ct is bringing health insurance to more children and families
DESCRIPTION
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Kristin DowtyTRANSCRIPT
CT is bringing health insurance to more children and families
“My goal is to make sure that every adult and child in Connecticut has access to health insurance.”
- Governor M. Jodi Rell (12/26/06)
HUSKY – 10 years strong
October 1997 - historic legislation signed HUSKY into law with the support of every member of the General Assembly
2007 – Continued commitmentEncourage renewal of existing familiesReach out to new families who are eligibleExpand programs to cover more individuals
and families
CT’s health care picture today
Approximately 222,000 residents have no health insurance. [OHCA data, 2006]
Although CT has large populations covered by public assistance programs, many are too old for HUSKY, too young for Medicare, and not eligible for Medicaid or SAGA.
HUSKY A & B - 310,000 Medicaid FFS – 88,600 Medicare – 600,000 SAGA – 32,300
Changes in the health insurance environment
CT Changes between 2004 – 2006Employment based coverage increased
from 64% to 66.5%Public coverage declined from 26.2% to
23.3%Number of uninsured grew slightly from
5.8% to 6.4%
Connecticut’s uninsured
66% of uninsured families have incomes under 300% of the FPL
53% of the uninsured are under age 4055% of the uninsured are minorities with
Hispanics comprising 34%66% of the uninsured are single or living
with a partner
Connecticut’s uninsured
61% of the uninsured are working adults49% of the uninsured work for employers
with less than 25 employees57% of “Mom & Pop” employers (<10
employees) do not offer insurance25% of the uninsured may meet the
current Medicaid, HUSKY or Medicare eligibility requirements
HUSKY A – Medicaid managed care
Children to 185% FPL Parents/Caretakers to 185% FPL 19 & 20 year olds up to MNIL Pregnant Women to 185% FPL (soon to be 250%
FPL) 1 year TMA Rich benefit package No cost to clients Children up to age 19 Enrollment as of 9/07- 209,544 children & 93,523
adults
HUSKY B – SCHIP managed care
All children covered regardless of income 186% - 235% FPL, small co-pays, no premiums 236% - 300% FPL, small co-pays, $30/$50 monthly
premium 300% FPL, small co-pays, full premium to $222
monthly Children up to age 19 Comprehensive benefit package modeled after
State employees benefit package Enrollment as of 9/07 – 16,865 children
New initiatives to enroll children
HUSKY Health 2007 InitiativesLocal and statewide HUSKY outreachEnrollment and retention of school-age
childrenCoverage for uninsured newborns
Local and Statewide HUSKY Outreach
$1.1 million grants for outreach contractsCommunity-based outreach (5)Regional outreach (2)Statewide outreach (1)Statutorily defined “Priority School Districts”
(15)State Department of Education’s 6 Regional
Educational Service Centers
Local and Statewide HUSKY Outreach
Outreach strategies for enrollment and retention Door to door; person to person Telephone contact with follow-up Local media - radio, TV, newspapers, posters, web-
sites Seminars/presentations, multi-lingual Employers with low-wage workers, health clinics,
community centers, faith-based organizations, job centers, town social service offices
Enrollment & retention of school-age children
Priority School Districts Collect & track student insurance information Provide HUSKY information and application
assistance to families of uninsured students Follow-up with families
SDE’s Regional Educational Service Centers Implement training program to provide education on
the HUSKY program to school professionals including social workers, nurses, counselors and teachers
HUSKY Outreach Evaluation
Process Measures, self-reported by contractors:# of presentations and materials distributed# of families and children reached# of application and renewal assistance# of unsuccessful efforts and reasons why
(e.g. undocumented)
HUSKY Outreach Outcome Measures
Applications & Renewals – tracked by ACS and DSS # of submitted applications # of successful applications Increase in % of returned renewals Increase in % of successful renewals
Increase in overall enrollment Anecdotal/Qualitative
Feedback from Consumers
Covering uninsured newborns
Cover all uninsured newborns born in CT hospitals or participating border hospitals
Partner with CT & border hospitals for notification
Expedite eligibility determination of all uninsured newborns
DSS will pay the first 4 month’s premium, if required
Other new initiatives
Pregnant woman expansionFamily planning programPrimary Care Case Management PilotPremium Assistance for ESICharter Oak Health Plan
Pregnant woman expansion
Cover pregnant women to 250% FPLFull Medicaid benefit package including
transportationNo out-of-pocket costsNewborns automatically deemed eligible
for 1 year
Family Planning Program
Increase availability of effective contraceptive methods
Decrease the number of unintended or mistimed pregnancies
Increase the spacing between pregnancies
Increase access to primary care
Family Planning Program
Family income to 185% FPL, ineligible for Medicaid
No asset testFemales - ages 14 – 55Males – ages 14 – 60US Citizen or qualified immigrant
Family Planning Program
Family planning services including annual physical exam diagnostic and laboratory testing immunizations treatment of STDs medications required incidental to family planning
procedures contraception management including devices,
prescription and non-prescription contraceptives tubal ligation and vasectomy
Primary Care Case Management
Pilot programMay attract more provider participation
PCPs work with one entity, rather than 4 MCOs
FFS reimbursement plus PMPM fee for care management
Integrated disease management program
Premium Assistance Program
Promotes family coverageRequired to enroll self & dependents if
insurance is available and meets certain conditions
For employed HUSKY A clientsDSS accountable for premium
contribution, deductibles, co-payments and full Medicaid wrap around coverage
Charter Oak Health Plan – covering uninsured adults
Coverage through a private model
No asset test No pre-existing
conditions No individual or
employer mandate Participation is voluntary Payments from
members to MCOs
Payments from members to MCOs
Deductible - $1000 max State investment is
premium subsidies on a sliding scale – up to 300% FPL
$1 million lifetime benefit max
6 month crowd-out
For more information
Kristin R. Dowty, HUSKY ProgramPhone: 860-424-4805Email: [email protected]