Title of Rule:	SSI Medicaid Eligibility Effective Date Rules for Children Under 21, Section 8.110	
Rule Number:	MSB 07-01-31-B	
Division / Contact / Phone:	Legal / Brian Zolynas / 303-866-2814	

SECRETARY OF STATE
RULES ACTION SUMMARY AND FILING INSTRUCTIONS

SUMMARY OF ACTION ON RULE(S)

1.	Department / Agency Name:	Health Care Policy and Financing / Medical Services Board	
2.	Title of Rule:	MSB 07-01-31-B, SSI Medicaid Eligibility Effective Date Rules for Children Under 21, Section 8.110	
3.	This action is an adoption of:	an amendment	
4.	Rule sections affected in this action (if existing rule, also give Code of Regulations number and page numbers affected): 	
Sections(s) 8.110.1, Colorado Department of Health Care Policy and Financing, Staff Manual Volume 8, Medical Assistance (10 CCR 2505-10).	
5.	Does this action involve any temporary or emergency rule(s)?	No	
If yes, state effective date:		
Is rule to be made permanent? (If yes, please attach notice of hearing).	Yes	

PUBLICATION INSTRUCTIONS*
Please replace current text in §8.110  MEDICAL ASSISTANCE FOR THE AGED, DISABLED OR BLIND; §8.110.1  SSI ELIGIBLES beginning at §8.110.11 through the end of  §8.110.12 with the new text attached.  This change is effective 8/30/2008.

Title of Rule:	SSI Medicaid Eligibility Effective Date Rules for Children Under 21, Section 8.110	
Rule Number:	MSB 07-01-31-B	
Division / Contact / Phone:	Legal / Brian Zolynas / 303-866-2814	
STATEMENT OF BASIS AND PURPOSE

1.	Summary of the basis and purpose for the rule or rule change.  (State what the rule says or does and explain why the rule or rule change is necessary).	
The purpose of this rule change is to revise the Supplemental Security Income (SSI) Medicaid eligibility requirements to incorporate changes in federal law governing the effective date of eligibility for individuals under 21 and to provide criteria for granting eligibility to infants who are found to be disabled shortly after birth.	
2.	An emergency rule-making is imperatively necessary	
	to comply with state or federal regulation and/or	
	for the preservation of public health, safety and welfare.	
Explain:	
     	
3.	Federal authority for the Rule, if any:	
42 CFR §435.120, 42 CFR §435.909(b)(1), 42 CFR §435.914, 42 USC §1396a(a)(10)(A)(i)(II)(cc) 	
4.	State Authority for the Rule:	
25.5-1-301 through 25.5-1-303, C.R.S. (2007);
25.5-4-104(1), C.R.S. (2007)	

Title of Rule:	SSI Medicaid Eligibility Effective Date Rules for Children Under 21, Section 8.110	
Rule Number:	MSB 07-01-31-B	
Division / Contact / Phone:	Legal / Brian Zolynas / 303-866-2814	
REGULATORY ANALYSIS

1.	Describe the classes of persons who will be affected by the proposed rule, including classes that will bear the costs of the proposed rule and classes that will benefit from the proposed rule.
The proposed rule changes will affect children under the age of 21 who are eligible for or who are receiving SSI benefits and infants found to be disabled at or shortly after birth who are eligible for or who are receiving SSI. Under the current rules, Medicaid eligibility for these infants does not begin until the date on which they are found eligible for SSI, and this sometimes does not occur until days or weeks after the child was born. As a result, some disabled children do not have insurance coverage to cover the cost of their birth and first few days or weeks of hospitalization. Current Department policy allows the effective date for Medicaid eligibility for individuals eligible for or receiving SSI benefits to be backdated up to 90 days, if the individual otherwise meets the SSI financial and disability criteria, and this policy has been employed to provide coverage for some infants in these situations. The proposed rule change would clarify that Medicaid coverage is available for SSI-eligible infants found to be disabled shortly after birth by providing for automatic coverage back to the date of birth if certain criteria are met.

The proposed rule changes will also affect caseworkers at the county departments of social/human services and medical assistance sites who make determinations of Medicaid eligibility. These individuals will need to become familiar with the new rules and with procedures for implementing them.

2.	To the extent practicable, describe the probable quantitative and qualitative impact of the proposed rule, economic or otherwise, upon affected classes of persons.
The proposed rule change will eliminate gaps in insurance coverage experienced by some disabled infants who are eligible for or who receive SSI. These gaps in coverage result in medical bills that become the responsibility of the infant's parents, counties, or other parties, and often end up unpaid, unless the infant's Medicaid eligibility is backdated 90 days. While the Department's policy has been to backdate Medicaid eligibility for up to 90 days for these infants if they otherwise meet the SSI financial criteria, this has not been done consistently or expeditiously in all cases. The proposed regulations should help alleviate this problem.
3.	Discuss the probable costs to the Department and to any other agency of the implementation and enforcement of the proposed rule and any anticipated effect on state revenues.
Current Department policy already allows for backdating Medicaid eligibility for individuals who are eligible for or who are receiving SSI benefits up to 90 days, if they meet the SSI financial and disability criteria. This policy has not been consistently applied in all cases in which it could have been invoked and has resulted in some individuals who may have been eligible for Medicaid coverage of their medical bills not receiving that coverage. The proposed rule change is intended to help reduce the prevalence of this problem among infants, and, to the extent that it is successful, there may be a fiscal impact to the Department in providing that coverage. The Department does not have data at this time with which to quantify this potential fiscal impact.

4.	Compare the probable costs and benefits of the proposed rule to the probable costs and benefits of inaction.
Inaction would result the department being out of compliance with federal statute. It would also result in some SSI eligible disabled infants continuing to experience difficulties in obtaining Medicaid coverage for bills incurred from date of birth until the date on which SSI eligibility is established. The proposed rule would alleviate this problem.

5.	Determine whether there are less costly methods or less intrusive methods for achieving the purpose of the proposed rule.
There are no less costly or less intrusive methods for achieving the purpose of the proposed rule.

6.	Describe any alternative methods for achieving the purpose for the proposed rule that were seriously considered by the Department and the reasons why they were rejected in favor of the proposed rule.
There are no effective alternative methods for achieving the purpose of the proposed rule. 

8.110  MEDICAL ASSISTANCE FOR THE AGED, DISABLED OR BLIND
8.110.1  SSI ELIGIBLES
.11  Benefits of the Colorado Medicaid Program must be provided to the following:
a.  persons receiving financial assistance under the federal Supplemental Security Income program (SSI);
b.  persons who are eligible for financial assistance under SSI, but are not receiving SSI;
c.  persons receiving SSI payments based on presumptive eligibility for SSI pending final determination of disability or blindness; and
d.  persons receiving SSI payments based on conditional eligibility for SSI pending disposal of excess resources.
.115	For individuals under 21 years of age who are eligible for or who are receiving SSI, the effective date of Medicaid eligibility shall be the date on which the individual applied for SSI or the date on which the individual became eligible for SSI, whichever is later.
a.	Special Provisions for Infants
1.	For an infant who is eligible for or who is receiving SSI, the effective date of Medicaid eligibility shall be the infant’s date of birth if:
a)	the infant was born in a hospital; 
b)	the disability onset date, as reported by the Social Security Administration, occurred during the infant’s hospital stay; and
c)	the infant’s date of birth is within three (3) months of the date on which the infant became eligible for SSI.
.12  The State Department of Social Services has entered into an agreement with the Social Security Administration (SSA) in which SSA shall determine Medicaid eligibility for all SSI applicants.
Medicaid benefits shall be provided to all individuals receiving SSI benefits as are determined by SSA to be eligible for Medicaid.
The county department shall receive a weekly unmatched listing of all individuals newly approved and also, a weekly SSI-Cases Denied or Discontinued listing. These lists shall include the necessary information for the county to complete an eligibility form authorizing medical assistance.