The legislature passed a two year budget last week for the state fiscal years (FY) 2014 and 2015. Below are a few highlights concerning the HUSKY program. Fortunately, parents will retain their coverage in the HUSKY program. For more information, check out the synopsis by the legislature's Office of Fiscal Analysis about legislation that implements many of the budgetary changes.
- Parents of HUSKY A children will remain eligible for HUSKY coverage with family income up to 185% of the federal poverty level (FPL) (e.g., $36,130 annually for a family of three). The Governor had proposed ending eligibility for parents above 133% of the federal poverty level with the expectation that they would be able to purchase private coverage through the new health insurance exchange (Access Health CT) starting in 2014. Given the costs of premiums in the health insurance exchange, it is likely that thousands of currently insured parents in HUSKY would have become uninsured because they could not afford the private coverage.
- Individuals with incomes up to 133% of the FPL ($15,282 annually for an individual) will be eligible for Medicaid, beginning January 1, 2014. The new budget eliminates the Medicaid program for low-income adults (LIA) that currently covers adults up to 56% FPL, as of January 1, 2014, and merges these individuals into a new "Medicaid Coverage for the Lowest Income Populations" (MCLIP) program as authorized by the federal Affordable Care Act, effective January 1, 2014.
- Certain adults on Medicaid (HUSKY A, C and D) will be charged co-payments for nonemergency use of hospital emergency rooms. The extent to which such co-pays may be imposed is limited by federal Medicaid law. Lawmakers expect to save $700,000 in each of the two years of the budget. The savings may be far greater, according to the legislature's Office of Fiscal Analysis, if individuals are diverted from the emergency rooms and receive care in a less costly setting, such as a doctor's office.
- The Department of Social Services (DSS) is authorized to establish a "step therapy" program for prescription drugs available through Medicaid. The program may require patients to try a drug on the DSS preferred drug list before DSS will authorize payment for alternative (and presumably more expensive) drugs. The program will not apply to mental health-related drugs. Lawmakers expect to save $11.8 million in FY 2014, and $15.8 million in FY 2015) .
- As required by the federal Affordable Care Act, primary care physician rates will increase. The full cost of the increase is borne by the federal government. The increase is $107.2 million in SFY 2014 and $47.6 million in FY 2015.
- The budget continues funding for HUSKY Performance Monitoring ($208,050 for each year). The Governor had proposed eliminating the funding. This funding is a grant from the Department of Social Services to the Hartford Foundation for Public Giving, which in turn re-grants the funding to CT Voices for Children for the monitoring work. This monitoring helps to assess how well the program serves children and families and how it can be improved.
- The budget continues funding for Healthy Start, which assists low-income women in obtaining health coverage and prenatal care. The Governor had proposed eliminating the program. It will receive funding of $1.4 million in each budget year.
- HUSKY Infoline, a project of United Way/2-1-1, receives funding of $159,000 in FY 2014 and no funding in FY 2015. The Governor had proposed eliminating all the funding for both years. HUSKY Infoline is a longstanding project that provides one-to-one assistance regarding coverage and access to care issues for HUSKY members. It is unclear to what extent this service will be provided by other entities, such as the health insurance exchange.
- The budget and authorizing legislation makes a number of changes to the CT Behavioral Health Partnership (BHP) and its oversight council, including requiring the council to find $1 million in savings in collaboration with its agency partners – the Departments of Social Service, Children and Families and Mental Health and Addiction Services. In addition, the BHP must use the statutory definition of "medical necessity" when authorizing or denying authorization for behavioral health or substance abuse services.
- Hospitals will receive decreased funding due in part to lawmakers' expectations that more individuals will be covered under private or public insurance in 2014 once the insurance mandate under the Affordable Care Act kicks in, and more individuals sign up for coverage through the exchange, Medicaid or at their workplace. Historically, hospitals were reimbursed by the government for serving the uninsured or underinsured through "disproportionate share hospital" payments. These and other reductions to hospitals amount to cuts of $194.7 million in FY 14, and $328.9 million in FY 15. There is, however, $15 million budgeted insupplemental Medicaid payments for certain "low-cost hospitals" in each of year of the budget.
- Savings of $80 million in FY 14 and $100 million in FY 15 through increased fraud prevention and detection in the Medicaid program.
- The Charter Oak Health Plan is eliminated as of January 1, 2014 with the expectation that those currently covered under the state funded program will gain coverage through Medicaid or the plans offered on the exchange. There are about 4,000 individuals currently enrolled in Charter Oak.