Topic:
INCOME MAINTENANCE PROGRAMS; CHILD HEALTH; CENSUS; JUVENILES; HEALTH INSURANCE; MEDICAID; STATISTICAL INFORMATION;
Location:
INSURANCE - HEALTH; JUVENILES;

OLR Research Report


April 12, 2007

 

2007-R-0259

HUSKY-ELIGIBLE INDIVIDUALS AND CARE UTILIZATION

By: Robin K. Cohen, Principal Analyst

You asked how many people are eligible for but not enrolled in HUSKY. You also asked what percentage of people who are enrolled are actually receiving services.

We have included information regarding the State-Administered General Assistance (SAGA) program for your additional information.

SUMMARY

We do not know the exact number of individuals who may be eligible for but not enrolled in HUSKY (Part A or B). But the Office of Health Care Access (OHCA) and others studying state uninsured rates have tried to estimate these numbers, either through surveys or using current U.S. Census data. A 2006 OHCA household survey suggests that as many as 21,000 uninsured children may be eligible for but not enrolled in HUSKY, with an additional 31,000 adults who might qualify for HUSKY A adult coverage.

The Connecticut Health Insurance Policy Council, a group representing the state's business and insurance communities, used 2005 census data to make its estimates, which are considerably higher. It asserts that as many as 66,000 uninsured residents may qualify for public coverage, with 63.6% (about 42,000) children eligible.

As of April 2007, 206,418 children were enrolled in HUSKY A, another 16,985 were enrolled in HUSKY B, and 90,243 adults were enrolled in HUSKY A as caretaker relatives of children receiving HUSKY A. While these numbers indicate that a significant portion of the state's children and some of their caretaker relatives are getting public health care coverage, utilization data suggest that not all are actually receiving services. Analyses of 2005 enrollment data suggest that just a little over half of all children enrolled received well child care, while less than half received any dental care. And only about one-third of HUSKY adults received preventive care that year.

NUMBER OF POTENTIAL HUSKY ENROLLEES

Office of Health Care Access (OHCA) Estimate

In January 2007, OHCA released a survey showing current rates of uninsured Connecticut residents. The survey concluded that about 56,400 of the state's 222,699 uninsured residents might be eligible for but not enrolled in public health insurance, which could include HUSKY (Parts A and B), Medicaid fee-for-service, or SAGA.

We asked OHCA to provide a breakout of this figure to get a sense of how many of these residents could potentially qualify for HUSKY. Table 1 presents this information.

Table 1: OHCA Estimates of Uninsured Who Might Qualify for Public Health Insurance

Federal Poverty Level

Age <19

Age 19+

Total

<100%

4,599

15,581

20,180

100% - <150%

1,538

15,362

16,900

150% - <185%

5,234

0

5,234

185% - <300%

2,168

815

2,983

300%+

6,602

0

6,602

Don't know/refused/ unknown

878

3,612

4,490

Total

21,019

35,370

56,389

Source: OHCA (2007)

OHCA officials stated that respondents were assigned to public coverage eligibility based on their income as a percentage of the FPL and family structure, based on some assumptions it made. For example, adults in families with children were considered to be eligible for HUSKY A if their income was under 150% of the FPL. All children were considered eligible for HUSKY since there are essentially no income limits for that program. (Once income is higher than 300% of FPL, the state subsidy ends.) OHCA did not assume that the childless adults earning less than 100% of the FPL would be eligible for Medicaid. (Some might qualify under the medically needy group or SAGA.)

Based on these figures, OHCA concluded that 11,371 children under age 19 might be eligible for HUSKY A, another 2,168 could qualify for subsidized HUSKY B coverage, with an additional 6,602 potentially eligible for unsubsidized HUSKY B coverage.

An additional 30,943 adults with incomes up to 150% of the FPL could qualify for HUSKY A. (HUSKY A for adults is available only to caretaker relatives of children receiving HUSKY A.) And some portion of the 15,581 adults with incomes under 100% of FPL may alternatively qualify for SAGA medical assistance.

OHCA estimated that a total of 222, 600 were uninsured in 2006. Some of the uninsured that OHCA excluded from those eligible for public health insurance could potentially qualify for public coverage. For example, OHCA excluded respondents who indicated they were eligible for employer coverage; but it acknowledged that these people could conceivably qualify for public coverage. (Although HUSKY B is generally not available to families who are enrolled in private coverage, HUSKY A and other Medicaid allows low-income residents with private coverage to enroll, with the state providing coverage the private plan does not.)

The Connecticut Health Insurance Policy Council—Census Data

The Connecticut Health Insurance Policy Council's estimates of uninsured suggest that a higher number of individuals might qualify for public coverage. The council hired the Lewin Group to do its analysis. Lewin relied on 2005 census data and estimated that as many as 66,000 people (22% of the estimated 297,700 uninsured) could be financially eligible for Medicaid or SCHIP. (Lewin estimated that a little over 54,000 uninsured individuals had income less than 100% of the FPL, while 136,942 had incomes between 100% and 300% of the FPL.) (We attempted to reach a spokesperson from the council to discuss the report but our calls were not returned.)

The council's breakdown by age of potential Medicaid eligibility is provided in Table 2. It suggests that a significant portion of those uninsured potentially eligible for Medicaid are children, although the council's numbers are higher than OHCA's.

Table 2: Connecticut Health Insurance Policy Council Estimates of Uninsured Potentially Eligible for Medicaid or HUSKY B

Age

Percentage of Uninsured Eligible for Medicaid or HUSKY B

Under 6

18.1%

6-18

45.5

19-24

6.0

25-34

12.1

35-44

13.6

45-54

3.0

55+

1.0

Source: Lewin Group (2006)

Why the Numbers Vary

The OHCA survey report explains the reasons for the differences in the two estimates. OHCA's report stated that its estimates of the uninsured had been consistently lower than the census estimates. OHCA added that the census' uninsured rate for Connecticut was similar to OHCA's estimate of those who experienced a period of uninsurance in the last year. And it suggests that the instability of coverage that many families experience argues for an estimated range instead of single number. The comparison of the two measuring tools can be found at www.ct.gov/ohca/lib/ohca/common_elements/household06_databook_1-31_version.pdf

UTILIZATION

Voices for Children Analysis of HUSKY Children's Utilization of Services

Connecticut Voices for Children, a nonprofit child advocacy group that provides consulting services to the HUSKY program, periodically measures utilization in the HUSKY program. Its latest ambulatory care report covers children enrolled in HUSKY A in 2005.

Voices found that 86% of the 156,368 children between the ages of two and 19 enrolled in HUSKY A in 2005 received ambulatory care, a “statistically significant” increase over the previous year (85%), but “not noteworthy.” Fifty-seven percent received well-child care that year, which was up from 46% in 1999 (an increase of 37,000 children receiving this care).

Certain factors affected utilization. For example, the older the child, the more likely the child would not receive ambulatory care. African American children were less likely than other children to receive this care. And children enrolled in the Medicaid managed care organization, Preferred One, were the least likely to receive well-child care or ambulatory care in 2005.

Medicaid's Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) provisions prescribe periodicity schedules for children receiving Medicaid-funded health care. In Connecticut, the schedule calls for annual well-child exams for children ages two to five and 11 to 19, and exams every two years for children between age six and 10.

Voices also measured dental access for HUSKY A children in 2005. (EPSDT calls for preventive dental care services twice a year beginning with an initial screening visit at age two.) The researchers used HUSKY A enrollment data of children age three to 19 who were continuously enrolled in HUSKY A for all of 2005. They found that 48% of these children received some dental care, while 41% of this group received at least one preventive dental care service. They also found that 35% of these children receive two or more preventive visits that year. Preventive dental care rates were higher for school-aged children age six to 11.

The Voices reports, which provide additional demographic information about HUSKY enrollees and utilization, are at www.ctkidslink.org.

Adult Utilization

With one exception, a recent DSS analysis of HUSKY A adult service utilization shows a small increase in both adult preventative care and adult preventative or ambulatory care between calendar years 2004 and 2005. Table 3 shows adult (22 years or older) preventative care utilization for HUSKY recipients continuously enrolled for at least 11 months of the year. Table 4 does the same for preventative and ambulatory care.

Table 3: Percentage of Adults Receiving Preventative Care — 2004 and 2005

MCO

% of Continuously enrolled receiving preventative care (2004)

% of Continuously enrolled receive preventative care (2005)

Bluecare

34.96

36.66

Community Health Network

32.11

33.25

Health Net

37.65

38.42

Preferred One

34.27

31.43

Source: DSS

Table 4: Percentage of HUSKY A Adults Receiving Preventative or Ambulatory Care — 2004-2005

MCO

2004

2005

Bluecare

77.03

79.57

CHN

82.25

83.00

Health Net

81.36

83.46

Preferred One

75.59

75.97

Source: DSS

Voices for Children performed a more detailed analysis of the same data. For example, it found that while 35% of all adult enrollees received preventive care, 50% received episodic care only, and 6.9% of these medical visits were for emergency care.

Breast and Cervical Cancer Screening. DSS also compiled statistics using MCO reports on two adult health screenings (breast and cervical cancer) with recommended periodicity schedules. The data show that for all four MCOs in 2004 and 2005, less than 40% of women aged 41 and older had such screenings. (The recommended screening is every one to two years, up to age 50, and annually thereafter. Likewise, we do not know how many women enrolled in HUSKY A are in these two age groups. So it is difficult to draw clear conclusions from the data.)

OHCA Analysis of Utilization

In its 2006 survey, OHCA found that uninsured people made half the number of doctor visits than people with public or private coverage. OHCA asked households several questions related to HUSKY and SAGA utilization. Uninsured people averaged only 50% (5) of the number of annual medical care visits that all people had (10) and a smaller percentage of those with private insurance (11). HUSKY and SAGA recipients (10) had the same average number of visits as all people, and slightly less than the privately insured.

The survey also found that HUSKY and SAGA recipients received a higher average number of prescriptions per year (17) than both all people and privately insured people (13). It also found that HUSKY and SAGA recipients were twice as likely to forego medical care in an emergency than privately insured residents, but were just slightly less likely to seek care for nonemergency illnesses than the privately insured. Moreover, they were less than half as likely to forego both emergency and nonemergency care than the uninsured.

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