Sharon Langer, M.Ed., J.D., , and Dumingu Aparna Gomes
This post was first published at the CT Mirror's CT Viewpoints website.
Connecticut has every reason to be proud of its long-term commitment to ensuring access to care for low-income children and families through the HUSKY program (Medicaid and Children’s Health Insurance Program). We have one of the lowest rates of uninsured residents in the nation, thanks in large part to the State’s Medicaid program. Long before enactment of the Affordable Care Act in 2010, Connecticut invested in the health of its children and their parents by aligning income eligibility for everyone in a family. This policy was based on knowing that when whole families are insured, children’s access to care improves and parents stay healthy for work and family responsibilities. Just last month, Connecticut’s Governor Malloy, along with Connecticut’s budget director and state Medicaid administrators, extolled the quality improvements and cost savings realized through innovative changes to the HUSKY program.
Some of this progress will be undone if the Connecticut General Assembly goes along with the Governor’s April budget proposal to reduce income eligibility for almost 10,000 low-income parents. For example, in 2016 the income limit for a family of four would be lowered from $37,665 (155 percent of the federal poverty level (FPL) to $33,534 (138% FPL). Because of federal Medicaid rules, the estimated savings associated with reducing coverage is just $900,000 in state fiscal year 2017. This cutback in parent coverage follows a very significant change in eligibility just last year (from 201% FPL to 155% FPL), the full effects of which will not occur until this summer when up to 20,000 parents may lose HUSKY coverage. Taken altogether, this proposal means almost 30,000 low-income parents could lose affordable health coverage over the course of this year and next.
State officials have emphasized that affordable health care coverage is available for these parents through the health insurance marketplace, Access Health CT. However, even with federal subsidies for premiums and limits on out-of-pocket costs, coverage in a qualified health plan can be very costly for low-income families. For example, a family with two parents and two children earning $48,843 could be billed as much as $13,676 (28 percent of household income) for their health coverage. In addition, dental health insurance for adults is a separate purchase, without premium subsidies and with significant out-of-pocket costs for limited coverage.
We now know what can happen when coverage is cut for low-income parents: Last year, most parents were eligible for a one-year extension, putting off until July 31, 2016, the risk that they will lose coverage altogether. Among those who actually lost coverage last summer (645 parents), just one in four enrolled in a qualified health plan through Access Health CT, including some who experienced gaps in coverage. Three of every four parents who were cut from HUSKY A last year are not currently enrolled through Access Health CT and may be uninsured.
Missing from the data collected last year is whether eligible children were cut off inadvertently from the HUSKY program when their parents lost coverage, as happened in Maine and Wisconsin.
Experience in other states suggests that the effect of the rollback of Medicaid eligibility can be reduced in part with policies that address the financial burden for families forced to pay for their own coverage. For example, Connecticut could use state subsidies to help reduce the overall costs of marketplace coverage. To date, we have not heard discussion of these or other proposals to mitigate the effect of this cutback on Connecticut’s families.
Cutting income eligibility for parents—once again and before the full effects of last year’s cut are evident—is a huge step backward in Connecticut’s long-standing commitment to covering children and parents in low-income families.