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Voices Speaking

June 17, 2013

Welcoming our new staff and fellowship intern

Michael Sullivan

We're excited to announce two new staff and a Yale fellowship intern that have joined Connecticut Voices!  Please join us in welcoming them.

Tamara KramerTamara Kramer is familiar to many who have worked with Connecticut Voices, since she previously worked at Voices as a Policy Fellow from 2008 to 2010.  She is rejoining us through December as a Research and Policy Project Manager.  As in her past work, she will focus on issues related to early childhood education, juvenile justice and child welfare. Prior to joining CT Voices in 2008, Tamara interned with Judith Blei Government Relations, where she worked with a variety of not-for-profit clients, representing interests ranging from the environment to children’s health.

Tamara received her B.A. in Political Science and, in 2013, her J.D. from the University of Connecticut. While in law school, she continued to pursue her interest in advocacy and policy through internships at the Center for Children’s Advocacy and the National Health Law Program. While at the National Health Law Program, Tamara’s work focused on the Medicaid expansion included in the Affordable Care Act as well as initiatives regarding access to birth control for low income women.

Edie JosephEdie Joseph is our new Policy Fellow at Connecticut Voices for Children. Our policy fellowship program, aimed at fostering the next generation of child advocates, provides two-year positions to exceptional recent college graduates with a strong interest in advancing public policy to benefit children and youth.  Edie’s research and policy analysis will focus primarily on juvenile justice and early care and education. She will assist in state legislative initiatives and represent Connecticut Voices on several advocacy coalitions in these issue areas.

Prior to joining Connecticut Voices, Edie worked in New York City at The Bronfman Fellowships, a learning and leadership program, and also volunteered with an alternative-to-incarceration program for teenage boys. She graduated with a BA in American Studies from Yale University in 2012. At Yale, Edie coordinated debate programs in New Haven public high schools, was a leader in the Jewish community, and served as a Head Freshman Counselor through the Yale College Dean’s Office.

Brooke GirleyBrooke Girley will be working with Connecticut Voices for Children this summer as a Yale Presidential Public Service Fellow.  Connecticut Voices was honored to be selected as a placement for this fellowship among many applicants.  The program provides opportunities for Yale students to work on behalf of economic development, human development, and neighborhood revitalization with public sector and nonprofit organizations in New Haven.

At Connecticut Voices, Brooke will be researching racial and ethnic disparities in the use of oral health care services among children in the HUSKY program.  She received her Bachelors of Arts from New York University as a double major in Religious Studies and Africana Studies.  After earning her law degree from Duke Law School, she worked as a civil rights and criminal defense attorney.  Currently she is studying for a Master of Arts in Religious Studies at the Yale Divinity School, with a concentration in Black Religion in the African Diaspora.

Issue Areas:
Child Welfare, Early Care, Health, Juvenile Justice

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June 11, 2013

Impact of State Budget on HUSKY: Parents Remain Covered

Sharon Langer, M.Ed., J.D.

The legislature passed a two year budget last week for the state fiscal years (FY) 2014 and 2015. Below are a few highlights concerning the HUSKY program.  Fortunately, parents will retain their coverage in the HUSKY program. For more information, check out the synopsis by the legislature's Office of Fiscal Analysis about legislation that implements many of the budgetary changes.

  • Parents of HUSKY A children will remain eligible for HUSKY coverage with family income up to 185% of the federal poverty level (FPL) (e.g., $36,130 annually for a family of three). The Governor had proposed ending eligibility for parents above 133% of the federal poverty level with the expectation that they would be able to purchase private coverage through the new health insurance exchange (Access Health CT) starting in 2014. Given the costs of premiums in the health insurance exchange, it is likely that thousands of currently insured parents in HUSKY would have become uninsured because they could not afford the private coverage.
  • Individuals with incomes up to 133% of the FPL ($15,282 annually for an individual) will be eligible for Medicaid, beginning January 1, 2014. The new budget eliminates the Medicaid program for low-income adults (LIA) that currently covers adults up to 56% FPL, as of January 1, 2014, and merges these individuals into a new "Medicaid Coverage for the Lowest Income Populations" (MCLIP) program as authorized by the federal Affordable Care Act, effective January 1, 2014.
  • Certain adults on Medicaid (HUSKY A, C and D) will be charged co-payments for nonemergency use of hospital emergency rooms. The extent to which such co-pays may be imposed is limited by federal Medicaid law. Lawmakers expect to save $700,000 in each of the two years of the budget. The savings may be far greater, according to the legislature's Office of Fiscal Analysis, if individuals are diverted from the emergency rooms and receive care in a less costly setting, such as a doctor's office.
  • The Department of Social Services (DSS) is authorized to establish a "step therapy" program for prescription drugs available through Medicaid. The program may require patients to try a drug on the DSS preferred drug list before DSS will authorize payment for alternative (and presumably more expensive) drugs. The program will not apply to mental health-related drugs. Lawmakers expect to save $11.8 million in FY 2014, and $15.8 million in FY 2015) .
  • As required by the federal Affordable Care Act, primary care physician rates will increase. The full cost of the increase is borne by the federal government. The increase is $107.2 million in SFY 2014 and $47.6 million in FY 2015.
  • The budget continues funding for HUSKY Performance Monitoring ($208,050 for each year). The Governor had proposed eliminating the funding. This funding is a grant from the Department of Social Services to the Hartford Foundation for Public Giving, which in turn re-grants the funding to CT Voices for Children for the monitoring work. This monitoring helps to assess how well the program serves children and families and how it can be improved.
  • The budget continues funding for Healthy Start, which assists low-income women in obtaining health coverage and prenatal care. The Governor had proposed eliminating the program. It will receive funding of $1.4 million in each budget year.
  • HUSKY Infoline, a project of United Way/2-1-1, receives funding of $159,000 in FY 2014 and no funding in FY 2015. The Governor had proposed eliminating all the funding for both years. HUSKY Infoline is a longstanding project that provides one-to-one assistance regarding coverage and access to care issues for HUSKY members. It is unclear to what extent this service will be provided by other entities, such as the health insurance exchange.  
  • The budget and authorizing legislation makes a number of changes to the CT Behavioral Health Partnership (BHP) and its oversight council, including requiring the council to find $1 million in savings in collaboration with its agency partners - the Departments of Social Service, Children and Families and Mental Health and Addiction Services. In addition, the BHP must use the statutory definition of "medical necessity" when authorizing or denying authorization for behavioral health or substance abuse services. 
  • Hospitals will receive decreased funding due in part to lawmakers' expectations that more individuals will be covered under private or public insurance in 2014 once the insurance mandate under the Affordable Care Act kicks in, and more individuals sign up for coverage through the exchange, Medicaid or at their workplace. Historically, hospitals were reimbursed by the government for serving the uninsured or underinsured through "disproportionate share hospital" payments. These and other reductions to hospitals amount to cuts of $194.7 million in FY 14, and $328.9 million in FY 15. There is, however, $15 million budgeted insupplemental Medicaid payments for certain "low-cost hospitals" in each of year of the budget.
  • Savings of $80 million in FY 14 and $100 million in FY 15 through increased fraud prevention and detection in the Medicaid program.
  • The Charter Oak Health Plan is eliminated as of January 1, 2014 with the expectation that those currently covered under the state funded program will gain coverage through Medicaid or the plans offered on the exchange.   There are about 4,000 individuals currently enrolled in Charter Oak.
Issue Areas:
Budget and Tax, Health

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May 29, 2013

Medicaid Expansion: Keep the Federal Money, and Budget Transparency Too

Wade Gibson, J.D.

The coming influx of federal funds to expand Medicaid for low-income individuals highlights the need for common sense reforms to Connecticut’s spending cap, as well as the importance of transparency in how the state treats funds it receives from the federal government.

Connecticut’s spending cap, which is intended to limit state spending, also covers federal funds that flow through the state budget. Even when such programs are 100% federally funded—as the Medicaid expansion under the Affordable Care Act is—the spending cap treats them as state spending. This creates the current, perverse situation in which Connecticut cannot accept over $1 billion in federal funds without cutting over $1 billion from vital state services over the next two fiscal years. Clearly, the rules governing the cap should be modified so that it can serve its intended purpose of limiting state, not federal, spending.

Lacking the votes to make such a modification, however, the Governor and General Assembly have elected to move the $1+ billion off budget, beyond the realm of appropriated funds— funds the legislature explicitly authorizes to be spent for a particular purpose. Since the spending cap covers only appropriated funds, this move sidesteps the flaw in the cap; however, the safeguards for such “unappropriated” funds are not clear.

It is essential that the state provide transparency for these “unappropriated” funds. The vast majority of states appropriate federal funds, ensuring that they receive public and legislative scrutiny through disclosure and public hearings. If Connecticut is to break from the pack, we must preserve transparency. The Medicaid expansion funds should be clearly noted in the budget books published by the Office of Fiscal Analysis, as well as publications by other state agencies, and they should be the subject of public hearings also. With totals reaching into ten figures, sunlight is a necessity.

Issue Area:
Budget and Tax

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May 20, 2013

Cap Crunch

Matt Santacroce

As budget negotiations enter the final weeks of the legislative session, a major obstacle remains: without a two-thirds majority of each chamber of the General Assembly agreeing to the Governor’s proposed spending cap changes, legislators will need to cut over a billion dollars from the proposed upcoming biennial budget due in large part to existing structural flaws in the current spending cap formula. To do so would be to miss a prime opportunity to address these structural flaws, and would slash critical resources from a state budget already stretched thin.

The Governor has proposed two substantive reforms to the cap rules. Here’s why they matter:

  • To help the state take advantage of fully-funded federal programs (like the expansion of Medicaid to low-income adults under Obamacare), the Governor proposes exempting new spending that is entirely reimbursed by the federal government from the spending cap. This will ensure that the spending cap fulfills its original purpose – to limit state, not federal, spending.  Under current cap rules, the state has an incentive to turn away new federal funds.
  • Additionally, the Governor proposes that contributions to pay down the state’s huge unfunded pension liabilities should be exempted from the cap.   Making these pension fund contributions is important to improving the state’s long-term fiscal health, and the Governor’s proposed reform would  help us fill the hole in the pension system without squeezing out other important investments in kids and families.

Failure to adopt these proposed changes would force more than a billion dollars in proposed cuts to critical investments in Connecticut’s future – while handcuffing the state’s ability to pay ahead on longstanding fiscal obligations, and creating a disincentive for the state to maximize important new federal revenue.

Lawmakers should act swiftly to approve the changes set forth in House Bill 6352.  For more information, see Voices’ recently-released fact sheet and see our new issue brief on the topic, which explores additional reforms that could improve spending cap rules.

 

Issue Area:
Budget and Tax

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May 16, 2013

Take Action to Protect Parents in HUSKY

Sharon Langer, M.Ed., J.D.

ActionThe legislature’s Appropriations Committee budget proposal would maintain Medicaid (HUSKY A) coverage for parents up to 185% of the federal poverty level. The Governor proposed reducing coverage to 133% of the federal poverty level with the expectation that these parents would pay for coverage in the new health insurance exchange come 2014.  A recent research report found that thousands of parents currently enrolled in the HUSKY program would go without health care as a result of the Governor’s eligibility cuts, because parents would not be able to afford premiums and co-payments in the private health insurance exchange.  The Malloy administration is now considering using state funds to reduce the costs of the premiums the parents would have to pay in the Exchange, though the complete details of this proposal have not been released.  The final budget package must be negotiated between legislative leaders and the Governor.

Given the anticipated cost of insurance in the exchange and the lack of access to dental, vision, non-emergency transportation and the mental health services currently available to HUSKY members, the proposal to provide  “premium assistance” or “wraparound” coverage won’t work for families enrolled in HUSKY.  It also won’t work for the state budget, since the estimated cost of subsidizing premiums and out-of-pocket payments for parents through the health insurance exchange would be greater than the current cost of the HUSKY coverage that the state is now paying for.  See this fact sheet for more information.

To help preserve HUSKY coverage for parents, please contact your state legislators now.  Ask them to urge legislative leaders to maintain Medicaid (HUSKY A) coverage for parents up to185% of the federal poverty level when the budget is negotiated.

To e-mail your legislators, or find out the names of your legislators, see the General Assembly website.

To call your state legislators:

  • Senate Democrats: 1-800-842-1420
  • House Democrats: 1-800-842-8267
  • Senate Republicans: 1-800-842-1421
  • House Republicans: 1-800-842-8270

 

Issue Area:
Health

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May 14, 2013

Spotlight on Early Education: Promising Signs, But Lots of Work To Do

Sarah Esty

From Hartford to Washington, D.C., early childhood education and services have been a major topic of conversation over the last few months. In February, President Obama proposed to invest $75 billion in expanding preschool, Early Head Start, and other services to young children. Nobel prize winner and early childhood expert James Heckman argued that our society’s significant investment in remediation and interventions in later years is massively inefficient, and we are dramatically underinvesting in the earliest years. The New York Times reported last month on multiple recent studies highlighting the need for greater services targeted at children before they enter kindergarten.

Our fourth annual Connecticut Early Care and Education Progress Report: 2012, released last week, finds that Connecticut is making some progress on providing access to early care experiences for Connecticut’s most vulnerable infants, toddlers, and preschoolers and improving the quality of those programs. However, funding for early childhood services fell between Fiscal Years 2011 and 2012, and remains below levels from a decade ago. And too many children in the state’s low-income families lack access to state-subsidized care. Most significantly, the report finds:

  1. Spending on early care and education fell by 1.1% ($2.6 million) from Fiscal Year (FY) 2011 to FY 2012 (ending June 2012). Funding has been stagnant or declining since 2008.

Early care spending

  1. Connecticut served 4.4% more infants and toddlers and 5.5% more preschoolers with state subsidies in FY 2012, compared to FY 2011. However, even with these increases, 80% of infants and toddlers in low income families (below 75% of the State Median Income) and 30% of preschoolers in low income families did not receive state-subsidized care.  The counterintuitive finding that the number of children served increased while state spending fell is a result of provider reimbursement rates that have not kept pace with inflation (rates in Care4Kids, the largest subsidy program for low-income working families, have not been raised since 2001). Thus, while it appears that the state is serving more children with less money, in reality, this merely reflects that the per-child subsidy amount has fallen, leaving parents and providers to shoulder an ever-larger share of the cost.

Access to early care

  1. Connecticut has seen improvements in quality, with a growing percentage of state-subsidized children being served in accredited settings – 35.2% of infants/toddlers and 56.1% of preschoolers in 2012. The average level of education of the early childhood workforce has also risen, with 57% of administrators and 37% of teachers holding a BA or more and at least 12 ECE-related credits. This is particularly important because most of the benefits of ECE accrue only when children have access to high quality care.

Children in accredited settings

Looking forward to the results of the current fiscal year and beyond, we have several reasons for optimism. First, the budget for FY 13 funded 1,000 new preschool slots, facilities capital improvements to support those slots, and $6 million for the creation of a Quality Rating and Improvement System (QRIS) that will help parents identify high quality programs and providers improve their performance. If these funds are fully spent during the current fiscal year (FY 13), even after rescissions and deficit mitigation, this will represent an 8% increase over FY 12 and the greatest amount spent on early care and education since 2002.

Second, and perhaps even more exciting, is the proposed new Office of Early Childhood. For each of the last four years, one of the most significant recommendations in our annual reports has been the need for a coordinated early childhood system to overcome the present patchwork of programs and funding streams which are confusing for parents and providers. House Bill 6359 is the result of a yearlong planning process kicked off by legislation passed in 2011. It would create a new Office of Early Childhood that addresses this concern by bringing together under one roof the hundreds of millions of dollars in funding and staff from five agencies.

This office is not an end in and of itself – even if all the programs and staff are brought together, much work will remain to be done to  achieve the streamlining, coordination, and improved data collection necessary to realize the benefits of an ECE system. In the long term, the state will need to increase funding in order to raise wages to a level where we can attract and retain quality providers and extend access to all children through the creation of new slots. However, despite the long road still to travel before we see universal high quality early childhood education for all Connecticut’s young children, the Office of Early Childhood will be a critical first step and significant achievement.

Issue Area:
Early Care

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