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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
Tags:
Affordable Care Act, Georgetown, HUSKY, Medicaid, Rhode Island
October 17, 2018

Public Charge Open for Comments: Rule change would discourage non-citizens from using social services

Karen Siegel, M.P.H.

A few weeks ago, we posted about the “public charge” determination and proposed changes to this rule. The comment period on this rule change began this week and is open until December 10.

Specifically, how would the “public charge” determination change?

The proposed changes would continue to rely on “totality of circumstances” in making immigration decisions. However, they would:

  • Change the threshold from an applicant being “primarily dependent on” to being “likely to receive” a public benefit

  • Expand the list of benefits considered to include Medicaid, SNAP, housing assistance, and more

  • Consider factors such as health, age, and English proficiency

  • Impose a specific income test that makes those earning less than $26,000/per year for a family of three less likely to be approved

These changes include a complex set of rules designed to disqualify immigrants of low to moderate income and favor those with higher incomes (over $52,000/year for a family of 3). The “public charge” determination is considered when a lawfully present immigrant applies for a change in status (for example when applying to change from a student visa to Lawful Permanent Resident status or “green card” holder, or when a “green card” holder leaves the country for more than 180 days and seeks to reenter). See these scenarios explaining when and to whom these rules apply.

The end result will most likely be children and families going without health insurance and other key supports for fear of repercussions, whether or not the rules apply to their circumstances.

How would these changes impact children in Connecticut?

Connecticut’s current laws and rules provide extremely limited access to social services and public health insurance for non-citizens. Nonetheless, there are reports that the rule is already causing confusion, fear, and disenrollment. In Connecticut, an estimated 87,000 children who have at least one non-citizen parent live in families enrolled in a benefit program such as Medicaid (our state’s HUSKY program) or SNAP.  Even though very few of those families would be subject to a public charge determination, the rules are confusing. As a result, the state’s rate of families without insurance or access to adequate nutrition is likely to increase.

Connecticut Voices for Children will submit comments to the federal register and will share our comments here.

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Issue Area:
Health
Tags:
Benefits, immigration, Medicaid, public charge, SNAP

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