HUSKY A Benefits/Co-Pays

Bring Medicaid medical benefit package in line with commercial HMO coverage, likely reducing available services and increasing co-pays

SB 2001, Sec 72-73

-Benefits for enrollees in managed care will be identical to the State employee Non-Gatekeeper POE plan, shall comply with all Medicaid federal law & regulation.

-Enrollees with income between 50 –100% FPL will pay a monthly premium of $10 per person (PP), not to exceed family amount of $25 per month.

-Enrollees with incomes 100-185% will pay a monthly premium of $20 PP, family aggregate no more than $50/month

-The MCOs will assess the cost sharing; DSS can deny/discontinue coverage if premium payment is in arrears for2 months. Client will receive 30-day notice of termination.

-Co-payments for all enrollees: maximum $3 for medical services, $1.50 for prescriptions.

FY 04- $15.9M

FY 05-$22.2M

Implementation: Requires an 1115 waiver

HUSKY A Presumptive Eligibility (PE) for Children

Eliminate the PE policy

SB 2001 Sec 57

Eliminated

FY 04-$2.8M

FY 05-$3M

Effective upon passage

HUSKY B Enrollment/restructure benefit package/ HUSKY B Premiums

Suspension of HUSKY B enrollment for 2 yrs of budget, change benefit package to that similar to commercial HMO benefits

. Apply the $30/m premiums to families in Band 1 (>186%-235%FPL). Increase Band 2 (>235-300%FPL) to $50/m with a $75 family cap.

SB 2001 Sec 55,56

-No suspension of enrollment

-Benefit structure: services & cost-sharing to be ‘substantially similar’ to the largest State commercially available HMO benefit package.

-Cost sharing may increase, no greater than 5% of gross income.

-Premiums added to band 1 (>185-235%).

-Eliminates requirement for DSS to submit cost sharing changes to GA committees for approval, denial or modification.

FY 04- $2.4M

FY 05-$3.9M

Requires state amendment change

HUSKY Self declaration of income

Repeal

SB 2001, sec 56(h):  remains unchanged from PA01-37

Transitional Medical Assistance (TMA)

Reduce TMA eligibility for those with earned income from 24 to 12 months

No change noted: CT TMA remains at 24 months.

Medicaid Prescription co-pays

(PA 03-2)

SB 2001 Sec 69

Requires DSS to make State amendment plan changes to allow pharmacies to deny prescriptions to those that have a ‘documented continuous failure’ to pay co-pays within 6 months. Upon payment, prescriptions will again be filled. Psychotropic drugs are exempt.

Saving associated with PA 03-2:

FY 04 & 05 - $4.5M

Requires waiver to implement

Implementation the Behavioral Health Partnership

Adult Rehab Option; FFP allocation

Reallocation of $200M in FY05 from Medicaid & HUSKY B programs to BHP Special accounts within the BHP agencies.

HB 6806 Sec 209

For FY05, 1) $200M transferred to BHP account under DSS Medicaid account. 2) $92,100,551 transferred to BHP account under DCF account. Special accounts for integrated administration of BH benefits have been eliminated

SB 2001, Sec 70: Adult Rehab Option

Allocates up to $3M of federal match (FFP) from Rehab Option to Community MH Restoration sub-account for FY04 & 05.

Care Enhancement/Disease Management (DM) for high cost Medicaid recipients.

SB 2001, Sec 51

Requires DSS to design & implement a DM Medicaid program for high cost Medicaid clients. Annual report to GA appropriations & Human Services committees.

FY 04 -$2M

FY 05 - $3M

Effective upon passage

Medicaid Dental Funding

Eliminate Medicaid adult dental services, redirecting $10M to children ‘s dental services that would be carved out of the MC program

Adult dental services were not eliminated.

Employer Health Insurance Subsidy (ESI) program

DSS could contract with small employer health subsidy program: individuals and families <185% could participate.

No specific provision for this in either bill.

State General Assistance (SAGA) Funding

Eliminate funding; increase private hospital DSH payments by $58.3M to offset increased uncompensated care due to this

 SB 2001

Sec 42: Cash Assistance

-Eligibility criteria unchanged, reduction in monthly benefit from $350 to $200.

-$50 less to eligible family cases.

Sec 43: Medical Assistance

-Grant funded ‘entitlement program, services thru FQHCs, health centers or hospitals.  Benefits limited to those available @ these sites. DSS will ensure ancillary/specialty services available based on access needs.

-DSS may contract with MCO/other entity for program administration.

-Drugs will be dispensed thru FQHCs 340B program. Recipient $1.50 co-pay per script.

-Requires DSS to apply for a HIFA waiver by 3/1/04 to >SAGA numbers for Medicaid coverage.  Waiver subject to GA committees’ approval (17b-8).

SB 2001, Sec 80 allows DSS to transfer families currently enrolled in SAGA to TFA (400-500 families)

Medicaid Fee-For-Service (FFS) Preferred Drug List (PDL)

For next 2 yrs phase in PDL with one class of drugs (proton pump inhibitor).

SB 2001, Sec 82-84

-Pharmacy to use most cost effective dosage, unless PA allows otherwise.

-FY04, PDL includes 3 drug classes including proton pump inhibitor (PPI). PDL applies to Medicaid, ConnPace, and SAGA.

-Changes Medicaid P & T Committee composition & abilities.

FY 04 -  $12.5M

FY 05 - $15M

Effective date: upon passage

Qualified aliens’ eligibility for state funded TFA or SAGA (17b-112c)

No extension of 6/30/03 statutory (17b-112c) application deadline:

-DSS cannot process/accept applications received after 6/30/03.

-Those previously deemed eligible remain eligible for services.

Children’s Health Council (CHC) Funding

Funding eliminated

HB 6806 Sec 243

$100,000 carries forward from DSS funds ‘Other Expenses’ as a grant to the Hartford Foundation for Public Giving for CHC for FY04.