Medicaid Managed Care Council/Charter Oak update

The news from today’s Council meeting is that while Charter Oak’s enrollment continues to increase – 8,210 as of May 1st -- the number of people denied coverage under the program is far higher -- 18,635 so far. While 705 of those were denied because they have coverage or have had it in the last six months, 16,672 are getting caught in the application process. The quick start application, which is short and is online, is only the beginning of the process. Applicants then get a follow up form requesting more information and that appears to be the problem. The Council should get a copy of that form at the next meeting. If consumers have not completed the entire process within 60 days, they must start all over again and re-apply from the beginning.
We also learned that to qualify for Charter Oak under the financial hardship exception to the six months uninsured rule, consumers must be spending over 33% of their income on health care. Members of the Council felt that this was an extremely high bar to set between consumers and affordable coverage. DSS noted that anyone who is paying between 25% and 32% of income on health care are held for a closer look by the Dept.; approximately 100 people are in that category now. DSS explained that the six month provision was meant to keep people from dropping private coverage, even if it’s more expensive, to come into Charter Oak. It is unclear what the state’s interest is in keeping people from benefitting from a more affordable coverage option if they are in the unsubsidized category.
On HUSKY, PCCM plans are moving forward and several questions were deferred to the upcoming PCCM Subcommittee meeting May 20th at 10:00am in Room 3800 of the LOB. We learned that from December 2007 to January 2009, while the health plans were not at financial risk and were not denying treatment, administrative costs were 13% for Anthem, 11% for CHN, 12% for Health Net and 14% for WellCare.
A lively exchange resulted from a presentation by the CT Health Foundation on their new reports outlining the potential impact of eliminating coverage for legal immigrants and implementing copays and premiums in HUSKY Part A. Pat Baker of the Foundation pointed out that research on imposing copays shows that both necessary and unnecessary services and drug use are reduced – that imposing copays on drugs that keep people well and out of the ER and hospital would be counterproductive. DSS argued that copays are used routinely in private plans and are necessary to keep the program within budget constraints. Members pointed out that this would be “penny wise and pound foolish” and that many private plans are moving to more sophisticated copay systems of reduced or eliminated costs on maintenance drugs, such as blood pressure regulators or asthma medications, that keep people well and out of more intense treatment.
Ellen Andrews