OLR Bill Analysis

sHB 6402



This bill requires the Department of Social Service (DSS) to (1) extend medical assistance to certain legal aliens and (2) apply for a federal waiver to obtain federal Medicaid matching funds for the state-funded State-Administered General Assistance (SAGA) and Charter Oak medical assistance programs. It sets a deadline for the DSS commissioner to apply for a federal waiver to provide family planning services to more women.

The bill also requires the DSS commissioner to develop and implement a provider-directed care coordination program for HUSKY recipients by January 1, 2010.

EFFECTIVE DATE: July 1, 2009, except for the provision requiring the waiver for Medicaid coverage of SAGA and Charter Oak, which is effective upon passage.


The bill requires the DSS commissioner, by January 1, 2010, to seek federal funds to provide medical assistance to qualified alien children and pregnant women who were admitted into the U. S. less than five years before the “date services are provided.

The recently passed federal Children's Health Insurance Program Reauthorization Act (CHIPRA, PL 111-3) permits states to claim federal Medicaid (HUSKY A in Connecticut) and State Children's Health Insurance Program (SCHIP, HUSKY B) funds to provide health care coverage to pregnant women and children who are recent (within five years) immigrants.

The 1996 federal welfare reform law generally bars legal immigrants who have been in the U. S. for fewer than five years from receiving federally funded assistance. States can provide this assistance with state-only funds, which Connecticut has done since 1997.


PA 05-120 directed DSS to seek a federal Medicaid 1115 waiver to provide family planning coverage to adults in households with income up to 185% of the federal poverty level (FPL). (These are individuals who would not otherwise qualify for HUSKY A. ) DSS never requested the waiver.

The bill requires the commissioner to (1) apply for this waiver by September 1, 2009 or (2) if he fails to do so, report to the Human Services Committee by September 15, 2009 explaining the reasons why.


The bill requires the DSS commissioner, by January 1, 2010, to apply for a federal Health Insurance and Flexibility and Accountability (HIFA) demonstration waiver to provide Medicaid coverage to individuals qualifying for either the SAGA medical assistance program or the Charter Oak Health Plan (see BACKGROUND). Currently, state funds are used to pay for the SAGA program and the subsidized portion of the Charter Oak Health Plan. Medicaid coverage would provide a federal match for these state expenditures.

The bill requires the commissioner to submit the waiver application to the Human Services and Appropriations committees before sending it to the federal Medicaid agency, in accordance with state law. If he fails to do so by the above date, he must report to both committees explaining (1) why he is not seeking the waiver and (2) an estimate of the cost savings that such a waiver would provide in a single calendar year. This report must be submitted by January 2, 2010.

Current law requires the DSS commissioner, by January 1, 2008, to seek a waiver to cover SAGA recipients with income up to 100% of the federal poverty level. He never sought the waiver.


The bill's provider-directed care coordination program must pay primary care providers (PCP) for care coordination services they provide to individuals who need care beyond what the PCP offers.

To qualify for these payments, a provider must:

1. develop written care plans that include evidence of family participation;

2. have staff members dedicated to care coordination;

3. maintain documentation of care plans;

4. be designated as the patient's provider by patient selection or by assignment when the patient does not choose a provider;

5. provide services 24 hours per day, seven days per week;

6. arrange for the patient's comprehensive health care needs; and

7. provide integration, coordination, and continuity of care with referrals for specialty care and other necessary health care services.

DSS is currently running a pilot primary care case management program for HUSKY recipients in two parts of the state. The program contains many of the same elements that the bill's program includes.


Legislative History

The House referred the bill (File 509) to Appropriations, which eliminated provisions (1) requiring (a) health care professionals to do post-partum depression screenings, (b) DSS to provide HUSKY coverage for these screenings, and (c) the Behavioral Health Partnership to play a role in these screenings; (2) revising DSS' Medicaid smoking cessation coverage; and (3) requiring an SCHIP waiver to cover supports and services for children with special health care needs.

Federal Waivers

Federal Medicaid law (Section 1115 of the Social Security Act) allows states to request “demonstration” waivers of federal rules to expand health care coverage when those rules would otherwise not allow this or to limit who the program covers. These waivers generally run for five years but can be renewed.

The federal government introduced the HIFA waiver in 2001, which used the existing 1115 Medicaid waiver to encourage states, through their Medicaid- and State Children's Health Insurance Program-funded programs, to experiment with alternate strategies in an effort to reduce the number of uninsured residents. The federal Medicaid agency gave states broad authority under these waivers, including limiting enrollment, modifying benefit structures, and increasing beneficiaries' cost sharing which, without the waiver, would not be allowed. At the same time, states were expected to expand coverage.

States may still request 1115 waivers, which are research and demonstration waivers that allow states to experiment with coverage. These states must be able to demonstrate that they are “budget neutral” over the life of the demonstration, meaning they cannot be expected to cost the federal government more than it would cost without the waiver.

Legislative Approval of Waivers—CGS 17b-8

State law requires the DSS commissioner, when submitting an application for a federal waiver for anything more than routine operational issues, to submit the waiver to the Human Services and Appropriations committees before sending it to the federal government. The committees have 30 days to hold a hearing and advise the commissioner of their approval, denial, or modification. If the committees deny the application, the commissioner may not submit it to the federal government. The law also sets up a process for when the committees do not agree. If the committees do not act within the 30-day period, the application is deemed approved.

Medicaid Coverage for SAGA

In 2003, the legislature directed DSS to seek a Medicaid waiver to cover SAGA medical assistance recipients by March 1, 2004 (PA 03-3, June 30 SS). In 2007, the legislature extended the deadline to January 1, 2008 and extended the waiver to individuals with incomes up to 100% of the FPL (PA 07-185). Currently, SAGA medical assistance is available to individuals with income up to about 55% of the FPL.

Charter Oak Health Plan

Since August 2008, the Charter Oak Health Plan has offered state residents another health insurance option. Individuals must be uninsured for at least six months to qualify, and benefits are provided by managed care organizations with which DSS contracts. The state provides both premium and deductible assistance to individuals whose incomes are under 300% of the FPL.

Related Bills

sSB 988 (File 195) requires DSS to seek a 1115 demonstration waiver for SAGA and Charter Oak by January 1, 2010.


Human Services Committee

Joint Favorable Substitute






Appropriations Committee

Joint Favorable Substitute