August 24, 2019

SB 12-018: Creating Voluntary Alternative Medical Assistance Program for Medicaid-Eligible Elderly

On January 11, 2012, Sen. Lundberg introduced SB 12-018 – Concerning the development of an alternative medical assistance program for the elderly. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill creates a voluntary alternative medical assistance program for the Medicaid-eligible elderly. An eligible participant agrees to receive an amount equal to 70% of the medical assistance benefits that he or she would have received if the participant were enrolled in the state’s traditional Medicaid program in exchange for 2 features currently not allowed under the traditional Medicaid program:

  • The participant can choose any provider; and
  • The state waives the right to pursue all estate recovery methods from the participant’s family after the participant dies.

The participant’s physician assesses the level of care the participant needs. The department of health care policy and financing then determines the expected costs to provide that level of care if the participant were enrolled in and were receiving services under the traditional Medicaid program and allocates 70% of that amount annually to reimburse providers for the participant’s care. The department issues a debit card to the participant that is funded monthly with one-twelfth of the annual amount so allocated to the participant, which the participant uses to pay for medical services while enrolled in the alternative program. The eligible participant purchases long-term care services, assisted living services, home- and community-based services, home health services, prescribed drugs, or any health or dental care service at rates set by the provider, and the participant agrees to provide all additional resources needed for his or her care beyond the 70% Medicaid benefit amount provided through the program. The participant is responsible for researching and selecting the services.

Each year, the department conducts a redetermination of the participant’s eligibility for services and the participant’s physician reassesses the level of care that the participant needs. The department must seek a federal waiver for the program. Assigned to the Health and Human Services Committee.

Summaries of other featured bills can be found here.