DSS trying to keep 1-year-olds from mistakenly losing health coverage

The state Department of Social Services is revising and shortening the notices sent to families of infants in an effort to keep thousands of children from mistakenly losing Medicaid coverage after their first birthday.

The department is also trying to ensure that workers are alerted when babies are at risk of losing coverage, DSS officials told members of the Medicaid Care Management Oversight Council Friday.

“This has taken on a great sense of urgency,” said Daniel J. Buckson, a DSS public assistance consultant.

The changes come in response to findings that thousands of 1-year-olds are inadvertently removed from the HUSKY health insurance program because of a confusing process that occurs when the department changes the way the infants are categorized.

DSS uses multiple coverage groups to categorize children and adults in HUSKY, the state’s Medicaid-funded health insurance program for low-income children and their parents. The different categories are required by the federal government and used for administrative purposes, but they don’t affect the type of benefits a child or family receives. A person could become ineligible for one coverage group but still be qualified for HUSKY; he or she would just need to be assigned to a different coverage group.

Newborns can be placed in one of several coverage groups, including one just for infants under 1. Federal law entitles all children born to women who qualify for Medicaid to one year of Medicaid coverage, even if the mother loses eligibility, and placing a child in the newborn-only category ensures that he or she won’t lose coverage before turning 1.

But Connecticut Voices for Children Senior Policy Fellows Mary Alice Lee and Sharon Langer found that infants placed in that category are more vulnerable to losing coverage when they turn 1 and become too old for the newborn coverage group. From January 2008 through September 2009, they found, 5,621 infants in the newborn category lost health insurance in the month after their first birthdays–41.6 percent of the children in that coverage group. By contrast, only 5.8 percent of 1-year-olds in the other coverage groups were not covered in the month after turning 1.

Lee and Langer found problems in moving infants from the newborn-only coverage group to other groups.

Before infants in the program turn 1, their families are sent coverage renewal forms. But the form sent for a child in the newborn group is a blank eight-page form used to apply for Medicaid and other public assistance programs, and asks for information not typically required in a HUSKY application. In addition, caseworkers sometimes ask for documentation that is not required for HUSKY, Lee and Langer’s report said.

By contrast, renewal forms for other children in HUSKY are four pages and come with the family’s information filled in.

If the renewal form is not returned, the family is sent a notice that the coverage is being discontinued because “YOU ARE NOT THE RIGHT AGE TO BE ELIGIBLE FOR THIS PROGRAM.” That’s not true; all children under 19 are potentially eligible for HUSKY. The question is whether the infant’s family still qualifies for the program, and whether DSS assigns the 1-year-old to another coverage group.

Families then receive another notice telling them that the baby has been disenrolled from managed care.

In some cases, Lee and Langer found, infants lost health insurance even though their families were still covered, and parents only learned of it when they went to the pediatrician or tried to fill a prescription.

To address the problem, DSS officials said, they are revising the notices and changing the incorrect language about not being the right age to be eligible.

Instead of the eight-page general application form, DSS will send families the four-page HUSKY renewal form. The department is looking into whether the form can be pre-filled with the family’s information.

Some 1-year-olds could be moved into other coverage groups, and kept in HUSKY, even if their parents or guardians don’t send back the renewal forms. If a baby has siblings in HUSKY, the family would have already been deemed eligible, and DSS could use the information from the siblings’ files to maintain the 1-year-old’s coverage.

DSS has started to determine which 1-year-olds have siblings in HUSKY and is working on a way to make sure that workers know which infants could be moved to other coverage groups whether or not their parents or guardians return the renewal form.

The department is testing a new alert that would notify workers when an infant in the newborn category is about to turn 1. Workers already get alerts about cases up for renewal, but they don’t specify what type of coverage it involves. The new alerts would let workers know the case involves an infant about to age out of the newborn category, and would allow staff to more easily track and monitor newborn cases.

It’s important that the alerts identify the right cases, Buckson said, and don’t get buried among the other alerts that workers receive.

The department is also doing refresher training for staff and community groups, and has reminded DSS workers that some information families reported being asked for is not required to keep the 1-year-olds covered.

Lee asked how soon the department will begin using the new notices.

Deputy Commissioner Claudette Beaulieu said she hopes to see the changes in place in the next 90 days. “This is very high on the priority list,” she said.

“We’re under the gun,” Buckson said. “We’re doing the best we can.”