Medicaid Managed Care Council update

According to DSS at today’s Medicaid Managed Care Council, the number of dental providers participating in the CT Dental Partnership grew by 20.8% from December to June. There are now 924 dental providers at 541 locations across the state caring for HUSKY and SAGA consumers.

DSS also reported that there were only 366 HUSKY appeals filed in 2007 and even fewer, only 174, in 2008. It is not clear that consumers know that they have the right or know how to appeal treatment denials.

SAGA medical expenses per member per month declined by 0.6% in the fiscal year that ended June 30th after rising 7% in 2008 and 8.2% in 2007, probably because spending in the program is capped and enrollment grew by 12% this year. The average per member per month cost in the program is $424.47. Pharmacy costs decreased by 6.5% because, after carving out pharmacy benefits, drug company rebates rose significantly. Other states have also increased rebate recoveries after carving out pharmacy benefits. The SAGA provider panel has increased by 181 providers this year and utilization of physician services is up 33% from last year. The increase in primary care access may be the reason that ED visits are down by 7% in the program.

Charter Oak enrollment is up to 8,979 as of July 1st, however 824 people stopped paying their premiums in June and dropped out of the program.
Ellen Andrews