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Voices Speaking

September 28, 2015

Unintended Consequences of the ACA: Retraction of Medicaid Eligibility for Parents in Connecticut

Research has consistently demonstrated that insuring parents is good for their health and their children’s. Children of parents insured through Medicaid are more likely to be covered and receive regular check-ups. In 2007, when Connecticut aligned its Medicaid income limit for parents and children at 185% FPL it made it easier for the whole family to get covered together.

In 2014, the Affordable Care Act (ACA) “expanded” Medicaid coverage to low-income individuals with family income under 138% FPL ($27, 724 for a family of three). But Connecticut, like most New England states and a few others, already covered parents well above 138% FPL. In implementing the ACA, virtually all of the states with higher Medicaid income limits reduced those limits with the expectation that these families would purchase coverage through the newly created health insurance marketplaces. The federal government subsidizes marketplace coverage for individuals not eligible for Medicaid, lowering premiums and other out-of-pocket costs. Although, experience from other states shows that many of these low-income parents still find the costs associated with marketplace plans too expensive.

Eight years later and with the advent of the Affordable Care Act, and responding to state budgetary pressures, lawmakers in the “Land of Steady Habits” rolled back the income eligibility for parents on Medicaid (known as HUSKY A in Connecticut). As a result, parents (or other caretaker relatives) currently on HUSKY A with family income above 155% of the federal poverty level ( $31,140 for a family of three) were notified this summer that the income limit for parent coverage has been reduced. Eligibility was reduced from 201% FPL (the income limit based on the ACA income counting rules effective 2014) to 155% FPL. (Governor Malloy’s original budget proposal was to reduce the eligibility for parents and pregnant women to 138% FPL; lawmakers completely rejected lowering the income limit for pregnant women and it remains at 263% FPL). Effective August 1st, most of the affected individuals (about 18,000) will remain on HUSKY coverage but under a different category called “transitional medical assistance” (TMA). These are parents in families with income from a job. Once they are moved to TMA they remain eligible for a full year.

A much smaller number of parents (about 1,200) without income from a job, but over the lower income limit, were notified this month that that their Medicaid coverage may change effective September 1, 2015. They are given an opportunity to notify the HUSKY program that they fit into another HUSKY coverage category before their coverage ends.

If the parents are no longer qualify for HUSKY coverage under any category then they may qualify for subsidized commercial insurance through Access Health CT (AHCT), Connecticut’s state insurance marketplace. The Medicaid agency (Connecticut Department of Social Services) and AHCT are tasked to work together to make the transition as smooth as possible for the affected families. Families have been notified that their children’s coverage will remain unchanged. (In some other states when parent eligibility changed their children inadvertently lost coverage). Connecticut is trying to avert this unintended consequence by letting parents know that their children’s eligibility remains unchanged.

State legislation (Public Act 15-5) that implemented the state budget requires that data be collected and disseminated by DSS and Access Health CT to better understand what happens to families during such a transition. This law requires DSS and Access Health CT to report to the legislature’s Council on Medicaid Assistance Program Oversight beginning November 1, 2015 (and quarterly after that) the number of parents and caretaker relatives:

  1. no longer eligible for HUSKY A as a result of the rollback of the income limit
  2. who remained eligible for HUSKY after review
  3. who lost HUSKY A coverage and enrolled in a commercial plan offered by Access Health CT without a gap in coverage
  4. who did not enroll in commercial coverage offered by Access Health CT as soon as they lost HUSKY coverage
  5. who enrolled in commercial coverage but were dis-enrolled for failure to pay premiums

As the Rhode Island experience has shown without collecting and analyzing relevant data, and providing assistance from trusted and well-informed outreach workers, it is difficult or impossible to know whether low-income parents become uninsured after they lose Medicaid coverage.

Overall the Affordable Care Act has been a great success in Connecticut and in the nation. Since 2014, Connecticut has expanded Medicaid to almost a hundred thousand low-income adults, and instituted a successful state insurance marketplace where tens of thousands of others sign up for affordable commercial coverage, most of whom receive subsidies to pay for such coverage.

Nonetheless, we in Connecticut must be mindful that, despite our best efforts, thousands of low-income working parents may find themselves without coverage in the next year – unable to afford even the modest cost-sharing required by health plans offered through AHCT. This year will be critical for Connecticut families and lawmakers as we begin to collect the data to understand if this rollback of coverage helps or hurts our most important investment, the health of our children and families.

(Editor's note: the following was originally submitted as a guest blog to Georgetown University Health Policy Institute Center for Children and Families' Children Health Policy Blog on August 27, 2015.)

Issue Areas:
Child Welfare, Health
Affordable Care Act, Georgetown, HUSKY, Medicaid, Rhode Island
January 15, 2019

Healthcare in 2019 - What to Expect

Karen Siegel, M.P.H.

Health insurance coverage rates are slipping

Connecticut’s HUSKY (Medicaid and CHIP) programs are key to our state’s health and economic success. Medicaid coverage has an enormous impact: it reduces poverty, provides lifelong benefits for children, and helps to reduce infant mortality rates. Children are more likely to have insurance and to see a doctor when their parents are insured; so, covering whole families is especially important. Being insured means parents with chronic conditions can stay healthy enough to work and parent well. It also means freedom from exposure to catastrophic medical debt for families and less uncompensated care for hospitals and clinics. Further, Connecticut’s HUSKY program is fiscally efficient, boasting the lowest per member per month Medicaid costs nationwide.

Maintaining the HUSKY programs is a key part of working towards ensuring all of our state’s residents have health insurance coverage. HUSKY expansion helped raise the rate of Connecticut residents who have health insurance to one of the highest in the nation. Yet, recently released 2017 American Community Survey data suggests that while insurance coverage rates in the nation continue to improve, in Connecticut they are at best stable and likely decreased by roughly 20,000 individuals from 2016 to 2017.

Since 2015, the legislature has twice voted to cut Medicaid income eligibility levels for parents/caregivers. We cannot afford to balance the state budget by putting families at risk of preventable disease and economic instability.

Health insurance quality at risk

Having health insurance helps people access care, but being insured alone is not enough. For Connecticut’s families to avoid preventable illness or complications, health insurance must pay for services that families need to stay healthy. Proposals at the state and federal levels threaten to erode what it means to have health insurance coverage. These include allowing short-term and “junk” insurance plans, consolidation of providers through hospital mergers and the Aetna/CVS merger—which could limit access and increase costs, and efforts to trim the state budget by covering fewer benefits for Medicaid enrollees. 

When parents have to choose between paying out of pocket towards a high deductible or paying a utility bill, they are likely to forgo or put off treatment. Inexpensive measures that could prevent a crisis—like a vaccination or a checkup—keep health care costs down.

Recent attempts to trim the Medicaid budget have targeted dental coverage and primary care provider rates. When Connecticut raised Medicaid reimbursement rates for primary care, provider participation increased, meaning more Medicaid patients were able to make appointments for routine care. Given the state fiscal crisis, Medicaid is likely to be targeted again. Additional cuts will cause real harm to real families.

Connecticut should join nearby states by adopting paid family and medical leave

Paid parental leave leads to a host of positive life outcomes for both parents and children, including decreased infant mortality, decreased child behavioral problems, decreased rates of maternal post-partum depression, and increased rates of father involvement throughout childhood. Children begin building vital brain architecture from the time they are born. By giving parents time to develop secure attachments with their new child, family and medical leave plays an important role in nurturing healthy child development for biological and adoptive parents.

Often, workers lacking paid family and medical leave hold low-income and/or multiple part-time jobs, and so cannot afford to take time off. Workers who take time off with no pay or reduced pay report borrowing money, enrolling in public assistance, putting off paying bills, and cutting their leave short. Family medical leave strengthens families’ economic stability and alleviates stress by allowing parents to care for their children without financial hardship.

Further, paid family medical leave is a smart way to improve Connecticut’s workforce. Access to paid family medical leave results in workers taking better care of their health, taking fewer risks, taking fewer and shorter sick leaves throughout the course of their careers, and having less inpatient care. Further, leave is paid for by employees, as detailed in the plan Connecticut has come close to adopting.

Opportunities to promote healthy, stable, and safe communities

Racial and ethnic disparities in health cannot be addressed in the clinic or hospital alone. To promote health equity, it is necessary to enhance community-based services and connect people to what they need in the places where they live, play, study, and work. For example, by connecting the parent of a child with chronic asthma to resources that can remove mold or offer pest-control for the family home, emergency room visits can be decreased while the family’s wellbeing increases. Community health workers can help bridge the gap between doctors’ visits and life at home, helping to identify non-medical causes of health issues and find resources to address these. Community health workers can also help empower families to play a bigger role in their care or help families to incorporate lifestyle changes in response to a diagnosis or addiction.

Opportunities to promote these strategies and to link communities to medical providers and vice versa include soon to be released proposals by the Office of the State Health Innovation Model, the recently announced federal Integrated Care for Kids grant and recently passed federal funding to address opioid addiction.

Opportunities to promote lifelong mental health starting at birth

In the first thousand days of life, children’s brains develop rapidly, making this period an especially important one for promoting health and preventing illness. Identifying and addressing children’s and families’ needs early on can prevent a lifetime of struggling to learn or coping with mental health challenges. Whole-family approaches can support children in developing resilience and other protective factors while supporting caregivers to respond to challenges in productive ways.

Opportunities to access additional federal funding mentioned above and through the Families First Prevention Services Act could also be used to bolster our state’s behavioral health system, especially for young children. Connecticut is poised to take advantage of these resources and to leverage the State Health Innovation Model to promote positive outcomes for children by improving the links between pediatricians’ offices and the state’s home visiting and community-based early childhood efforts.  Connecticut is the birthplace of robust, best-practice initiatives like Help Me Grow and Birth to Three and home to an array of home-visiting and screening programs, but these programs remain underfunded and links between programs, schools, and medical care providers could be improved.   

Issue Area:
health, Healthcare, HUSKY, insurance
January 17, 2019

Health coverage in Connecticut: HUSKY Health fact sheets

We have created a series of fact sheets to document how Connecticut’s HUSKY Health programs impact a wide range of the state’s residents and services. You can download them below:

Husky Health Programs for Children and Families in Connecticut - an Overview

How Medicaid Supports Work and the State Economy

Medicaid and Education

Medicaid and the Child Welfare and Juvenile Justice Systems

We also have created a fact sheet with links to more sources.

Issue Areas:
Family Economic Security, Health
coverage, Fact Sheets, Healthcare, HUSKY, insurance