CT is Bringing Health Insurance to More Children and Families


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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Kristin Dowty

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CT is Bringing Health Insurance to More Children and Families

  1. 1. 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)
  2. 2. HUSKY – 10 years strong <ul><li>October 1997 - historic legislation signed HUSKY into law with the support of every member of the General Assembly </li></ul><ul><li>2007 – Continued commitment </li></ul><ul><ul><li>Encourage renewal of existing families </li></ul></ul><ul><ul><li>Reach out to new families who are eligible </li></ul></ul><ul><ul><li>Expand programs to cover more individuals and families </li></ul></ul>
  3. 3. CT’s health care picture today <ul><li>Approximately 222,000 residents have no health insurance. [OHCA data, 2006] </li></ul><ul><li>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. </li></ul><ul><ul><ul><li>HUSKY A & B - 310,000 </li></ul></ul></ul><ul><ul><ul><li>Medicaid FFS – 88,600 </li></ul></ul></ul><ul><ul><ul><li>Medicare – 600,000 </li></ul></ul></ul><ul><ul><ul><li>SAGA – 32,300 </li></ul></ul></ul>
  4. 4. Changes in the health insurance environment <ul><li>CT Changes between 2004 – 2006 </li></ul><ul><ul><li>Employment based coverage increased from 64% to 66.5% </li></ul></ul><ul><ul><li>Public coverage declined from 26.2% to 23.3% </li></ul></ul><ul><ul><li>Number of uninsured grew slightly from 5.8% to 6.4% </li></ul></ul>
  5. 5. Connecticut’s uninsured <ul><li>66% of uninsured families have incomes under 300% of the FPL </li></ul><ul><li>53% of the uninsured are under age 40 </li></ul><ul><li>55% of the uninsured are minorities with Hispanics comprising 34% </li></ul><ul><li>66% of the uninsured are single or living with a partner </li></ul>
  6. 6. Connecticut’s uninsured <ul><li>61% of the uninsured are working adults </li></ul><ul><li>49% of the uninsured work for employers with less than 25 employees </li></ul><ul><li>57% of “Mom & Pop” employers (<10 employees) do not offer insurance </li></ul><ul><li>25% of the uninsured may meet the current Medicaid, HUSKY or Medicare eligibility requirements </li></ul>
  7. 7. HUSKY A – Medicaid managed care <ul><li>Children to 185% FPL </li></ul><ul><li>Parents/Caretakers to 185% FPL </li></ul><ul><li>19 & 20 year olds up to MNIL </li></ul><ul><li>Pregnant Women to 185% FPL (soon to be 250% FPL) </li></ul><ul><li>1 year TMA </li></ul><ul><li>Rich benefit package </li></ul><ul><li>No cost to clients </li></ul><ul><li>Children up to age 19 </li></ul><ul><li>Enrollment as of 9/07- 209,544 children & 93,523 adults </li></ul>
  8. 8. HUSKY B – SCHIP managed care <ul><li>All children covered regardless of income </li></ul><ul><ul><li>186% - 235% FPL, small co-pays, no premiums </li></ul></ul><ul><ul><li>236% - 300% FPL, small co-pays, $30/$50 monthly premium </li></ul></ul><ul><ul><li>300% FPL, small co-pays, full premium to $222 monthly </li></ul></ul><ul><li>Children up to age 19 </li></ul><ul><li>Comprehensive benefit package modeled after State employees benefit package </li></ul><ul><li>Enrollment as of 9/07 – 16,865 children </li></ul>
  9. 9. New initiatives to enroll children <ul><li>HUSKY Health 2007 Initiatives </li></ul><ul><ul><li>Local and statewide HUSKY outreach </li></ul></ul><ul><ul><li>Enrollment and retention of school-age children </li></ul></ul><ul><ul><li>Coverage for uninsured newborns </li></ul></ul>
  10. 10. Local and Statewide HUSKY Outreach <ul><li>$1.1 million grants for outreach contracts </li></ul><ul><ul><li>Community-based outreach (5) </li></ul></ul><ul><ul><li>Regional outreach (2) </li></ul></ul><ul><ul><li>Statewide outreach (1) </li></ul></ul><ul><ul><li>Statutorily defined “Priority School Districts” (15) </li></ul></ul><ul><ul><li>State Department of Education’s 6 Regional Educational Service Centers </li></ul></ul>
  11. 11. Local and Statewide HUSKY Outreach <ul><li>Outreach strategies for enrollment and retention </li></ul><ul><ul><li>Door to door; person to person </li></ul></ul><ul><ul><li>Telephone contact with follow-up </li></ul></ul><ul><ul><li>Local media - radio, TV, newspapers, posters, web-sites </li></ul></ul><ul><ul><li>Seminars/presentations, multi-lingual </li></ul></ul><ul><ul><li>Employers with low-wage workers, health clinics, community centers, faith-based organizations, job centers, town social service offices </li></ul></ul>
  12. 12. Enrollment & retention of school-age children <ul><li>Priority School Districts </li></ul><ul><ul><li>Collect & track student insurance information </li></ul></ul><ul><ul><li>Provide HUSKY information and application assistance to families of uninsured students </li></ul></ul><ul><ul><li>Follow-up with families </li></ul></ul><ul><li>SDE’s Regional Educational Service Centers </li></ul><ul><ul><li>Implement training program to provide education on the HUSKY program to school professionals including social workers, nurses, counselors and teachers </li></ul></ul>
  13. 13. HUSKY Outreach Evaluation <ul><li>Process Measures, self-reported by contractors: </li></ul><ul><ul><li># of presentations and materials distributed </li></ul></ul><ul><ul><li># of families and children reached </li></ul></ul><ul><ul><li># of application and renewal assistance </li></ul></ul><ul><ul><li># of unsuccessful efforts and reasons why (e.g. undocumented) </li></ul></ul>
  14. 14. HUSKY Outreach Outcome Measures <ul><li>Applications & Renewals – tracked by ACS and DSS </li></ul><ul><ul><li># of submitted applications </li></ul></ul><ul><ul><li># of successful applications </li></ul></ul><ul><ul><li>Increase in % of returned renewals </li></ul></ul><ul><ul><li>Increase in % of successful renewals </li></ul></ul><ul><li>Increase in overall enrollment </li></ul><ul><li>Anecdotal/Qualitative </li></ul><ul><ul><li>Feedback from Consumers </li></ul></ul>
  15. 15. Covering uninsured newborns <ul><li>Cover all uninsured newborns born in CT hospitals or participating border hospitals </li></ul><ul><li>Partner with CT & border hospitals for notification </li></ul><ul><li>Expedite eligibility determination of all uninsured newborns </li></ul><ul><li>DSS will pay the first 4 month’s premium, if required </li></ul>
  16. 16. Other new initiatives <ul><li>Pregnant woman expansion </li></ul><ul><li>Family planning program </li></ul><ul><li>Primary Care Case Management Pilot </li></ul><ul><li>Premium Assistance for ESI </li></ul><ul><li>Charter Oak Health Plan </li></ul>
  17. 17. Pregnant woman expansion <ul><li>Cover pregnant women to 250% FPL </li></ul><ul><li>Full Medicaid benefit package including transportation </li></ul><ul><li>No out-of-pocket costs </li></ul><ul><li>Newborns automatically deemed eligible for 1 year </li></ul>
  18. 18. Family Planning Program <ul><li>Increase availability of effective contraceptive methods </li></ul><ul><li>Decrease the number of unintended or mistimed pregnancies </li></ul><ul><li>Increase the spacing between pregnancies </li></ul><ul><li>Increase access to primary care </li></ul>
  19. 19. Family Planning Program <ul><li>Family income to 185% FPL, ineligible for Medicaid </li></ul><ul><li>No asset test </li></ul><ul><li>Females - ages 14 – 55 </li></ul><ul><li>Males – ages 14 – 60 </li></ul><ul><li>US Citizen or qualified immigrant </li></ul>
  20. 20. Family Planning Program <ul><li>Family planning services </li></ul><ul><ul><li>including annual physical exam </li></ul></ul><ul><ul><li>diagnostic and laboratory testing </li></ul></ul><ul><ul><li>immunizations </li></ul></ul><ul><ul><li>treatment of STDs </li></ul></ul><ul><ul><li>medications required incidental to family planning procedures </li></ul></ul><ul><ul><li>contraception management including devices, prescription and non-prescription contraceptives </li></ul></ul><ul><ul><li>tubal ligation and vasectomy </li></ul></ul>
  21. 21. Primary Care Case Management <ul><li>Pilot program </li></ul><ul><li>May attract more provider participation </li></ul><ul><ul><li>PCPs work with one entity, rather than 4 MCOs </li></ul></ul><ul><ul><li>FFS reimbursement plus PMPM fee for care management </li></ul></ul><ul><li>Integrated disease management program </li></ul>
  22. 22. Premium Assistance Program <ul><li>Promotes family coverage </li></ul><ul><ul><li>Required to enroll self & dependents if insurance is available and meets certain conditions </li></ul></ul><ul><li>For employed HUSKY A clients </li></ul><ul><li>DSS accountable for premium contribution, deductibles, co-payments and full Medicaid wrap around coverage </li></ul>
  23. 23. Charter Oak Health Plan – covering uninsured adults <ul><li>Coverage through a private model </li></ul><ul><li>No asset test </li></ul><ul><li>No pre-existing conditions </li></ul><ul><li>No individual or employer mandate </li></ul><ul><li>Participation is voluntary </li></ul><ul><li>Payments from members to MCOs </li></ul><ul><li>Payments from members to MCOs </li></ul><ul><li>Deductible - $1000 max </li></ul><ul><li>State investment is premium subsidies on a sliding scale – up to 300% FPL </li></ul><ul><li>$1 million lifetime benefit max </li></ul><ul><li>6 month crowd-out </li></ul>
  24. 24. For more information Kristin R. Dowty, HUSKY Program Phone: 860-424-4805 Email: [email_address]