CHILD HEALTH; HEALTH INSURANCE;

INSURANCE - HEALTH;

OLR Research Report


December 4, 2003

 

2003-R-0846

HISTORY OF HUSKY

 

By: Robin K. Cohen, Principal Analyst

You asked for a summary of changes in the HUSKY program since its creation in 1997.

SUMMARY

Unsubsidized coverage is also available to children in higher income families. These families pay the full premium cost of between $ 151 and $ 221 per month per child, plus the required co-payments.

HUSKY—HISTORY

Enabling Federal Law and State Response

For several years before the passage of HUSKY, Connecticut had been incrementally increasing its child Medicaid program coverage. Thus, when HUSKY was established, children in families up to 185% of FPL (designated HUSKY A) were already covered. The state decided to use the SCHIP funds to cover two additional groups of children: (1) children in families with incomes between 185% and 300% of FPL (to be designated HUSKY B) and (2) 17- and 18-year-olds who were not HUSKY A-eligible (only kids aged 16 and under were Medicaid-eligible at the time the HUSKY law was passed).

PA 97-1, October 29 Special Session, also established annual co-payment and premium requirements for HUSKY B families. (There were no coinsurance requirements in HUSKY A. ) For families with incomes between 185% and 235% of the FPL, the maximum annual co-payment was set at $ 650 and there were no premiums. Families with incomes between 235% and 300% of FPL could not be required to pay out more than $ 1,250 in combined premiums and co-payments. No co-payments or premiums were set for higher-income families. Rather, they would buy into the health plan at a negotiated group rate.

Adult Coverage

Expanding Outreach and Easing Enrollment Process

Eligibility, Premiums, Co-Payments, and Covered Benefits

Family Income
Monthly Premiums—Per Person
Monthly Family Cap

50% to 100% of FPL

$ 10

$ 25

100% to 185% of FPL

$ 20

$ 50

Previously, HUSKY A required no cost sharing.

Individuals participating in HUSKY A, but not enrolled in managed care, must be assessed similar co-payments and premium requirements. The act permits the DSS commissioner to deny coverage or discontinue HUSKY A eligibility when a recipient falls two months behind in making premium payments. But the termination cannot occur until 30 days after the clients is notified. (Federal Medicaid law gives individuals the right to appeal benefit terminations. )

PA 03-3, JSS requires the DSS commissioner to amend the state’s Medicaid plan and to seek any necessary waivers to carry out these provisions. It requires her to implement the changes while in the process of adopting necessary policies and procedures in regulation form.

Federal regulations (42 CFR 447. 52, et. seq. ) limit what cost sharing can be imposed on Medicaid recipients, both in terms of the actual amount that can be charged, as well as who can be required to pay (e. g. , pregnant women and children under the age of 21 cannot be required to pay cost sharing). But states can get federal waivers to allow them to impose cost-sharing on otherwise exempted groups of program enrollees.

Nonpayment of Co-Payments. Section 69 of PA 03-3, June 30 SS, requires the DSS commissioner to submit to the federal Medicaid agency a Medicaid state plan amendment to allow pharmacies to refuse to fill Medicaid prescriptions, except those for psychotropic therapies, for program beneficiaries who demonstrate a documented and continuous failure to pay co-payments in spite of their ability to make them. (Federal regulations (42 CFR 447. 53) prohibit Medicaid providers from denying services to individuals who are Medicaid-eligible based on their inability to pay the program’s cost sharing requirements. ) Continuous failure is defined as failure to make required co-payments (1) within six months after a prescription is filled or (2) on six or more prescriptions when these prescriptions are filled during any six-month period. The amendment must allow for a resumption of drug benefits once the beneficiary pays all of his outstanding co-payments.

DSS has not yet received federal approval to implement this change.

Service Package for Program Beneficiaries. Section 56 of PA 03-3, June 30 Special Session, requires the HUSKY B services and cost-sharing requirements to be substantially similar to the services and cost sharing requirements of the largest available MCO offered to state residents, as measured by the number of covered lives reported to the Insurance Department in the most recent audited annual report.

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