Attorney General's Opinion
Attorney General, Richard Blumenthal
March 1, 2005
Robert M. Ward
House Minority Leader
House of Representatives
Hartford, CT 06106-1591
Dear Representative Ward:
You have asked for a formal opinion regarding the possible consequences of enacting Substitute House Bill 6438, An Act Extending Husky Plan, Part A Benefits for Parents and Needy Caretaker Relatives. The proposed Bill would temporarily continue the Medicaid eligibility of individuals whose eligibility for Medicaid under the Transitional Medical Assistance ("TMA") coverage group will end between March 31, 2005 and May 31, 2005. Eligibility for this group of individuals would be extended through June 30, 2005 under the proposed Bill. You inquire whether or not this proposed temporary extension of benefits may "ultimately allow these adults to qualify for any additional extension under federal law?" We conclude that House Bill 6438, if enacted into law, would not afford the individuals affected by the temporary extension of benefits any additional rights to a further extension of eligibility under federal law.
By way of background information, an individual qualifies for Medicaid by reference to the eligibility rules that apply to one or more "coverage groups." 42 U.S.C. § 1396a(A)(10). The eligibility rules vary by coverage group in a number of respects, including assistance unit composition (which members of a family are covered) and income and resource limitations. The primary coverage group that applies to families that contain children and their adult supervising relatives is commonly called the "1931 coverage group," based upon the section of the Social Security Act that mandates that participating states cover this group of individuals. Section 1931 of the Social Security Act, codified at 42 U.S.C. §§ 1396u-1. This group of individuals includes families who formerly would have qualified for Medicaid as a result of their receipt of cash assistance benefits under the Aid to Families with Dependent Children program.
Effective April 1, 2003, Connecticut reduced its income eligibility limit for its 1931 Medicaid coverage group from 150 percent to 100 percent of federal poverty guidelines, pursuant to state legislative directions. P.A. 03-2. The children who were formerly covered under Connecticut's 1931 coverage group remained eligible under different coverage groups that apply to children only and allow eligibility to be established based upon family income that is within much higher percentages of poverty. Many adults, however, who did not otherwise qualify for assistance under another coverage group, faced a loss in coverage and were notified of the termination of their medical assistance benefits.
An action was brought, entitled Rabin v. Wilson-Coker, 266 F. Supp. 2d 332 (D. Conn. 2003, rev'd, 362 F.3d 190 (2nd Cir., 2004), claiming that these adults were entitled to extended Medicaid eligibility under the TMA Medicaid coverage group. 42 U.S.C. § 1396r-6. Federal law mandates that the states temporarily continue eligibility for individuals who lose eligibility under the state's 1931 coverage group "because of income from employment" for a one year period under the TMA coverage group. Id. The purpose of the requirement that the states provide extended medical assistance is to encourage work by eliminating the disincentive that the family may precipitously lose Medicaid eligibility if they go to work and realize family income in excess of the 1931 income eligibility limit. The District Court ruled that these adults were not entitled to extended coverage under the TMA coverage group because their loss in eligibility was due to the statutory reduction in the income eligibility limit, and not due to any individual increase in family income due to income from employment. 266 F. Supp. 2d 232. The Second Circuit, however, granted a temporary injunction pending appeal, and then reversed, ruling that these individuals were entitled to TMA as long as they had any income from employment. 362 F. 3d 190. These individuals continued to receive Medicaid benefits under the TMA coverage group as a result.
In fact, Connecticut, by statute, provides for a two year period of extended eligibility for this coverage group. Conn. Gen. Stat. § 17b-261(g).1 The two year time period for extended medical assistance benefits for adults who would have otherwise lost eligibility on April 1, 2003 is due to expire on April 1, 2005. The proposed Bill temporarily extends coverage for this group of individuals for up to three more months, to July 1, 2005.2 It is our understanding that consideration is being given to increasing the income eligibility limit for Connecticut's 1931 coverage group, effective July 1, 2005. The purpose of Substitute House Bill 6438 is to prevent these individuals from losing assistance on April 1, only to have them regain eligibility on July 1, if the legislature subsequently increases the 1931 income eligibility limit at that time.
It should be noted that the Rabin injunction only applies to adults who were previously eligible for assistance under Connecticut's 1931 coverage group, and who would have lost assistance but for TMA due to the reduction in the income eligibility limit. The reduced income eligibility limit (100 percent of poverty) remains applicable to new applicants for assistance, resulting in the denial of assistance for adult family members in families with incomes over 100 percent of poverty, unless the adult otherwise qualifies for assistance under a different coverage group.
With the foregoing background,3 the answer to your question is that the proposed further extension in eligibility for these individuals will not result in a right for any additional extensions under federal law. As noted supra, federal law only provides for a one year extension for individuals who lose eligibility under the state's 1931 coverage group because of income from employment. 42 U.S.C. § 1396r-6. The federally mandated one year period of extended eligibility, supplemented by Connecticut law, will expire between March 30 and June 30, 2005, thereby fulfilling the state's obligation under federal law to provide TMA. 42 U.S.C. § 1396 r-6. The Department of Social Services examined the circumstances of the adults who were losing eligibility under the 1931 coverage group in 2003, and continued eligibility for those adults who qualified under another Medicaid coverage group at that time. Individuals received extended Medicaid coverage under the temporary TMA coverage group, pursuant to the Court's injunction in Rabin, only if they did not otherwise qualify for assistance. Accordingly, assuming that their circumstances have not changed, these individuals will not be entitled to any further benefits under federal law since the mandated extension period has already been provided. The proposed extension in eligibility for up to three months under the proposed Bill will not give rights to any further extensions under any other provision in federal law.
Of course, if the circumstances of individual families change with respect to a characteristic that is pertinent to Medicaid eligibility (eg., onset of disability, reduced family income, etc), the family member may remain eligible for Medicaid because he or she now meets the requirements for eligibility under one of the regular Medicaid coverage groups. The individual's ongoing eligibility, however, will be because of the family's changed circumstances, and not as a result of any further temporary extension granted by the proposed Bill.4
In conclusion, it is our opinion that the enactment of the proposed Bill would not afford the individuals benefited thereby with any additional rights to further extension of eligibility under federal law.
1Federal approval (with resulting federal financial participation) for two years of extended medical assistance was obtained through the use of a state plan amendment that "disregards" the excess income for the first year of extended eligibility, with the federally mandated one year extension of Medicaid eligibility then becoming available.
2Although, the primary impact of the proposed Bill would be on individuals who otherwise would have lost assistance on April 1, 2003 due to the statutory reduction in the income eligibility limit for Connecticut's 1931 coverage group, it also covers individuals who lost assistance in May or June 2003 because their individual family circumstances changed and their increased family income exceeded the reduced eligibility limit of 100 percent of poverty.
3The Office of Legislative Research Bill ("OLR") analysis of the proposed Bill, attached hereto as Exhibit A, indicates that it is unclear whether expenditures for the proposed up to three months of additional benefits will qualify for federal financial participation under the Medicaid program.
4The individual's continued eligibility will be determined by reference to the eligibility rules applicable to one of Connecticut's regular coverage group, and not by reference to the rules applicable to a temporary extension in eligibility under TMA.