SB 210 would require Connecticut's Medicaid program to increase reimbursement rates for pediatric care services by at least 5% above rates in effect on June 30, 2026. This directly affects healthcare providers who treat children through Medicaid, such as pediatricians and clinics. The bill mandates that the state submit a report assessing how these rate increases impact provider participation, patient access to care, and state budget costs. The policy change aims to improve financial incentives for providers serving Medicaid-covered children. The bill focuses on concrete rate adjustments and reporting, not broader program changes.
HB 5301 excludes income earned by a spouse who provides over 25% of daily care for their partner from income calculations when determining eligibility for home and community-based Medicaid services. It directly affects spouses caring for a partner receiving such services under Medicaid waiver programs. The bill requires the Social Services Commissioner to seek a federal Medicaid waiver or amend the state plan to disregard this spousal income, effective October 1, 2026. This change modifies how income is assessed for Medicaid eligibility under specific home and community-based service programs.
SB 120 suspends annual cost increase limits on direct care expenses for Medicaid-funded intermediate care facilities (long-term care facilities serving individuals with disabilities or chronic conditions). This change directly affects these facilities by removing a cap that previously restricted how much they could raise costs each year to cover inflation. The bill modifies existing law (section 17b-340) to allow facilities to adjust direct care costs without the previous inflation-based limitation. The stated purpose is to reduce financial strain on these facilities operating under Medicaid.
HB 5300 increases the monthly personal needs allowance for Medicaid and Supplemental Security Income (SSI) recipients living in long-term care facilities to $75, effective July 1, 2026. It requires annual adjustments to this allowance each July 1, increasing it by 25% of the federal SSI cost-of-living adjustment (COLA) each year. The bill directly affects residents in licensed nursing homes, chronic disease hospitals, and similar facilities who receive Medicaid or SSI benefits. Funds will be paid to the facilities to deposit into residents’ personal accounts, ensuring the allowance keeps pace with inflation.
SB 289 establishes a state-funded quality metrics program for nursing homes, directly affecting facilities serving Medicaid beneficiaries. It creates two funding pools: a $10 million annual pool for performance-based payments tied to quality metrics (using CMS measures and consumer surveys), and a $2.5-$5 million pool for facilities with over 75% Medicaid residents. Nursing homes must report quality metrics annually, with payments determined by performance scores - excluding facilities flagged for serious quality issues. The program begins October 1, 2026, with payments phased in over time using existing Medicaid appropriations.
HB 5198 would change state rules so that life insurance policy values are no longer counted when determining eligibility for public assistance programs like Medicaid. This directly affects individuals applying for or receiving state-funded benefits who own life insurance policies. The bill's key provision removes life insurance assets from the calculation of financial eligibility, meaning these policies won't disqualify applicants. The change applies only to state-administered programs and must comply with existing federal law.
SB 153 expands Medicaid eligibility for older adults with disabilities who qualify as "adult disabled children" under federal Social Security rules. The bill amends state law to disregard certain income (such as Social Security benefits) that would otherwise make these individuals ineligible for Medicaid. This change directly affects older adults with disabilities meeting federal Social Security criteria who previously lost Medicaid coverage due to income thresholds. The key mechanism is excluding specific income sources from eligibility calculations, aligning state policy with a federal Medicaid provision.
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People with Disabilities
HB 5356 requires Connecticut's Commissioner of Social Services to identify geographic areas where competitive bidding for nonemergency medical transportation (NEMT) services for Medicaid recipients could save state costs. It mandates that providers meeting state licensure/certification standards must compete for contracts to offer these services, with payment only made for actual transport provided. The bill also requires annual review of reimbursement rates to ensure they maintain an adequate driver pool and includes provisions for pilot programs before statewide implementation. This directly affects Medicaid recipients needing nonemergency medical transport and transportation providers contracted to serve them.
SB 327 expands emergency Medicaid coverage to include specific medical conditions requiring immediate care, such as high-risk pregnancies, severe diabetes complications, diabetic ketoacidosis, renal failure needing dialysis, certain fractures, hypertensive emergencies, unstable seizure disorders, active cancer treatment, ventilator dependency, labor/delivery, and acute psychiatric care. It directly affects low-income residents who need emergency medical treatment but may not qualify for regular Medicaid. The bill requires the state Commissioner to implement this expanded coverage starting July 1, 2026, and establish an online advance application system by July 1, 2027, for outpatient emergency care. This system will include clear information on covered conditions on the Department of Social Services website and in department materials. The law aims to ensure timely access to critical emergency care without requiring hospital emergency department visits for qualifying conditions.
HB 5354 limits how Connecticut can audit Medicaid pharmacies by prohibiting the use of data extrapolation for minor clerical errors in audits. It requires the state to confirm notices to pharmacies about billing and maintain a real-time database of approved drugs on the preferred drug list. Pharmacies can challenge disputed reimbursements through a new grievance process starting October 2026, allowing them to present cost evidence. The bill directly affects pharmacies participating in Connecticut's Medicaid program and takes effect July 1, 2026.
