Study says teens wrongly denied state health coverage

Nearly one in six teens covered by the state’s HUSKY insurance program loses coverage after turning 18, even though the program covers young people until age 19.

The rate of disenrollment for 18-year-olds is nearly eight times higher than it is for other age groups, and a can lead teens to go without health care coverage or pay for another plan even though they could be covered by HUSKY at no cost, according to an analysis by researchers at Connecticut Voices for Children.

“This is in our minds pretty good evidence of a problem in the program,” Mary Alice Lee, senior policy fellow at Connecticut Voices for Children, said during a presentation to the Medicaid Care Management Oversight Council Friday.

In some cases, Department of Social Services workers told 18-year-olds they were no longer eligible for HUSKY because they were in college, which is not true, Lee said. One woman whose daughter has HIV and lost coverage when she turned 18 spent months paying out of pocket for antiretroviral drugs even though the girl was eligible for HUSKY.

Department of Social Services officials are looking at adjustments that can be made, said Mark Schaefer, the department’s director of medical care administration.

“Although the great majority of kids who turn 18 are continued in coverage, we’re very concerned about the number of situations where the coverage is not continued,” Schaefer said.

Eighteen-year-olds who meet the requirements for HUSKY – based on residency, income and citizenship – are eligible to be covered under the Medicaid program until they turn 19.

But maintaining their coverage can be complicated because the department assigns children and parents covered by HUSKY into multiple aid categories, which Schaefer said is necessary for the federal government to know who receives coverage.

Teens in the family coverage category are only eligible after age 18 if they live at home, attend school fulltime and are expected to graduate before turning 19. Other 18-year-olds are who don’t meet those requirements can still be eligible for HUSKY coverage in a separate category, but making the switch requires action by a DSS worker.

When children who receive family coverage turn 18, their parents receive a notice from the department that the child is no longer eligible for cash assistance. Soon after, they get a letter of disenrollment from the managed care company that administers the family’s plan, Lee said.

“There is something that goes out to the parent notifying them of this transition but there’s also information that the caseworker has which notifies them that they need to make this transition within 30 days,” Schaefer said. “That’s something that I think we need to do more effectively.”

He added that he expects the department can improve the reassignment process to keep 18-year-olds covered.

The Connecticut Voices for Children analysis, based on data from 2006 and 2007, found that 15.9 percent of teens enrolled in HUSKY on their 18^th birthdays were no longer enrolled the following month. By contrast, only 2.1 percent of children enrolled on their 10^th birthday lost coverage by the following month. For 15 year olds, the rate was 2.2 percent.

Lee said the data likely understates the problem because it does not identify teens who lost coverage but later had it reinstated.

The issue only affects teens in the HUSKY A Medicaid program. It is rooted in a policy that once linked Medicaid eligibility to eligibilty for cash assistance, which can only go to 18 year olds living at home, in school fulltime and expected to graduate by age 19. Eligibility for the two programs were separated as part of welfare reform in 1996.

In her presentation, Lee cited examples based on calls to the HUSKY Infoline.

In one case, the mother of a child with HIV called after her daughter lost HUSKY coverage when she turned 18 months earlier. The mother called for help because she could no longer afford to pay out-of-pocket for the girl’s antiretroviral drugs.

“This girl is eligible for coverage and should have been covered until she’s 19,” Lee said.

A student with a part-time job lost HUSKY coverage after turning 18. Instead of being told he could still be covered by HUSKY, he had referred to the Charter Oak Health Plan, which, unlike HUSKY, charges premiums and does not cover dental care.

And another 18-year-old college student learned she no longer had coverage when she went for a check-up. A department supervisor said she was not eligible because she was in college, which is not true. The girl did not receive the check-up, Lee said.

Lee said the department should, as soon as possible, update the notices it sends to families when their children turn 18.

“There should be some procedure for ensuring that these 18-year-olds stay on pending a review of their school attendance status or whatever it is that makes them qualify,” Lee said.

The department should also hold case workers and supervisors accountable for 18 year olds who lose HUSKY enrollment, she said.

Lee and Sharon Langer, a senior policy fellow at Connecticut Voices for Children who also worked on the analysis, have discussed the issue with community-based providers and outreach workers, which Lee said she hopes will make a difference.

The findings come as federal health officials urge states to cover more young people who are eligible for Medicaid but not enrolled. A recent study found that 85.2 percent of eligible children participate in Medicaid and the Children’s Health Insurance Program, higher than the national average of 81.8 percent. Research has suggested that many of the eligible uninsured children were once covered by public insurance programs but lost coverage.