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INSURANCE - HEALTH; WELFARE - MEDICAL ASSISTANCE (MEDICAID);

OLR Research Report


Public Health Insurance Options in Connecticut

 

September 9, 2009 2009-R-0328

While Congress and the Obama administration continue to work on legislation to reduce the number of people without health insurance, states for years have incrementally addressed the lack of insurance among the non-elderly poor, mostly by implementing the federal Medicaid and State Children's Health Insurance (SCHIP) programs and other medical assistance programs. (Two of the current health care reform bills would expand Medicaid to cover individuals traditionally not served by that program.) [1]

Indeed, in Connecticut over a half-million residents were covered by one of these programs as of summer 2009. In addition to Medicaid and SCHIP (HUSKY B in Connecticut), the state's other major comprehensive public health insurance programs are the State-Administered General Assistance (SAGA) medical assistance program and the relatively new Charter Oak Health Plan, which is available to higher-income adults regardless of their health status.

Program

Enrollment 09

Medicaid [2]

450,377 (July)

HUSKY B

15,174 (Aug)

SAGA

40,549 (July)

Charter Oak

16,141 (Aug.)

Total

522,241

Source: Department of Social Services, Active Assistance Units Report for July 2009; press release from Governor Rell's office, August 14, 2009

[1] Medicare, the main public health insurance program for seniors and certain people with disabilities, is not described here as the state's role in its implementation is limited.

[2] This figure includes families (HUSKY A); aged, blind, and disabled individuals; and State Supplement recipients. Additionally, for about 70,000 individuals who are eligible for Medicare, the state's Medicaid program pays the Medicare premiums and deductibles.

Medicaid

Since 1965, this federal-state program has offered comprehensive health coverage (largely through managed care) to low-income children, families, and pregnant women and to the elderly and younger adults with disabilities (on a fee-for-service basis). The eligibility criteria for the program's numerous coverage groups vary both in federal and state law. For example, HUSKY A is available to children and their caretaker relatives in a family whose income is under 185% of the federal poverty level (FPL, $33,873 for a family of three in 2009), while an adult under age 65 with a disability living alone in most communities qualifies as “medically needy” if his or her income is under about 60% of the FPL. Asset tests apply to some categories of beneficiaries but not others. For example, there is no asset test for HUSKY A, while the medically needy client may have no more than $1,600 in liquid assets. There is currently no cost sharing for any Medicaid clients.

In general, the state receives a 50% match for every Medicaid dollar it spends. The program is an entitlement, which means that if someone meets the eligibility criteria, the state must cover him or her, with some exceptions (e.g., waiver groups).

HUSKY B

Recognizing that Medicaid was not reaching many lower-income children, in 1997, Congress enacted the SCHIP legislation and late that year, Connecticut's legislature adopted its own SCHIP program, HUSKY B. Because the state's Medicaid program at the time had some of the most liberal child Medicaid eligibility criteria in the country (it covered children up to the 185% of FPL level with no asset test), the legislature created a separate program to cover children in families with higher incomes. To qualify, family income cannot exceed 300% of the FPL ($54,930 for a family of three in 2009). Unlike HUSKY A, HUSKY B requires co-payments, and premiums are required once family income reaches 235% of the FPL. Families with incomes above 300% of the FPL can buy into the program by paying the full premium. The benefits are essentially the same as those in HUSKY A and the HUSKY A managed care organizations also manage HUSKY B beneficiaries' care.

Unlike Medicaid, SCHIP is a block grant and not an entitlement, which means the state receives a set amount of federal funds each year. For every dollar the state spends on SCHIP-covered children, it can “draw down” 65 cents from its block grant allotment. Connecticut has never spent its yearly allotment.

SAGA

To qualify for Medicaid, an individual must be poor and fit into one of the categories described above for Medicaid. For example, a single adult without a severe disability does not qualify. To address this gap, the state for many years has offered health care through the SAGA program. Initially, services were provided on a fee-for-service basis similar to Medicaid but since 2004, care has been provided by the state's federally qualified health centers. To qualify, an individual must meet the Medicaid medically needy income limit and may have no more than $1,000 in liquid assets. SAGA is an entitlement and anyone meeting the program's eligibility criteria must be provided benefits. SAGA is an entirely state-funded program, but recent state law requires the Department of Social Services (DSS) to seek Medicaid funding for it.

Charter Oak Health Plan

In 2007, the Governor proposed and the legislature approved the Charter Oak Health Plan for adults regardless of their health status who are ineligible for Medicaid or SAGA. The program requires premiums (maximum of about $259 per month) and co-payments, with premium subsidies for individuals with incomes under 300% of the FPL. It also includes income-based deductibles, with exceptions for certain care (e.g., primary care), for individuals at all income levels. Charter Oak enrollees' care is managed by the same MCOs that manage HUSKY recipients' care. Dental and vision services are not covered, and program participants are subject to annual and lifetime benefit limits.

Additional Information

OLR Backgrounder, Charter Oak Health Plan, 2008-R-0403

Charter Oak Health Plan website, www.charteroakhealthplan.com

HUSKY website, www.huskyhealth.com

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