Fewer kids losing Medicaid, but those turning 1 or 18 still vulnerable

The number of children and adolescents dropped from the state’s HUSKY health care program fell during a recent two-year period, but those turning 1 and 18 are still especially vulnerable to losing their medical benefits, according to a report released Friday.

The report follows up on earlier findings that thousands of 1-year-olds and 18-year-olds were inadvertently losing Medicaid coverage because of administrative glitches and confusing notices from the state Department of Social Services.

Report author Mary Alice Lee, a senior policy fellow at Connecticut Voices for Children, praised DSS, policymakers, advocates and community organizations for helping to reduce the number of children and teens losing their health-care coverage between 2010 and 2012.

But she noted that more recently, clients and advocates have raised concerns that it’s becoming more difficult for people to stay in HUSKY. DSS has changed its system for handling clients’ paperwork, and advocates say many people who submit the information needed to maintain their coverage are being cut off, even if they still qualify.

Lee said maintaining eligible children’s coverage is critical for quality care. The state is making efforts to improve the care Medicaid patients receive and ensure that doctors participate in the program.

“But the bottom line is if [eligible] kids are not in the program and they go in and out…then they aren’t getting access to all of what we’ve built to serve them,” she said.

The focus on ensuring that kids who qualify remain in Medicaid also reflects a relatively new strategy for keeping down the number of children without health insurance. Research indicates that many children who are uninsured have had Medicaid coverage within the past year.

The HUSKY program is open to all Connecticut children who are in the country legally, although families earning higher incomes must pay for the coverage. It includes Medicaid and the Children’s Health Insurance Program, which covers kids whose parents earn too much to qualify for Medicaid.

Between 2010 and 2012, Lee found, the proportion of children enrolled in HUSKY who lost coverage for at least part of the year dropped from 17.9 percent to 13.5 percent. Although the number of children in HUSKY in 2012 — 285,000 — was 15 percent higher than in 2010, fewer children had a gap or lost their coverage in 2012.

The percentage of 1-year-olds and 18-year-olds losing coverage fell, too, but remained higher than for other groups. In 2012, 22 percent of babies receiving Medicaid when they turned 1 lost coverage for at least part of the year, as did 25 percent of adolescents who turned 18 while in HUSKY.

Families covered by HUSKY must renew their eligibility at least once a year, and Lee wrote that the risk of losing coverage rises during renewal, even for those who remain eligible.

1-year-olds, 18-year-olds still face problems

The elevated coverage loss rates among 1-year-olds and 18-year-olds are related to how DSS categorizes their cases. The department categorizes clients into specific coverage groups for administrative purposes and to meet federal requirements.

Newborns, for example, can be placed in one of several categories, including one just for infants under 1. When an infant in that category turns 1, he or she could still be eligible for Medicaid, but would have to be moved into a separate administrative category, such as one for families.

But Lee and colleague Sharon Langer found that often, babies placed in the newborn-only category were losing coverage. From January 2008 through September 2009, 41.6 percent of the infants in that category lost insurance in the month after turning 1. One problem they identified in 2011 was that DSS sent families of children in the newborn-only category renewal forms that were lengthier than those typically used in HUSKY, and families that didn’t return the forms received termination notices that inaccurately said the child was not the right age to be eligible for the program.

According to Lee’s report Friday, in 2012, 23 percent of babies enrolled in the newborn-only coverage group lost coverage, a significant decrease.

She attributed the drop to efforts within DSS and work by outside organizations to help families renew coverage and spread the word that babies could be at risk for losing HUSKY. One effort involved creating posters for pediatricians’ offices to remind doctors and patients’ parents that coverage must be renewed when babies turn 1.

The problem 18-year-olds face is also related to coverage categories. Lee and Langer reported in 2010 that nearly one in six teens in HUSKY lost coverage after turning 18, a rate nearly eight times higher than for other age groups.

In the coverage category for families, teens are only eligible between ages 18 and 19 if they live at home, attend school fulltime and are expected to graduate before their next birthday. But 18-year-olds who don’t meet that criteria can still be eligible for HUSKY, as long as a DSS worker moves them to a different coverage category.

Lee recommended that legislators consider changing state policy to make all children and adults in HUSKY eligible for 12 months, rather than making those who undergo income or household composition changes during the year renew their eligibility. The state had such a policy for children between 1998 and 2003, when it was eliminated as part of budget cuts. She noted that 23 other states provide 12 months of continuous eligibility for children in Medicaid and CHIP, and that the federal government has urged state Medicaid directors to continue adopting the policy.

Kate McEvoy, director of DSS’ division of health services, said the department now has dedicated staff in its regional offices and central office charged with monitoring continuity of coverage for 1-year-olds and 18-year-olds. In addition, she said, families who must renew coverage for their children because of a birthday now receive prefilled renewal forms, rather than the longer, blank forms they used to get. The department is also implementing a system of robocalls to families before their children’s eligibility must be renewed.

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