Connecticut
Medicaid Managed Care Council
Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-8307
www.cga.state.ct.us/ph/medicaid

Consumer access to the HUSKY managed care program has been an issue raised in the legislative oversight Medicaid Managed Care Council since the design and implementation of the Medicaid program (Fall of 1995) and the SCHIPS program in July 1998. The concerns focused on the ability of the State to mobilize State-level and grass roots community and health care entities to reach out to potential members, informing them of the program(s) as they evolved and retain health care coverage as individuals exit the TFA program, change income, moving from the HUSKY A program to the B program, or reach the end of their eligibility period. Connecticut, not unlike other states, has lost health plans’ participation in the program over time. Connecticut began with 11 health plans and currently has four plans, three of whom are commercial and Medicaid plans and one is solely a Medicaid safety net plan. Ensuring that members of plans exiting the program remain enrolled in participating plans presented additional challenges that were well met by the Department of Social Services.

HUSKY enrollment has grown over the last 7 years, from 213,000 in 1997 to 286,255 members as of May 1, 2002. Expanded program eligibility, program changes and more targeted outreach associated with additional grant funding, as well as recent economic factors and rising medical inflation and double-digit commercial employer premiums have contributed to the growth in the overall HUSKY program.

· Expanded coverage for youth <19 years to 185% FPL, under Title XXI reimbursement 65/35.

· HUSKY B: Expanded coverage for children <19 years to 300%FPL. Full premium by-in for families >300%

Presumptive eligibility, with community health centers, Head Start programs and WIC as designated qualified entities. One page fast track application to the Central DSS office, followed by the regular HUSKY application.

· Benova , State Enrollment Broker, took a stronger role in community CB) education about HUSKY.

o CHC worked with DSS to ensure newborns enrolled before discharge, through the DSS Central office.

· HUSKY applications attached to school lunches resulting 3000 returned in one year.

· 10 CB outreach grants awarded, ranging from $20-100,000 (CCHI) The CHC coordinated ouitreach and provided technical assistance.

· Funds from DSS to SBHC for outreach, DSS began working with CT American Academy of Pediatrics for outreach in community health services.

· CHC and DSS received the RWJ grant for CB outreach, including two local pilots targeting adolescents and legal immigrants.

· CHC, DSS participated in the Children’s Defense Fund OR campaign – resulted in modest # of newly enrolled members.

· DSS/CHC RWJ grant for media campaign associated with the Back-to-School campaign.

· CHC received another 3 year grant from RWJ that will broaden the statewide coalition, add three more local outreach projects, provide feedback to DSS on efforts.

21 month Exit Interview: of the adults missing the interview some lost medical coverage as well as cash assistance, food stamps. MMCC requested DSS to monitor those closed cases, connect to Medicaid.

· CHC began tracking children newly enrolled, retention after 12 months, identifying at-risk periods for insurance loss: end of Cash Assistance, end of the 24 month transitional Medicaid for Welfare families, and end of continuous eligibility period.

· July 2000, loss of 4001 HUSKY members, >85% were children. Subsequent to this, DSS revised family notification of end-of -insured period, tracking ,with follow up, those who did not re-enroll. In July 2001, membership loss was 2000.

· DSS grant with RWJ: Phase I- work with CB organizations to identify retention barriers, lead to recommendations to strengthen accountability in the DSS infrastructure, coordinate Benova/DSS data, centralize HUSKY intake and renewal process in DSS Central Office, customer service performance measurement at both DSS & Benova. DSS has applied for the Phase II grant to implement strategies.

· Benova began the first reporting in the HUSKY program on racial/ethnic diversity in enrollment in HUSKY A & B (under representation of minorities in HUSKY B)

o Held 4 focus groups in the community to identify enrollment/retention barriers,.

o Initiated a project with DSS to provide HUSKY applications, information to imprisoned women, soon to be released into the community and the DOC staff.

o Recommended, proposed legislation, for objective assessment of statewide outreach efforts, spending & outcomes. Did not pass.

· There have been many CB outreach initiatives in addition to the CCHI grant, examples:

o A national student out reach project, SHOUT, at Yale University, that promote HUSKY outreach and follow up to potential members, providing application assistance.

o CHC worked with UCONN to interview 225 families that left HUSKY, found that 67% had other insurance, of which 40% were eligible for Medicaid HUSKY TPL, 45% were unaware of the yearly re-enrollment requirement.

· Presumptive eligibility one-year reports showed that 2990 were granted PE, 1341 were granted eligibility, 1145 were denied, 504 did not complete the application process.

· Benova tracked HUSKY B lost members, reasons for not reapplying: 43% difficulty gathering verification materials, 33% had other insurance, thought B co-pays too high or wanted family coverage, 22% were granted HUSKY A

Looking at the enrollment patterns over the years, despite significant outreach, enrollment gains were gradual, with significant losses in July 2000 (4011), and 2000 in July 2001. HUSKY B enrollment was slower and lower than anticipated, related in part, to over reporting of uninsured in CT. The major increase in enrollment was seen in September-November of 2001 and again from January-March 2002. Several possible causes for this sudden jump in enrollment have been offered: Fall of 2001: the RWJ media campaign associated with the Back to School OR, impact of September 11 on the recession that started in March 2001. Early 2002: the continuing uncertainty of the economy, recession, double-digit insurance premium increases that began in January 2002.

Outside financial resources to DSS have and will continue to support Department monitoring of membership, revision of infrastructure. State agency resources have been reduced over the past 6-8 years and they will face further cuts in the 2002 budget session.