NY State Senate Bill 2025-S1617

Senate Bill S1617

2025-2026 Legislative Session

Provides for automatic enrollment and recertification simplification for Medicaid eligible recipients

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Current Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 13, 2025	referred to health

co-Sponsors

2025-S1617 (ACTIVE) - Details

See Assembly Version of this Bill:: A2459
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4403-f, Pub Health L; amd §366-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S7523, A9017
2021-2022: S4965, A155
2023-2024: S4622, A5980

2025-S1617 (ACTIVE) - Summary

Provides for automatic enrollment and recertification simplification for Medicaid managed care plans and long term care plans.

2025-S1617 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S1617

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law and the social services law, in
relation to automatic enrollment and recertification simplification for
Medicaid eligible recipients

 
PURPOSE:

To shorten and simplify Medicaid long-term care eligibility processes.

 
SUMMARY OF PROVISIONS:

Section 1 amends Public Health Law (PHL) section 4403-f, as it relates
to Health Maintenance Organizations (HMOs), to enable auto-assignment in
a Managed Long Term Care (MLTC) Plan when a person determined to be
eligible has not chosen a plan within the first 75 days of eligibility
and extends that eligibility if that person does not complete auto-as-
signment within 75 days.

Sections 2 and 3 amend Social Services Law section 366-a, as it relates
to applications for assistance; investigations; reconsideration, to make
the Medicaid recertification process less burdensome and error-prone by
allowing attestation of resources that are unchanged or have diminished,
and providing automatic recertification for MLTC enrollees, mainstream
managed care members receiving personal care services, enrollees in the
Aged, Blind, and Disabled Category without excess income and Medicare
Savings Program recipients. These provisions would be subject to federal
financial participation.

Section 4 provides for the effective date.

 
JUSTIFICATION:

People who have successfully applied for Medicaid in order to enroll in
a MLTC plan face many hurdles and delays before they are effectively
enrolled. First, an in-home eligibility assessment by a nurse can take
several weeks to schedule and this assessment is valid for only 75 days.

After that assessment is completed, the Medicaid recipient will schedule
in-home assessments with prospective MTLC plans to determine the level
of care each will provide. It can take several weeks to schedule and
complete those visits. Once the recipient agrees to a plan, the plan
will process enrollment, which is effective either the first of the
following month or, if it is already after the 18th, effective the first
of the month after the following month. If 75 days have lapsed, the
process restarts at the beginning, resulting in care delays.

Currently, Medicaid recipients complete a mail renewal form, attesting
to their income, once a year in order to continue to receive health care
coverage. This is true even if the recipient is on a fixed income. The
recertification process is so prone to errors that it frequently results
in a discontinuance of eligibility. The recipient may not receive the
discontinuance notice on time or at all, or may not be able to request a
fair hearing within 10 days, which automatically triggers disenrollment.
In 2011, the Medicaid program recognized the problems and initiated a
demonstration program to automate renewals for Aged, Blind, and Disabled
Medicaid recipients with fixed incomes. This bill extends the benefits
of that demonstration to the rest of the program.

 
LEGISLATIVE HISTORY:

2023-24: S4622-B Rivera/A5980-A Paulin - Passed Senate

2021-22: S4965 Rivera/A155 Gottfried - Passed Senate

2020: S7523 Rivera/A9017 Gottfried - Advanced to 3rd Reading

2019: S5485-A Rivera/A7578-A Gottfried - Vetoed Memo. 183

 
FISCAL IMPLICATIONS:

None noted

 
EFFECTIVE DATE:
This act shall take effect 180 days after it becomes law. Sections 2 and
3 will be subjected to federal financial participation, therefore, these
sections will not take effect until the Federal Center for Medicaid and
Medicare Services (CMS) approves in writing to the state commissioner
that the changes do not affect eligibility requirements and federal
participation is not affected.

2025-S1617 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1617
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 13, 2025
                                ___________
 
 Introduced  by  Sens.  RIVERA,  JACKSON,  MAY  -- read twice and ordered
   printed, and when printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law and the social  services  law,  in
   relation  to  automatic  enrollment and recertification simplification
   for Medicaid eligible recipients

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  (b)  of subdivision 7 of section 4403-f of the
 public health law is amended by adding a new subparagraph (iv)  to  read
 as follows:
   (IV) WHERE A PERSON DETERMINED ELIGIBLE FOR MEDICAID ("MEDICAID RECIP-
 IENT")  HAS  BEEN DETERMINED BY THE COMMISSIONER OR THE DESIGNEE OF SUCH
 COMMISSIONER TO REQUIRE COMMUNITY-BASED LONG TERM CARE SERVICES FOR MORE
 THAN A CONTINUOUS PERIOD OF ONE HUNDRED TWENTY DAYS,  AND  THE  MEDICAID
 RECIPIENT HAS NOT SELECTED AND ENROLLED IN A MANAGED LONG TERM CARE PLAN
 PRIOR TO ANY EXPIRATION DATE OF SUCH DETERMINATION OF NEED FOR LONG TERM
 CARE,  AFTER BEING PROVIDED WITH INFORMATION TO MAKE AN INFORMED CHOICE,
 THE COMMISSIONER SHALL ASSIGN THE RECIPIENT TO A MANAGED LONG TERM  CARE
 PLAN,  TAKING  INTO  ACCOUNT  CONSISTENCY WITH ANY PRIOR COMMUNITY-BASED
 DIRECT CARE  WORKERS  HAVING  RECENTLY  SERVED  THE  RECIPIENT,  QUALITY
 PERFORMANCE  CRITERIA,  CAPACITY,  AND  GEOGRAPHIC  ACCESSIBILITY.   THE
 COMMISSIONER MAY ASSIGN PARTICIPANTS PURSUANT  TO  SUCH  CRITERIA  ON  A
 WEIGHTED  BASIS.   A RECIPIENT ASSIGNED TO A MANAGED LONG TERM CARE PLAN
 UNDER THIS SUBPARAGRAPH SHALL BE DEEMED TO HAVE BEEN DETERMINED TO BE IN
 NEED OF LONG TERM CARE SERVICES FOR MORE THAN A CONTINUOUS PERIOD OF ONE
 HUNDRED TWENTY DAYS AND ELIGIBLE TO BE ENROLLED IN A MANAGED  LONG  TERM
 CARE PLAN.
   §  2.  Paragraph  (b)  of subdivision 2 of section 366-a of the social
 services law, as added by section 51 of part A of chapter 1 of the  laws
 of 2002, is amended to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04128-01-5
 S. 1617                             2

 
   (b)  Notwithstanding  the provisions of paragraph (a) of this subdivi-
 sion, an applicant or recipient may attest to the amount of [his or her]
 THEIR accumulated resources, unless such applicant or recipient is seek-
 ing medical assistance payment for long term care services FOR THE FIRST
 TIME.  A  RECIPIENT  WHO HAS ALREADY PROVIDED DOCUMENTATION OF RESOURCES
 MAY ATTEST TO THE AMOUNT OF ACCUMULATED RESOURCES IF IT HAS REMAINED THE
 SAME OR IS LESS THAN THE AMOUNT ORIGINALLY DOCUMENTED.  For purposes  of
 this  paragraph,  long  term  care  services shall mean care, treatment,
 maintenance, and services described in paragraph (b) of subdivision  [1]
 ONE  of  section  three  hundred  sixty-seven-f  of this title, with the
 exception of short term rehabilitation, as defined by  the  commissioner
 of health.
   §  3.  Paragraph  (d)  of subdivision 5 of section 366-a of the social
 services law, as amended by section 12 of part D of chapter  56  of  the
 laws  of 2013, is relettered paragraph (e) and three new paragraphs (f),
 (g) and (h) are added to read as follows:
   (F) NOTWITHSTANDING PARAGRAPH (B) OF SUBDIVISION TWO OF  THIS  SECTION
 AND  PARAGRAPHS (A), (B), (C) AND (D) OF THIS SUBDIVISION, THE FOLLOWING
 RECIPIENTS WILL BE RECERTIFIED AUTOMATICALLY, UNLESS THERE  HAS  BEEN  A
 FINDING OF LACK OF ELIGIBILITY FOR MEDICAID:
   (I)  ENROLLEES  IN MEDICAID MANAGED LONG TERM CARE PLANS AS DEFINED IN
 SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW;
   (II) ENROLLEES IN MEDICAID MANAGED CARE PLANS AS  DEFINED  IN  SECTION
 THREE  HUNDRED  SIXTY-FOUR-J  OF  THIS  TITLE  WHO RECEIVE PERSONAL CARE
 SERVICES PURSUANT TO PARAGRAPH (E) OF SUBDIVISION TWO OF  SECTION  THREE
 HUNDRED SIXTY-FIVE-A OF THIS TITLE OR CONSUMER DIRECTED PERSONAL ASSIST-
 ANCE  SERVICES  PURSUANT  TO  SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS
 TITLE;
   (III) ENROLLEES RECEIVING MEDICAID IN THE  AGED,  BLIND  AND  DISABLED
 CATEGORY  WHO  RECEIVE  FIXED  INCOME  FROM THE SOCIAL SECURITY ADMINIS-
 TRATION (SSA); AND
   (IV) MEDICARE SAVINGS PROGRAM (MSP) RECIPIENTS WHO HAVE A FIXED INCOME
 FROM THE SOCIAL SECURITY ADMINISTRATION (SSA).
   (G) NOTHING IN PARAGRAPH (E) OF THIS SUBDIVISION SHOULD  BE  CONSTRUED
 TO  ALTER A MEDICAID RECIPIENT'S OBLIGATION TO INFORM THE PUBLIC WELFARE
 DISTRICT OF CHANGES IN INCOME OR OTHER FACTORS THAT MIGHT IMPACT  ELIGI-
 BILITY PURSUANT TO SUBDIVISION FOUR OF THIS SECTION.
   (H)  UPON  A  FINDING OF LACK OF ELIGIBILITY, RECIPIENTS IDENTIFIED IN
 PARAGRAPH (E) OF THIS SUBDIVISION WILL BE ENTITLED TO NOTICE AND HEARING
 RIGHTS AS PROVIDED IN SECTION TWENTY-TWO OF THIS CHAPTER.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law; provided that the  amendments  to  paragraph
 (b)  of subdivision 7 of section 4403-f of the public health law made by
 section one of this act shall be subject to the expiration and reversion
 of such paragraph and shall expire and be deemed repealed therewith  and
 provided  further  that  such  amendments shall not affect the repeal of
 such section and shall expire and be deemed repealed  therewith.  Effec-
 tive  immediately, the commissioner of health shall make regulations and
 take other actions reasonably necessary to implement this  act  on  that
 date.  Provided,  further, that sections two and three of this act shall
 only take effect when the  federal  center  for  Medicaid  and  Medicare
 services  (CMS)  approves in writing to the state commissioner of health
 that the changes do not affect federal financial participation; provided
 that the commissioner of health shall notify the legislative bill draft-
 ing commission upon the occurrence of the enactment of  the  legislation
 provided  for  in  sections  two and three of this act in order that the
 S. 1617                             3
 
 commission may maintain an accurate and timely effective  data  base  of
 the official text of the laws of the state of New York in furtherance of
 effectuating  the  provisions  of  section 44 of the legislative law and
 section 70-b of the public officers law.

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Senate Bill S1617

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Sponsored By

Gustavo Rivera