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August 9, 2024

CT’s stricter Medicaid limits could reduce coverage, advocates say

SHAHRZAD RASEKH / CT MIRROR Marisol Galarza, a pediatric care coordinator at Fair Haven Community Health Care, helps a patient with her Medicaid renewal application.
By Katy Golvala, CT Mirror

Beginning in October, Connecticut will enact a stricter income threshold for HUSKY A, the Medicaid coverage for parents and caretaker relatives of eligible children. 

Currently, parents and caretaker relatives who earn up to 160% of the federal poverty level, or FPL, qualify for HUSKY A. But a measure passed last session, which was introduced and backed by Gov. Ned Lamont, will reduce the eligibility threshold to 138% of the federal poverty level beginning Oct. 1, 2024. 

Roughly 15,300 people will lose HUSKY coverage, according to a brief released Thursday by the Connecticut Health Foundation. But most of those people will retain Medicaid coverage for another year under what’s known as Transitional Medical Assistance.

After that, most will qualify for a zero-premium, no cost-share coverage plan under Covered Connecticut, a program that provides free health insurance to residents who earn less than 175% of the FPL through Access Health CT, the state’s health insurance marketplace. 

According to the Lamont administration, Connecticut is currently the only state providing Medicaid coverage to parents and relative caregivers over 138% of the FPL. Bringing the eligibility threshold in line with other states will save $2.1 million in FY 2025 and $33 million on an annualized basis afterward. 

“This benefits everyone by stretching limited state dollars while maintaining zero premium, no-cost health care through commercial insurance for HUSKY A adults,” said Chris Collibee, a spokesperson for the Office of Policy and Management, in emailed comments.

Collibee said the policy “costs the taxpayers of Connecticut less than the costs under HUSKY A” and helps to strengthen Access Health CT. The program “covers out-of-pocket costs not covered by the federal government,” Collibee said, “while also providing coverage of dental and non-emergency medical transportation services.”

“This costs the taxpayers of Connecticut less than the costs under HUSKY A because we are leveraging the federal subsidies already available under the exchange.”

But advocates have concerns that the change will impact access to health care for some low-income residents.

“Covered Connecticut is an excellent option for people whose incomes are just above the limit for Medicaid and have not had access to affordable coverage in the past,” said Tiffany Donelson, president and CEO of the Connecticut Health Foundation. “However, it is most effective as a way to increase coverage options for people, not a mechanism to roll back HUSKY.”

A policy brief released today by the Connecticut Health Foundation states that while many of the parents and caregivers losing HUSKY coverage will qualify for Covered Connecticut, some won’t. Covered Connecticut is only available to people who do not have access to another source of insurance, like Medicare or employer-sponsored coverage. 

For example, some grandparents over the age of 65 who qualify for Medicare and serve as their grandchildren’s caretakers would not qualify for Covered Connecticut. Neither would someone whose employer offers health coverage, even if it’s a high-deductible plan. Under the Affordable Care Act, though, people with employer-sponsored insurance can still qualify for Covered Connecticut if the coverage is “unaffordable,” defined as having premium payments that make up more than 8.39% of their income. 

The brief also warns that the federal funding that supports Covered Connecticut is slated to expire at the end of 2025 unless Congress and the president extend the funding.

Sen. Matt Lesser, D-Middletown, co-chair of the Human Services Committee, said he does not agree with the change. Even though Connecticut had a higher eligibility threshold than any other state, it’s good policy to cover parents and children together, he said.

“It is very strange that we are kicking people off of Medicaid at a time of budget surplus,” said Lesser. 

Lamont introduced the measure in his proposed budget last session, but it failed to pass as part of a bill in the Human Services Committee. Then, during budget negotiations, the governor successfully pushed to include the provision in the final ARPA package, Lesser said. 

The move is the latest in a series of decisions that has advocates of Medicaid expansion questioning Lamont’s commitment to the program. 

The governor has yet to back increases to Medicaid reimbursement rates, which have near-universal support from providers and legislators from both sides of the aisle. He also recently began exploring the possibility of privatizing the state’s Medicaid program amidst strong pushback from the Council on Medical Assistance Program Oversight.

“I think the governor needs to figure out whether he cares about Medicaid,” said Lesser. “Medicaid costs a lot of money, and you can expand access or put money into rates, or both. But if you don’t do either, then the question is, are you serious about the program?”

Collibee, the spokesperson for OPM, said the governor has worked with the legislature to fund Medicaid expansions, including $7 million to increase Medicaid reimbursement rates, new rates for Urgent Crisis Centers and $17 million in ARPA funding for children’s behavioral health.

The administration also wants to ensure that rate increases are used effectively.

“We continue to see significant growth in Medicaid costs, driven not only by higher enrollment/utilization but also legislative adds and program expansions. If rates are going to be increased, the taxpayers of Connecticut deserve to know that they are seeing an improvement in services, including access, and not just paying more for the same service,” said Collibee.

The policy brief from the Connecticut Health Foundation recommends several specific strategies to ensure minimal loss of coverage during the HUSKY A transition, including identifying people who won’t be eligible for Covered Connecticut, using navigators to help people enroll in new coverage and making a plan for the potential expiration of federal subsidies.

The Department of Social Services is working to prepare for the transition by collaborating with Access Health CT to track and support people who do not automatically get enrolled in Transitional Medical Assistance or Covered Connecticut, said DSS Deputy Commissioner Peter Hadler.

And they’re making sure to get the message out about the change. DSS will notify people via mail and text message of changes and offer support in getting coverage. Both DSS and Access Health CT will also post information about the process on their websites and social media.

“We share a common goal of ensuring that eligible individuals continue to have health coverage, whether it be through HUSKY, Covered CT, or a qualified health plan,” said Hadler in emailed comments.

Editor’s Note: The CT Mirror is a grantee of the Connecticut Health Foundation.

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