You asked for an update of the 2005 OLR reports that supplied data on the employers who employ people who receive, or whose dependents receive, HUSKY. You also wanted to know how those states that have adopted reporting laws designed to get this data differ from Connecticut's current system for obtaining it.

We first asked the Department of Social Services (DSS) for the updated employer information two months ago and have asked several times since then. We asked for the data in a way that would satisfy staff concerns about confidentiality. Last week, we asked Commissioner Coker and her deputies to intervene, after being told by lower level staff that they could not get us the information. The commissioners have not responded. Lower level staff did note that they would not expect much change in the data since the 2005 reports.

DSS currently obtains employer information from HUSKY applications, but as far as we know it does not report this data on a regular basis. When it compiled the HUSKY A data we requested in early 2005, it used the DSS Eligibility Management System (EMS), plus manual checking because of system limitations (e. g. , different spellings of employer name). This was a very labor intensive undertaking. The HUSKY B data, which was generated by ACS, the enrollment broker for both HUSKY A and B, was apparently easier to retrieve, but it still required the re-direction of staff resources to create an ad hoc report.

SUMMARY

Massachusetts and Hawaii appear to be the only states with laws requiring the agencies that administer their publicly funded health insurance programs to report annually on the employers of employees who are program beneficiaries or whose dependents receive coverage. (Other states may receive this information but not require it statutorily. ) Both states' laws require annual reports to the legislature that list those employers who employ a minimum number of state-funded medical assistance program beneficiaries, along with the employers' addresses and the cost to the state for providing the insurance. Both states also require confidentiality of the beneficiary names and make reference to the confidentiality provisions in the federal Health Insurance Portability and Accountability Act (HIPAA).

Many states, including Connecticut, have tried but failed to pass these measures. In 2005, the Senate passed a reporting bill (SB 671) after amending it to include a provision requiring DSS to exclude an employer name from a report if its employees could be identified. DSS had requested this change and indicated to us recently that the bill, as amended, addressed its confidentiality concerns. The House never acted on the measure.

There are differing opinions on the confidentiality question. The National Conference of State Legislature's Health Program director, Laura Tobler, spoke to two NCSL experts on the HIPAA confidentiality provisions. Both said that they did not see a relationship between HIPAA and reporting the employers of Medicaid clients or their dependents. Tobler added that HIPAA is supposed to protect “medical and health” information and that the employer information is “employment” information. Despite this, the two states that have employer reporting laws contain references to HIPAA.

DSS program staff stated that reporting this information can require numerous hours of staff time, which take individuals away from other data collection tasks. NCSL's Tobler also points to the federal State Children's Health Insurance Program (SCHIP) law, which funds Connecticut's HUSKY B program. That law requires states to collect employer information to show that individuals are not dropping private coverage to enroll in the public program (a phenomenon called “crowd out”). State law does not require DSS to report on whether crowd out is occurring, but if DSS is producing something for the federal government, this could be modified to include data similar to what we provided in 2005.

STATES WITH LAWS REQUIRING EMPLOYER REPORTS

Massachusetts

In 2004, the Massachusetts legislature passed a law directing the Executive Office of Health and Human Services (EOHHS) to produce a list of employers who have 50 or more employees using public health insurance each year. (In that state, public health insurance includes Medicaid and the Uncompensated Care Pool. People qualify for the latter, which provides payments to acute care hospitals and community health centers, if their income is less than 400% of the federal poverty level (FPL)). People who do not qualify for Medicaid or the state's State Children's Health Insurance Program (SCHIP) get UCP care for one year. )

The report must include:

1. the employer's name and address;

2. the number of public health insurance beneficiaries the employer employs;

3. the number of program beneficiaries who are spouses or dependents of the employees;

4. whether the employer offers health benefits; and

5. the cost to the state for providing public health insurance to the employers, spouses, and dependents.

To address confidentiality concerns, the law prohibits the report from including the names of the beneficiaries and subjects it to the HIPAA's privacy standards. EOHHS must submit the report to the legislature's Health Care and Ways and Means committees.

The state's first report can be found at http: //www. mass. gov/Eeohhs2/docs/dhcfp/pdf/50+_ees_ph_assist. pdf

Hawaii

The legislature in Hawaii had a harder time passing its reporting law. It had to return to the state capitol to override the governor's veto in July 2005.

The new law (SB 1772) , which went into effect in July 2005, requires applicants for medical assistance under any Department of Human Services' (DHS) medical assistance program to identify the employer of any adult who is responsible for providing all or some of the program beneficiary's support. It applies to both employees and their dependents.

The law requires DHS, no later than October 1 each year, to submit a report to the legislature identifying all employers who employ at least 25 employees who receive, or whose dependents receive, state medical assistance. The report must be made available to the public.

The report must include:

1. each employer's name and names of its subsdiaries;

2. their location;

3. for each DHS medical assistance program, the total number of employees and dependents enrolled; and

4. the total cost to the state of providing the assistance.

The report may not include the beneficiary's name. It is subject to the HIPAA privacy standards.

In determining whether the 25-employee threshold is met, DHS must include all program beneficiaries employed by the employer and its subsidiaries at all locations in the state. It requires DHS to consult with the Department of Commerce and Consumer Affairs if it needs help determining this information.

RC: ts