SB 58 — AN ACT CONCERNING CONSERVATOR COMPENSATION BY MEDICAID APPLICANTS AND RECIPIENTS.

Senate General Assembly FileSubstitute Bill No.

358 January Session, 2023 SubstituteAN SenateACT BillCONCERNING No.CONSERVATOR COMPENSATION BY MEDICAID APPLICANTS AND RECIPIENTS.

58 Senate, February 28, 2023 The Committee on Human Services reported through SEN.

LESSER of the 9th Dist., Chairperson of the Committee on the part of the Senate, that the substitute bill ought to pass.

AN ACT CONCERNING CONSERVATOR COMPENSATION BY MEDICAID APPLICANTS AND RECIPIENTS.

and (4) any other fiduciary expenses approved by the Probate sSB58Court, /provided Filesuch No.deductions are permissible under federal law and are taken from applied income after all other deductions provided for in the Medicaid state plan.

(b) The provisions of this section shall be applied to conservator LCO \\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-00058-R01 of 3 1SB.docx sSB58Substitute FileBill No.

358 Court,expenses providedincurred suchon deductionsor areafter permissibleOctober under1, federal2023, lawor andthe areapproval takendate fromof appliedthe incomeMedicaid afterstate allplan otheramendment, deductionswhichever providedis forlater. in the Medicaid state plan.

(b)(c) TheNot provisionslater ofthan thisDecember section31, shall2024, beand appliedannually tothereafter, conservatorthe expensesCommissioner incurredof onSocial orServices aftershall Octobercalculate 1,the 2023,total oramount deducted from the approvalapplied dateincome of Medicaid applicants and recipientsundersubsection(a)ofthissectionduringtheprecedingfiscal year and inform the MedicaidProbate stateCourt planAdministrator, amendment,in whicheverwriting, isof later.the amount deducted.

(c) Not later than December 31, 2024, and annually thereafter, the Commissioner of Social Services shall calculate the total amount deducted from the applied income of Medicaid applicants and recipientsundersubsection(a)ofthissectionduringthe precedingfiscal year and inform the Probate Court Administrator, in writing, of the amount deducted.

Subsection (a) of section 45a-594 of the general statutes is sSB58repealed /andthefollowing Fileissubstituted No.inlieuthereof(EffectiveOctober 1, 2023):

(a) Compensation payable to the conservator or guardian of any LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-00052 of 3 2R03-SB.docx sSB58} FileSubstitute Bill No.

358 repealedperson andthefollowingwho issubstitutedis inlieuthereof(EffectiveOctobersupported 1,wholly 2023):or in part by the state in any humane institution, or who is receiving benefits under any of the state's programs of public assistance, shall be based upon services rendered and shall not exceed five per cent of the gross income to the estate during the period covered by any account.

(a) Compensation payable to the conservator or guardian of any person who is supported wholly or in part by the state in any humane institution, or who is receiving benefits under any of the state's programs of public assistance, shall be based upon services rendered and shall not exceed five per cent of the gross income to the estate during the period covered by any account.

sSB58APP /Joint FileFavorable No.LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-00058- 3 of 3 R03-SB.docx }

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3 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 24 $ FY 25 $ Social Services, Dept.

GF - Cost 1,450,000 950,000 Social Services, Dept.

GF - Revenue 375,000 Gain Probate Court PCAF - Savings 950,000 950,000 Note:

GF=General Fund;

PCAF=Probate Court Administration Fund Municipal Impact:

None Explanation The bill results in the impact described below due to requiring the state to deduct certain conservatorship expenses when calculating the amount of income an institutionalized Medicaid enrollee must contribute towards his or her care, to the extent allowed under federal law.

The bill results in increased state Medicaid costs of approximately $950,000inFY24 and$1.9millionin FY25 ($950,000 afteratransfer from the Probate Court Administration Fund) by requiring the Department of Social Services (DSS) to deduct certain conservator expenses when calculating a Medicaid-eligiblenursing homeresident’sappliedincome.

This assumes a start date of January 1, 2024.

In addition, DSS will incur one-time Other Expenses costs of approximately $500,000 in FY 23 to enhance the state's eligibility system in order to implement the applied income deductions specified in the bill.

The system enhancement costs are anticipated to result in a federal grants revenue gain of $375,000, which reflects federal reimbursement for such costs under Medicaid.

These provisions also result in a net savings to the Probate Court sSB58 / File No.

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3 Administration Fund (PCAF) of approximately $950,000 in FY 24 and FY 25 associated with requiring the Probate Court to transfer funds to DSS equal to one-half the amount deducted for conservator expenses in the prior fiscal year, beginning in FY 24.

In FY 22, the Probate Court supported conservator expenses for approximately 2,500 Medicaid individuals in long-term care.

The estimated impact to the PCAF and DSS is detailed in the tables below.

Probate Court PCAF $ FY 24 FY 25 FY 26 Reduction in Conservator Reimbursement/Fee Waivers 950,000 1,900,000 1,900,000 Transfer to DSS (950,000) (1,900,000) Net Impact to PCAF 950,000 950,000 - DSS Medicaid $ FY 24 FY 25 FY 26 Gross cost 1,900,000 3,800,000 3,800,000 State Share 950,000 1,900,000 1,900,000 Transfer from Probate - 950,000 1,900,000 Net Impact to DSS 950,000 950,000 - DSS Other Expense/Federal Grants $ FY 24 FY 25 FY 26 Impact System Enhancements 500,000 - - Federal Grants Rev 375,000 - - Net Impact to State 125,000 - - The actual cost to DSS will depend on (1) the amount of the conservator expenses (including conservator compensation), Probate Court filing fees/expenses, and premiums for any Probate Court bonds counted as a deduction from a beneficiary’s income, and (2) the commensurate shift to the state for Medicaid costs which would have been paid by the beneficiary.

The bill will also result in a cost to the state Medicaid program to the extent that the penalty period that would have been imposed on an sSB58 / File No.

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3 individual, making them temporarily ineligible for Medicaid long term care services, is either reduced or eliminated.

The cost to the state Medicaid program will depend on the reduction or elimination of the penalty period which would have been imposed on the individual and the scope of services that otherwise would not be eligible for Medicaid coverage.