CT is Bringing Health Insurance to More Children and Families

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: Kristin.Dowty@ct.gov