Effective July 1, 2005, the bill increases the income limit for adult coverage in the HUSKY A program from 100% to 150% of the federal poverty level (FPL). HUSKY A (Medicaid) coverage is available to adults who are parents or caretaker relatives of children receiving HUSKY A. The income limit for the children is 185% of the FPL. The current FPL is $ 19,350 for a four-person household.

				The bill requires the Department of Social Services commissioner, to the extent permitted by federal law or waiver, to impose cost sharing requirements on parents and needy caretaker relatives receiving HUSKY (presumably HUSKY A since HUSKY B is for children only) with income over 100% of the FPL. The cost sharing includes (1) a $ 25 monthly premium and (2) $ 1 co-payment for outpatient medical services. Currently, there are no cost sharing requirements in HUSKY A. If DSS seeks a federal waiver, it must submit a copy of the waiver to the Appropriations and Human Services committees for review, which is required by law for most waiver requests.

				Adults between 100% - 150% will be subject to a $1 co-payment on outpatient services.

				Adults between 100% - 150% will be subject to monthly premiums subject to approval by the Federal Government (waiver) of $25 per month

				Under current law, families who lose eligibility for HUSKY A coverage due to employment or child support income are eligible for transitional Medicaid. The bill reduces from two years to one the time that these families can receive this assistance. Federal law requires states to provide one year of transitional Medicaid but allows states to provide an additional year. The bill specifies that only working parents whose income from employment makes them ineligible (i. e. , their income goes above the set limits) can get the transitional assistance.

				The bill eliminates the DSS commissioner's authority to rely on income information that HUSKY A and B applicants put on the program renewal application unless she has reason to believe it is inaccurate or incomplete.

				HUSKY B provides subsidized, managed health insurance to children in families with incomes between 185% and 300% of the FPL. Families with incomes between 235% and 300% (Band 2) of the FPL currently pay $ 30 per month in premiums, as well as co-payments on most medical services, with an overall annual cost sharing cap of $ 1,250. Families with lower incomes (Band 1) pay no premiums, but they pay up to $ 650 annually in co-payments.

				New and increased premiums will be imposed on children in HUSKY B. Premiums will be $30/child per month with a family max. of $50/month for Band 1, and $50/child per month with a family max. of $70 for Band 2.

				A 12-month health plan lock-in period for clients in HUSKY A or B.

				Clients will be permitted to change plans before the end of the one-year period for good cause.

				The bill requires DSS to expedite Medicaid eligibility for pregnant women. DSS must ensure that it processes (1) emergency applications, as the commissioner determines, within 24 hours from when it receives all required information from the applicant and (2) all other applications no later than five calendar days after receiving the information.

				The bill requires the commissioner to submit reports every two years to the Medicaid Managed Care Council on how it is complying with these deadlines.

				The bill requires HUSKY A and B beneficiaries to remain enrolled in a managed care plan for 12 months before they can switch to another plan, unless (1) they can demonstrate good cause for switching sooner or (2) the beneficiary no longer mets the program's eligibility requirements. Under current DSS regulations, HUSKY B enrollees may only switch plans once a year. HUSKY A enrollees can switch more often.

				The bill requires the DSS commissioner to reinstitute PE for children applying for HUSKY A coverage. PE determinations must be made in accordance with applicable federal law. (In essence, PE enables children to start getting HUSKY A coverage while DSS is in the process of completing the eligibility determination. )

				It requires DSS to adopt regulations to establish standards and procedures for designating organizations as "qualified entities" to grant PE. These entities must ensure that at the time they grant PE, a completed Medicaid application is submitted to DSS for a full eligibility determination. In adopting the standards and procedures, DSS must ensure representation of statewide and local organizations that provide services to children.

				PA 03-3, June 30 Special Session, eliminated PE for HUSKY A children. Until then, DSS used qualified entities to make PE determinations, using the same requirements as those required in the bill.

				By law, DSS must contract with an entity to be a single point of entry "servicer" for HUSKY A and B applicants and enrollees. In addition to providing enrollment assistance, the servicer must do outreach and provide public information about these programs. DSS currently contracts with ACS, Inc.

				The bill requires DSS, when its existing contract expires, to develop one or more new contracts for single point of entry services and managed care enrollment brokering. It also allows it to enter into more than one contract, the duration of which cannot exceed seven years. The ACS contract, in place since 1995, expired in December 2004. It has never been formally re-bid.

				Any future contract must include performance measures, including (1) time limits for processing applications, (2) parameters establishing requirements for completed and "reviewable" applications, and (3) the percentage of applications forwarded to DSS in a complete and timely fashion. The contracts must also include a process for identifying and correcting noncompliance with performance measures, including sanctions when continued noncompliance occurs.