Sec. 17b-292. HUSKY Plan, Part B. Eligibility. Expedited eligibility under Husky Plan, Part B. Presumptive eligibility under Medicaid. Single point of entry services. Managed care enrollment brokerage
Sec. 17b-292. HUSKY Plan, Part B. Eligibility. Expedited eligibility under
Husky Plan, Part B. Presumptive eligibility under Medicaid. Single point of entry
services. Managed care enrollment brokerage services. Managed care enrollment
brokerage services. Continued eligibility determinations. Regulations. (a) A child
who resides in a household with a family income which exceeds one hundred eighty-five per cent of the federal poverty level and does not exceed three hundred per cent of
the federal poverty level may be eligible for subsidized benefits under the HUSKY Plan,
Part B.
(b) A child who resides in a household with a family income over three hundred
per cent of the federal poverty level may be eligible for unsubsidized benefits under the
HUSKY Plan, Part B.
(c) Whenever a court or family support magistrate orders a noncustodial parent to
provide health insurance for a child, such parent may provide for coverage under the
HUSKY Plan, Part B.
(d) To the extent allowed under federal law, the commissioner shall not pay for
services or durable medical equipment under the HUSKY Plan, Part B if the enrollee
has other insurance coverage for the services or such equipment.
(e) A newborn child who otherwise meets the eligibility criteria for the HUSKY
Plan, Part B shall be eligible for benefits retroactive to his or her date of birth, provided
an application is filed on behalf of the child not later than thirty days after such date.
Any uninsured child born in a hospital in this state or in a border state hospital shall be
enrolled on an expedited basis in the HUSKY Plan, Part B, provided (1) the parent or
caretaker relative of such child resides in this state, and (2) the parent or caretaker relative
of such child authorizes enrollment in the program. The commissioner shall pay any
premium cost such family would otherwise incur for the first four months of coverage
to the managed care organization selected by the parent or caretaker relative to provide
coverage for such child.
(f) The commissioner shall implement presumptive eligibility for children applying
for Medicaid. Such presumptive eligibility determinations shall be in accordance with
applicable federal law and regulations. The commissioner shall adopt regulations, in
accordance with chapter 54, to establish standards and procedures for the designation
of organizations as qualified entities to grant presumptive eligibility. Qualified entities
shall ensure that, at the time a presumptive eligibility determination is made, a completed
application for Medicaid is submitted to the department for a full eligibility determination. In establishing such standards and procedures, the commissioner shall ensure the
representation of state-wide and local organizations that provide services to children of
all ages in each region of the state.
(g) The commissioner shall provide for a single point of entry servicer for applicants
and enrollees under the HUSKY Plan, Part A and Part B. The commissioner, in consultation with the servicer, shall establish a centralized unit to be responsible for processing all
applications for assistance under the HUSKY Plan, Part A and Part B. The department,
through its servicer, shall ensure that a child who is determined to be eligible for benefits
under the HUSKY Plan, Part A, or the HUSKY Plan, Part B has uninterrupted health
insurance coverage for as long as the parent or guardian elects to enroll or re-enroll such
child in the HUSKY Plan, Part A or Part B. The commissioner, in consultation with the
servicer, and in accordance with the provisions of section 17b-297, shall jointly market
both Part A and Part B together as the HUSKY Plan and shall develop and implement
public information and outreach activities with community programs. Such servicer
shall electronically transmit data with respect to enrollment and disenrollment in the
HUSKY Plan, Part A and Part B to the commissioner.
(h) Upon the expiration of any contractual provisions entered into pursuant to subsection (g) of this section, the commissioner shall develop a new contract for single
point of entry services and managed care enrollment brokerage services. The commissioner may enter into one or more contractual arrangements for such services for a
contract period not to exceed seven years. Such contracts shall include performance
measures, including, but not limited to, specified time limits for the processing of applications, parameters setting forth the requirements for a completed and reviewable application and the percentage of applications forwarded to the department in a complete and
timely fashion. Such contracts shall also include a process for identifying and correcting
noncompliance with established performance measures, including sanctions applicable
for instances of continued noncompliance with performance measures.
(i) The single point of entry servicer shall send all applications and supporting documents to the commissioner for determination of eligibility. The servicer shall enroll
eligible beneficiaries in the applicant's choice of managed care plan. Upon enrollment
in a managed care plan, an eligible HUSKY Plan Part A or Part B beneficiary shall
remain enrolled in such managed care plan for twelve months from the date of such
enrollment unless (1) an eligible beneficiary demonstrates good cause to the satisfaction
of the commissioner of the need to enroll in a different managed care plan, or (2) the
beneficiary no longer meets program eligibility requirements.
(j) Not later than ten months after the determination of eligibility for benefits under
the HUSKY Plan, Part A and Part B and annually thereafter, the commissioner or the
servicer, as the case may be, shall within existing budgetary resources, mail or, upon
request of a participant, electronically transmit an application form to each participant in
the plan for the purposes of obtaining information to make a determination on continued
eligibility beyond the twelve months of initial eligibility. To the extent permitted by
federal law, in determining eligibility for benefits under the HUSKY Plan, Part A or
Part B with respect to family income, the commissioner or the servicer shall rely upon
information provided in such form by the participant unless the commissioner or the
servicer has reason to believe that such information is inaccurate or incomplete. The
Department of Social Services shall annually review a random sample of cases to confirm that, based on the statistical sample, relying on such information is not resulting
in ineligible clients receiving benefits under HUSKY Plan Part A or Part B. The determination of eligibility shall be coordinated with health plan open enrollment periods.
(k) The commissioner shall implement the HUSKY Plan, Part B while in the process
of adopting necessary policies and procedures in regulation form in accordance with
the provisions of section 17b-10.
(l) The commissioner shall adopt regulations, in accordance with chapter 54, to
establish residency requirements and income eligibility for participation in the HUSKY
Plan, Part B and procedures for a simplified mail-in application process. Notwithstanding the provisions of section 17b-257b, such regulations shall provide that any child
adopted from another country by an individual who is a citizen of the United States and
a resident of this state shall be eligible for benefits under the HUSKY Plan, Part B upon
arrival in this state.
(October 29 Sp. Sess. P.A. 97-1, S. 4, 23; P.A. 01-137, S. 1, 3, 4, 9; P.A. 03-2, S. 7; June 30 Sp. Sess. P.A. 03-3, S. 56;
P.A. 04-16, S. 10; P.A. 05-280, S. 5, 9; P.A. 06-188, S. 16; P.A. 07-185, S. 6; June Sp. Sess. P.A. 07-2, S. 17.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 01-137 amended Subsec. (h) to require servicer
to electronically transmit enrollment and disenrollment data re HUSKY Plan, Part B to commissioner who may transmit
such data to Children's Health Council and amended Subsec. (k) to require the commissioner or servicer, as the case may
be, to determine if a child continues to be eligible for benefits under the HUSKY Plan, Part A or Part B, to mail an application
form to each participant in the plan and to rely upon information provided in the application form by the participant in
determining eligibility for benefits under the plan with respect to family income unless the commissioner or servicer has
reason to believe that such information is inaccurate or incomplete, effective July 1, 2001, and amended Subsec. (m) to
require regulations providing that any child adopted from another country by a U.S. citizen and state resident shall be
eligible for benefits under the HUSKY Plan, Part B upon arrival in this state, effective June 28, 2001; P.A. 03-2 deleted
former Subsec. (d) which provided for 12 months of continuous eligibility under the HUSKY Plan, Part A or Part B, from
the date that a child was determined eligible for the program and redesignated existing Subsecs. (e) to (m), inclusive, as
Subsecs. (d) to (l), inclusive, effective February 28, 2003; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (a) to provide that
the services and cost-sharing requirements under HUSKY Plan, Part B shall be substantially similar to those afforded to
state residents by the largest commercially available health plan offered by a managed care organization, deleted former
Subsecs. (f) and (h) re granting of presumptive eligibility under HUSKY Plan, Part A, redesignated existing Subsec. (g)
as Subsec. (f) and deleted reference therein re transmittal of data to Children's Health Council, and redesignated existing
Subsecs. (i) to (l) as Subsecs. (g) to (j), effective August 20, 2003; P.A. 04-16 made a technical change in Subsec. (a); P.A.
05-280 amended Subsec. (a) to delete provision that required HUSKY Plan, Part B services and cost-sharing requirements
to be substantially similar to those of the largest commercially available health plan offered by a managed care organization,
added new Subsec. (f) re implementation of presumptive eligibility for children applying for Medicaid and requiring
commissioner to adopt regulations re standards and procedures for the designation of organizations that shall act as qualified
entities to grant presumptive eligibility, redesignated existing Subsec. (f) as new Subsec. (g), added new Subsec. (h) re
development of new contract for single point of entry services and managed care enrollment brokerage services, redesignated existing Subsecs. (g) to (j), inclusive, as new Subsecs. (i) to (l), inclusive, amended redesignated Subsec. (i) to require
HUSKY Plan, Part A or Part B beneficiaries, enrolled in managed care plan, to remain enrolled in such plan for 12 months
unless beneficiary demonstrates good cause to enroll in a different plan or no longer meets program eligibility requirements
and amended redesignated Subsec. (j) to eliminate mandate that commissioner rely on family income information provided
by participant in determining eligibility for benefits under the HUSKY Plan, Part A and Part B, effective July 1, 2005;
P.A. 06-188 amended Subsec. (j) to permit commissioner, to the extent permitted by federal law, to rely on self-declared
family income when making program eligibility determinations and to require department to review a random sample of
cases to confirm that ineligible clients are not receiving program benefits, effective July 1, 2006; P.A. 07-185 amended
Subsecs. (a) and (b) by adjusting family income eligibility limits from 300% to 400% of federal poverty level, amended
Subsec. (e) by providing that uninsured child born in a hospital in this state or a border state shall be enrolled in HUSKY
Plan, Part B with the commissioner to pay any premium costs for the first two months of coverage, provided the parent or
caretaker relative of such child authorizes enrollment and resides in this state, amended Subsec. (g) by requiring commissioner, in consultation with servicer, to establish a centralized unit for processing applications for assistance under HUSKY
Plan, Part A and Part B, to ensure that a child determined eligible for benefits has uninterrupted health insurance coverage
for as long as the parent or guardian elects to enroll the child for coverage and to electronically transmit both Part A and
Part B enrollment and disenrollment data to commissioner, amended Subsec. (i) by requiring servicer to transmit "all
applications" to commissioner and deleting language re transmittal of applications where child resides in a home with
family income not in excess of 185% of federal poverty level, amended Subsec. (j) by changing from 12 to 10 months the
time period for commissioner to make continued eligibility determinations and by requiring that, within existing budgetary
resources, commissioner, upon the request of a program participant, electronically transmit application information needed
to make continued eligibility determinations beyond the 12 months of initial eligibility, effective July 1, 2007; June Sp.
Sess. P.A. 07-2 amended Subsecs. (a) and (b) by adjusting family income eligibility limits from 400% to 300% of federal
poverty level, amended Subsec. (e) by replacing "two" with "four" re months that commissioner shall pay premium costs
for coverage of uninsured newborn children and made conforming changes in Subsecs. (g) and (j), effective July 1, 2007.
See Sec. 17b-261f re assessment of copayments and cost-sharing requirements for certain individuals participating in
HUSKY Plan, Part A.