;

6.

sue and be sued;

7.

establish accounts within the fund;

and 8.

take any other action needed to carry out the bill’s purposes and related to the bill’s duties for the treasurer.

EFFECTIVE DATE:

July 1, 2026 § 4 — CONNECTICUT OPTION AFFORDABLE HEALTH CARE PROGRAM Establishes the Connecticut Option program within OPM for affordable health insurance coverage;

requires it to provide premium subsidies until December 31, 2027, for QHPs for households with certain incomes who are ineligible for Covered Connecticut or who are ineligible for ACA subsidies;

allows the program to include other plans and subsidy options The bill establishes the Connecticut Option affordable health care program within OPM to create affordable health insurance coverage.

Under thebill,anaffordablehealthplanis aqualifiedhealth plan (QHP) with premiums that cost (1) up to 2% of household income for people with household income up to 200% of the federal poverty level (FPL) and (2) up to 8.5% of household income for people with household income of at least 400% of FPL.

EFFECTIVE DATE:

Upon passage Program Benefits and Eligibility Under the bill, the Connecticut Option program includes a state health care premium subsidy to enable an eligible enrollee to get an affordable health plan on Access Health CT from July 1, 2026, to December 31, 2027.

Eligible enrollees are state residents who are eligible for a QHP through Access Health CT and have (1) household income up to 200% of FPL but are ineligible for the Covered Connecticut program or (2) household income above 400% but not more than 600% of FPL but are ineligible for premium subsidies under the federal Affordable Care Act (ACA).

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447 48 sSB3 File No.

447 The bill additionally allows the program to include (1) a buy-in option for a health plan that mirrors Medicaid and (2) other options for subsidies for eligible enrollees or other people to buy affordable health plans.

The bill allows the program to include additional affordable health care options for people at all income levels.

It may promote these options by authorizing a primary insurer to transfer portions of its risk portfolios to another entity to limit maximum losses and stabilize financial performance.

Program Design and Implementation The bill requires the OPM secretary to design and implement the program:

1.

in consultation with the Department of Social Services (DSS) commissioner, the Connecticut Insurance Department (CID) commissioner, and the Access Health CT chief executive officer;

2.

using money from the Connecticut Affordable Health Care Trust Fund (see above) and other available funding sources;

and 3.

subject to recommendations from a working group the bill establishes (see § 7).

The bill requires OPM to adopt the working group’s recommendations based on:

1.

affordability analyses, 2.

projected impact on the rates of uninsured people, 3.

protection against adverse selection, 4.

benefit comprehensiveness, and 5.

impact on equitable access to health care and sustainability.

The bill authorizes the OPM secretary to:

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447 49 sSB3 File No.

447 1.

solicit economic analysis of key policy options for affordable health insurance (for example, plans mirroring Medicaid, QHPs, or the state employee health plan), which may include policies to promote cost containment and network adequacy and mitigate impacts on the individual health insurance market;

2.

accept gifts, grants, and donations, which must be deposited in the Connecticut Affordable Health Care Trust Fund (see above) and use any other available state or federal funds;

3.

employ or contract with actuaries and other professionals;

and 4.

contract with other state agencies, health carriers, or other qualified people and entities as needed.

Reporting Requirement The bill requires OPM to report to the Appropriations, Human Services, and Insurance and Real Estate committees on the Connecticut Option program’s operations, activities, and finances, and include any supporting documentation or data.

The report must be submitted by January 1, 2027, then every six months until January 1, 2030, and annually after that.

Background — Related Bills sHB5041,favorablyreportedbytheHumanServicesCommittee,and sHB 5378, favorably reported by the Insurance and Real Estate Committee, require OPM to study the feasibility of establishing a Connecticut Option program.

§§ 5 & 6 — BASIC HEALTH PROGRAM Requires DSS to establish a BHP to provide subsidized health insurance to eligible individuals with certain household incomes who are not eligible for state medical assistance but are eligible to buy QHPs through Access Health CT Starting October 1, 2026, the bill requires DSS, in consultation with OPM and based on recommendations from a working group the bill establishes (see § 7), to seek any necessary approvals from the federal government to establish a basic health program (BHP, see Background — BHP) and take all necessary actions to maximize federal funding.

(The sSB3 / File No.

447 50 sSB3 File No.

447 working group’s report is not due until December 1, 2026.) EFFECTIVE DATE:

Upon passage, except the provision establishing the account is effective July 1, 2026.

Program Administration and Benefits The bill requires the DSS commissioner to coordinate the BHP’s administration and benefits.

To the extent the ACA allows, it requires the BHP to provide the same benefits, cost-sharing limits, and other consumer safeguards that apply in the state’s medical assistance programs (generally Medicaid or HUSKY Health).

The bill allows the DSS commissioner, in consultation with OPM, to develop a plan to respond if she determines that:

1.

providing medical assistance to eligible individuals under the BHP will cost more than the federal subsidies available to the state to pay for the BHP or 2.

changes in federal law or regulations (or their administration) will affect BHP funding, eligibility requirements, or administration.

Under the bill, if the federal subsidies the state receives to pay for the BHPexceed thecost of care that wouldotherwise beprovidedto eligible individuals, the commissioner must use them to reduce these individuals’ premiums and cost sharing or provide additional benefits.

Eligibility Requirements Under the bill, the BHP provides subsidized health insurance to Connecticut residents (1) with household incomes above 133% but no more than 200% of the FPL;

(2) under age 65;

(3) ineligible for state medical assistance programs (for example, Medicaid);

and (4) otherwise eligible to buy a QHP through Access Health CT.

BHP Account The bill establishes a separate, nonlapsing BHP account, which contains any moneys required by law to be deposited into it (for sSB3 / File No.

447 51 sSB3 File No.

447 example, federal subsidies) and DSS must use the funds solely to operate the program.

Federal Applications and Reporting Requirement The bill requires the DSS commissioner to forward any application for federal approval of, or changes to, a BHP to the Appropriations and Human Services committees and the working group the bill establishes (see § 7) at least 30 days before doing so.

Under the bill, the DSS commissioner must report to the Appropriations, Human Services, and Insurance and Real Estate committees on the BHP’s operations, activities, and finances, as well as any supporting documentation or data, for the immediately preceding reporting period.

The commissioner must submit the reports (1) every six months, starting by January 1, 2027, and through January 1, 2030, and (2) annually after that.

Background — BHP The ACA allows states to establish BHPs for people (1) ineligible for Medicaid;

(2) under age 65;

(3) with household income between 133% and 200% of the FPL (individuals with incomes under 133% of the FPL qualify for Medicaid);

and(4)ineligiblefor minimalessentialhealthcare coverage (for example, State Children’s Health Insurance Program (HUSKY B in Connecticut)) or who cannot afford their employer’s coverage.

The federal law has cost-sharing limits and requires that state BHPs provide benefits at least as robust as those in the state’s “essential health benefits package” available to someone buying insurance through its health insurance exchange.

States that operate a BHP are eligible for federal subsidies equaling 95% of the premium tax credits and cost-sharing reductions that the federal government would have spent if BHP enrollees had received their assistance when enrolling in an exchange health plan.

The law requires states to establish funds into which the federal sSB3 / File No.

447 52 sSB3 File No.

447 subsidies are deposited and can be used only to reduce BHP enrollees’ premiumsandcostsharingortogivethemadditionalbenefits (42 U.S.C.

§ 18051).

Background — Related Bill sHB 5559, favorably reported by the Human Services Committee, similarly requires DSS to establish a BHP.

§ 7 — CONNECTICUT OPTION AND BHP WORKING GROUP Establishes a working group to oversee design of the Connecticut Option program and BHP and requires it to report recommendations for these programs by December 1, 2026 The bill requires the OPM secretary to establish a working group to oversee the design of the bill’s Connecticut Option program (§ 4) and BHP (§§ 5 & 6).

It authorizes the working group to consult with stakeholders, including Access Health CT enrollees, health care providers, health insurance issuers, health care advocates, researchers, actuaries, and nonprofit health care service providers.

EFFECTIVE DATE:

Upon passage Connecticut Option and BHP Recommendations The bill requires the working group to report to the Appropriations, Human Services, and Insurance and Real Estate committees by December 1, 2026, on its recommendations for the design and implementation of the Connecticut Option and BHP.

The submitted report must describe the programs, including their operation and funding.

Working Group Members and Structure The bill designates the following, or their designees, as working group members:

1.

Connecticut healthcare advocate;

2.

CID and DSS commissioners and the OPM Secretary;

3.

Commission on Racial Equity and Public Health executive director;

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447 53 sSB3 File No.

447 4.

state comptroller;

5.

the six legislative leaders;

6.

chairpersons of the Insurance and Real Estate Committee;

and 7.

Access Health CT chief executive officer.

The working group must also have the chairpersons of the Human Services Committee and three health insurance experts from nonprofit and academic communities with demonstrated knowledge about health plan design and actuarial practices.

The working group’s chairpersons (the OPM secretary and the Human Services Committee chairpersons) appoint the health insurance experts.

The bill also allows them to appoint any other members they deem necessary.

Under the bill, members appointed by the legislative leaders and the appointed experts may be legislators.

They serve at the pleasure of the appointing authority and continue to serve until their successors are appointed.

Appointing authorities fill any vacancies.

The bill requires all initial appointments to be made by 30 days after the bill passes.

If they are not done by this time, the bill allows the OPM secretary to designate people with the required qualifications to serve on the working group until the appointments are made.

Under the bill, a majority of working group members is a quorum to transact business and the working group makes decisions by majority vote of members present at a meeting, except that the co-chairpersons canestablishcommittees,sub-committees,orother entitiesastheydeem necessary to further the working group’s purposes.

The bill allows the working group to adopt rules of procedure.

Working group members serve without pay but must be reimbursed for expenses necessary in performing their duties, within available funds and subject to the working group co-chairpersons’ approval.

§ 8 — CONNECTICUT OPTION PROGRAM AND BHP PUBLIC HEARINGS AND STAKEHOLDER MEETINGS sSB3 / File No.

447 54 sSB3 File No.

447 Requires OPM to hold at least one public hearing and a series of stakeholder engagement meetings before each program’s implementation Thebillsetspublichearingandstakeholdermeetingrequirementsfor the Connecticut Option and the BHP.

For each program, it requires the OPM secretary to hold at least one public hearing and a series of stakeholder engagement meetings with potential stakeholders before they are implemented.

Under the bill, the stakeholders include:

1.

hospital, health center, and other health care provider representatives;

2.

HUSKY Health plan enrollees and Access Health CT enrollees;

3.

legislators on the Appropriations, Human Services, Public Health, and Insurance and Real Estate committees;

and 4.

other people with health equity and health coverage policy expertise.

EFFECTIVE DATE:

July 1, 2026 § 9 — SPOUSAL MEDICAL DEBT Prevents surviving spouses from being liable for certain medical debt of a deceased spouse Current law generally makes it the joint duty of each spouse to support their family, and makes them both liable for certain expenses, including rent and certain medical expenses.

The bill creates an exception to this liability.

Specifically, it prohibits a surviving spouse from being liable for a deceased spouse’s medical debt that is (1) not covered by the deceased spouse’s estate and (2) related to hospital expenses or reasonable and necessary physician or dentist services.

EFFECTIVE DATE:

July 1, 2026 §§ 10, 11, 19 & 20 — HOSPITAL FINANCIAL ASSISTANCE PROGRAM Establishes a voluntary hospital financial assistance program, sets requirements for the program, and authorizes hospitals to be reimbursed through DSH payments The bill establishes a voluntary hospital financial assistance program that requires participating hospitals to provide financial assistance to sSB3 / File No.

447 55 sSB3 File No.

447 patients, if they meet specified income thresholds and, in some cases, are enrolled in certain federal nutrition assistance programs.

The financial assistance, which may include a hospital bed fund, must partially or totally reduce a patient’s liability for the cost of care.

(Generally, a hospital bed fund refers to donations of money, stock, or other property to a hospital to give free patient care.) The bill sets related eligibility and care requirements for participating hospitals and authorizes them to be reimbursed by disproportionate share hospital (DSH) payments, which are Medicaid payments to hospitals that serve a disproportionately large number of Medicaid and uninsured patients.

Correspondingly, the bill requires the DSS commissioner to (1) amend the Medicaid state plan to use DSH payments to compensate participating hospitals and (2) set criteria for them to document the financial assistance they provide and be timely paid for it.

Under the bill, a hospital aggrieved by the commissioner’s final decision on the validity of its bills for financial assistance may request a rehearing using the existing process for DSS payment rates and audits.

Under this process, hospitals may appeal any items not resolved at a rehearing to the Superior Court, as authorized under the Uniform Administrative Procedure Act.

EFFECTIVE DATE:

October 1, 2026 Care Requirements Underthebill,hospitalsthatchoosetoparticipateinthebill’shospital financial assistance programmust provideinpatient andoutpatient care as follows:

1.

for free to uninsured patients with income up to 200% of the FPL;

2.

subsidized care to uninsuredpatientswithincome between201% and 300% FPL;

and 3.

subsidized care for patients with income up to 400% FPL who are sSB3 / File No.

447 56 sSB3 File No.

447 enrolled in the federal Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Food Program for Women, Infants, and Children (WIC).

For patients with incomes under 200% FPL who are ineligible for financial assistance, the bill requires participating hospitals to bill them on a payment plan that is 2% or less of their annual household income per year.

After 36 cumulative payments, hospitals must consider these patients’ bills paid in full and permanently stop collection activities on any remaining balance.

Eligibility Requirements The bill prohibits participating hospitals from (1) counting a patient’s assets when determining program eligibility or (2) requiring a patient to provide proof of a denial letter from a public insurance program (state medical assistance programs (for example, Medicaid), Emergency Medicaid, and Medicare), or insurance through Access Health CT.

Hospitals must use software that conforms to industry standards on electronic income verification and may accept one of the following documents to verify a patient’s income:

1.

a copy of the patient’s most recent tax return or W-2 and 1099 forms, 2.

copies of the patient’s two most recent pay stubs, and 3.

an employer’s written income verification if the patient is paid in cash.

The bill exempts from these income verification requirements patients who are experiencing (or are at imminent risk of) homelessness but allows hospitals to require them to give self-attested information for a program screening or application.

Program Information in Other Languages Regardless of the state’s law on hospital bed funds (see Background — Hospital Bed Fund Patient Summaries), the bill requires participating sSB3 / File No.

447 57 sSB3 File No.

447 hospitals to make available financial assistance program information in the languages spoken by 5% or more of the population living in the geographic area the hospital serves.

Under thebill,theinformationmust (1)beinalldischarge paperwork and on the hospital’s website;

(2) have the Office of the Health Care Advocate’s contact information;

and (3) comply with the federal Americans with Disabilities Act requirements for effective communication (providing free auxiliary aids and services, such as braille, large print, and relay services).

Background — Hospital Bed Fund Patient Summaries Existing law requires each hospital that maintains or administers bed funds to make available to patients a one-page plain language summary in English and Spanish on its financial assistance policy.

Background — Related Bill sSB 496, favorably reported by the Human Services Committee, also establishes a voluntary hospital financial assistance program.

§ 12 — SAFETY NET MITIGATION WORKING GROUP Establishes a safety net mitigation working group and requires it to report annually to the Appropriations, Human Services, Housing, and Insurance and Real Estate committees The bill establishes a safety net mitigation working group to advise on, monitor, and coordinate the state’s response to significant changes in federal law or policy that impact public health, social services, or other safety net programs.

Working Group Membership The bill designates the following, or their designees, as working group members:

1.

OPM secretary;

2.

DSS, Department of Revenue Services, Department of Mental Health and Addiction Services, Department of Developmental Services, Department of Public Health (DPH), Insurance sSB3 / File No.

447 58 sSB3 File No.

447 Department, and Department of Labor (DOL) commissioners;

and 3.

chairpersons of the Appropriations, Housing, Human Services, and Insurance and Real Estate committees, who must jointly choose the working group’s chairpersons.

The working group also includes (1) the Access Health CT chief executive officer, (2) the Commission on Racial Equity in Public Health executive director, (3) three subject matter experts jointly appointed by the working group’s chairpersons, and (4) any other members the chairpersons deem necessary.

Under the bill, the experts are one for each of the following subjects:

(1) health and human services policy administration, (2) data science, analytics, or interagency data integration;

and (3) user experience or person-centered design.

Appointed members serve at the pleasure of the chairpersons.

Working Group Duties Under the bill, the working group must convene within 30 days after the bill passes and has the following duties:

1.

review any significant changes in federal law or policy impacting public health, social services, or other safety net programs;

2.

evaluate the current or projected operational and fiscal impacts of these changes on agency procurement and service delivery;

3.

recommend budgetary, regulatory, administrative, or legislative measures to mitigate adverse procurement or service outcomes to OPM and the Appropriations, Housing, Human Services, and Insurance and Real Estate committees;

and 4.

solicit input from stakeholders, including municipal governments, community-based providers, and independent experts (such as academic researchers and policy organizations) as necessary.

sSB3 / File No.

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447 Annual Report The bill requires the working group to report annually, starting by February 1, 2027, to the Appropriations, Housing, Human Services, and Insurance and Real Estate committees.

The report must include:

1.

the estimated number and percentage of Medicaid and SNAP beneficiaries who may qualify for exemptions from work or community engagement requirements in two specified recent federal laws (P.L.

118-5 and P.L.

119-21 both expand these requirements);

2.

a review of current state and federal data systems used to verify whether someone qualifies for an exemption from these requirements due to disability or other allowable criteria or has met them;

3.

a review of any state applications for the Rural Health Transformation Program or federal technical assistance funding;

and 4.

recommendations for creating a structured and sustainable system to support interagency data sharing, beneficiary identification, and administrative practices that maximize allowable federal exemptions.

EFFECTIVE DATE:

Upon passage § 13 — MONTHLY DSS REPORTS ON WORK AND COMMUNITY ENGAGEMENT REQUIREMENTS Requires DSS to report monthly on implementation and effects of federal work and community engagement requirements in Medicaid and SNAP The bill requires the DSS commissioner to report monthly to the Human Services Committee on implementation and effects of federal work and community engagement requirements in Medicaid and SNAP.

The commissioner must do this in consultation with the DOL commissioner and start the reporting 30 days after the bill passes.

Specifically, the bill requires DSS to report on the following:

sSB3 / File No.