Department of Social Services / State of Connecticut
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Department of Social Services / State of Connecticut

About one in four low-income parents who lost Medicaid coverage in September signed up for a private health plan through the state’s health insurance exchange before the deadline last week – a total of 166 people.

Officials had hoped to boost the number who signed up in the final weeks before the deadline, but just 26 people signed up between early September and the end of the month.

About 695 parents lost Medicaid coverage Sept. 1, the first in a two-part cut that is expected to cause another 18,550 parents to lose access to the program next summer.

Proponents of the cut, including Gov. Dannel P. Malloy’s administration, have pointed out that parents could instead qualify for deeply discounted health insurance through the exchange, Access Health CT. But critics warned that many would likely opt against buying insurance and end up uninsured.

The cut was forecast to save $2.4 million this fiscal year and $43.5 million next year.

The number of people cut from the program in September was smaller than the 1,200 initially anticipated because approximately 505 parents were found to still be eligible for Medicaid, according to the state Department of Social Services. Pregnant women are not subject to the cut, and some families have lower incomes than they previously reported. Others qualified for a separate portion of the Medicaid program – known in Connecticut as HUSKY – that covers people with disabilities.

Of the remaining 695 or so whose HUSKY coverage was terminated, 166 signed up for coverage through the exchange. It’s not clear how many of the others have other coverage or are now uninsured.

The cut – which affects parents of minor children whose income is above 155 percent of the poverty level, the equivalent of $37,587 for a family of four – is taking part in two stages because federal law allows people with wages from a job or other earned income to receive 12 months of additional coverage. The 1,200 slated to be cut off in September did not have earned income.

Officials have said they would draw lessons from the first, smaller rounds to apply next year. So what lessons have they learned?

DSS spokesman David Dearborn said it’s still early to assess the experience, but said the department is likely to look at the notices DSS and Access Health sent to affected clients, “to make sure they’re as clear and as timely as possible.”

“This is more difficult than it may appear,” he said, noting that it requires ensuring the notices meet legal standards while explaining complex topics in plain language.

Access Health CEO Jim Wadleigh said it appears that those in the affected group require a lot of “handholding” to enroll.

Wadleigh said the exchange invested $5,000 to $8,000 in outreach, most of which was spent on staffing for the call center to reach out to 1,200 potential enrollees, making multiple calls in many cases.

At that rate, it would cost close to $125,000 to try to reach more than 18,000 people next summer, he said. “It’s a big expense that no one planned for,” Wadleigh said.

Instead of using the same process for a larger group, Wadleigh said, the exchange will likely “go back to the drawing board” to see what can be done to reach people.

“Is 166 people successful? I guess if you got one it’s successful because that’s one more family that’s covered, but there’s a lot of work that’s gone into that,” Wadleigh said. “Maybe it’s a telling sign of just how difficult we’ve been saying it is going to be to reach the remaining uninsured in the state of Connecticut, and you’re kind of seeing that with this group of customers as well.”

Sharon Langer, advocacy director for Connecticut Voices for Children, who has long warned that lowering HUSKY eligibility for parents could lead many to become uninsured, said that when trying to persuade people to sign up for coverage, it’s more effective to reach out to them in person, rather than making robocalls. If local organizations like community health centers could find out which people they work with are going to be affected by a cut, they could reach out to them, Langer said.

“To the extent that you can communicate messages simply and through people that folks on Medicaid or on the Children’s Health Insurance Program trust, that is the best way of doing outreach and connecting people to coverage,” Langer said.

Langer said DSS deserves credit for ensuring that people who still qualified for Medicaid remain covered, but said it will be important going forward to ensure that pregnant women – who, if they are over the new income limit, could lose coverage 60 days after giving birth – are given other options for coverage.

“It’s not a good sign,” Langer said of the rate of people losing coverage who signed up for private insurance.

Some advocates have indicated that they hope lawmakers will consider reversing the cut during next year’s legislative session, before the larger group loses coverage.

But Sen. Beth Bye, co-chair of the legislature’s Appropriations Committee, said she doesn’t favor reversing the change.

“We need time to see how this goes,” she said. “I think it’s sort of a change of mindset for some people that’s just going to take a little time.”

Bye, D-West Hartford, said the outreach to those losing coverage needs to improve.

“The exchange gets all these kudos for being very successful,” she said. “We have to look at how did they do outreach? We know who these people are, so we should be able to target them.”

Wadleigh said last month that many likely had not signed up because they found the available options too costly.

Advocates have also raised concerns about people who would have qualified for HUSKY under the old income limits, but were not signed up and would no longer qualify under the new rules. While people who qualify for Medicaid can sign up at any point during the year, people can only sign up for private insurance during a specific window. Some advocates pushed for there to be a special private insurance enrollment period for uninsured people whose income would have qualified them for Medicaid in the past but wouldn’t after the cut took effect, but that did not happen.

One of those pushing for it, Jane McNichol, executive director of the Legal Assistance Resource Center of Connecticut, said it likely would not have affected many people, but could affect people who opted against signing up for Medicaid because they were healthy, then need care and learn they can’t get coverage until January.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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