For Brenda Moore, Kimberly Roberts is more than a personal care aide. She’s a lifeline.
Moore lives with vascular disease, heart problems and arthritis in her hips and knee, making it difficult for her to move around on her own.
Roberts spends 40 hours a week with Moore, arriving at her home in New Haven around 6:30 in the morning to bathe her, dress her and make coffee. She then leaves to drop her own grandson at school and comes back to stay with Moore for the rest of the day. Roberts also handles grocery shopping, cooking, paying bills and caring for Moore’s three dogs — Daisy, Marley and Coco.
“She is one of the best,” said Moore of Roberts, her voice filling with joy. “I can count on her.”
But Connecticut’s income limits for Medicaid will soon put Moore at risk of losing access to the very services that she has come to depend on.
HUSKY C eligibility
The state’s eligibility criteria for HUSKY C, the Medicaid program for people who are over 65, blind or disabled, requires non-working people to remain in poverty and severely limit their savings in order to keep their Medicaid coverage.
To qualify, residents must effectively earn less than $1,182 per month, around 97% of the federal poverty level. Individuals must have less than $1,600 in assets, and couples must have under $2,400.
“No other Medicaid program comes close to having such low income limits. And it is only older and disabled adults who are subject to any asset limitations at all,” wrote Sheldon Toubman, an attorney with Disability Rights CT, in public testimony.
Moore brings in $1,524 per month from social security disability insurance. Even though she said it’s barely enough to cover her expenses, that income puts Moore $324 over the limit for HUSKY C. Soon, that will present a huge hurdle.
Prior to the pandemic, Moore got Medicaid coverage through the state’s HUSKY D program for adults with low incomes. During the pandemic, Moore also became eligible for Medicare. Technically, someone with Medicare cannot qualify for HUSKY D. But pandemic-era policies prevented state governments from kicking people off Medicaid, so Moore has been able stay on HUSKY D (though it did require a federal lawsuit to keep her coverage).
On March 31, those pandemic-era rules came to an end, kicking off a year-long process called “unwinding,” where many people with Medicaid will have their eligibility reassessed for the first time since the start of the public health emergency in March 2020. When Moore goes through this process, she will lose her HUSKY D coverage.
But people with Medicare can qualify for HUSKY C. Ideally, Moore would be able to shift from HUSKY D to HUSKY C and stay on Medicaid. But her SSDI income of $1,524 per month — above the $1,182 limit for HUSKY C — disqualifies her, meaning she will lose her Medicaid coverage entirely.
For many, Medicaid is critical. It offers much more expansive coverage than Medicare, covering services — like personal care aides — that allow people to stay in their homes and avoid institutionalization.
“I don’t want to be in a nursing home. I want to be in my bed,” said Moore, who enjoys watching music competition shows and sitcoms from the ’70s. “Without HUSKY C, not only me, but people who are worse off than me, we can’t do it.”
“She’s in serious danger,” said Toubman, who serves as Moore’s attorney. “If we don’t change the law in Connecticut to increase the income limit to an amount over her income, she is going to lose her benefits. That is clear.”
Two potential solutions
This session, the human services committee passed two different proposals to increase both the income and asset limits for HUSKY C.
The first, included as part of House Bill 5001, proposes raising the income limit from $1,182 to a fixed rate of $1,465 per month and the asset limits to $3,600 for a single person and $5,400 for a couple.
Several advocates believe this change would provide inadequate relief because it raises the income limit to a fixed amount, the value of which would erode with inflation.
“This would perpetuate the discrimination against people with disabilities and older adults in our Medicaid program and make that discrimination even worse each year,” said Catherine John, lead organizer with Black and Brown United in Action in emailed comments.
The second proposal, House Bill 6630, seeks to bring the HUSKY C income limit up to the same level as the HUSKY D income limit, which is set at 138% of the Federal Poverty Level, currently $1,677 a month. The bill would also bring the asset limits up to $10,000 for an individual and $15,000 for a couple.
Moore would qualify for HUSKY C under House Bill 6630 but not under House Bill 5001.
Sen. Matt Lesser, D-Middletown, a member of the human services subcommittee of appropriations, said that legislators still haven’t made a decision about which version to include in their budget proposal because they’re still figuring out how much each would cost.
“I think it’s important. I just don’t have any idea about the fiscal impact,” said Sen. Lesser, adding that he’s working with the “best policy minds” he can find to try and come up with a reasonable estimate.
In written testimony, Andrea Barton Reeves, the commissioner for the Department of Social Services, opposed the expansion, saying that it would require a “significant amount of funding that is not contemplated in the Governor’s budget.”
“In addition to the substantial increase in program costs that would be required, the Department would also be required to hire additional staff to support the increased program enrollment that would result from these changes,” wrote Reeves.
A continued push
This marks the second year in a row that the legislature has considered increasing the income and asset limits for HUSKY C.
Last year’s effort passed out of human services as well but ultimately failed to become law. Like House Bill 6630, it proposed raising the income limit to 138% of the poverty level but only proposed raising the asset limits to $5,000 for an individual and $7,500 for a couple.
An estimate from the Office of Fiscal Analysis concluded that the proposal — which also included raising the income and asset limits for Med-Connect, the Medicaid program for working people with disabilities — would cost the state $1.1 billion a year.
Lesser said he doubts this year’s proposals would cost as much as the “jaw-dropping” $1.1 billion estimated in last year’s fiscal note.
Toubman did a cost analysis of his own using estimates that California put together when it considered nearly identical expansions to its Medicaid equivalent of HUSKY C. Adjusting the costs for the size of Connecticut’s population, Toubman concluded that bringing the income limit up to 138% of the FPL and the asset limit up to $10,000 for an individual would cost the state $21.8 million annually.
Toubman’s analysis only included the cost of raising the limits for non-working people on HUSKY C, while the fiscal note from last year’s proposal also included raising the limits for working people with disabilities on Med-Connect.
‘Can you imagine?’
People like Moore, who otherwise qualify for HUSKY C but have incomes slightly above the limit, can go on what’s called a “spend-down.”
For the spend-down period, incurred medical expenses qualify as income deductions. Those expenses get subtracted from a person’s “excess income” until they’ve spent enough to bring them under the income limit. But residents don’t have Medicaid coverage while they are on a spend-down.
According to a notice Moore received from the state, to qualify for HUSKY C, she would have to spend roughly $2,000 over six months, or about 11% of $18,300 she earns every year from SSDI.
Though Moore wouldn’t automatically qualify for HUSKY C under the proposal to raise the income limit to $1,465 instead of $1,677, it would considerably decrease the amount she’d have to spend-down to around $350 over six months.
Moore has had her Medicaid coverage terminated in the past such that she had to go about five weeks without a personal care aide. Her mobility issues prevented her from cooking for herself, so she ate mostly canned food that she could easily pop open. She fell several times, including once in the shower.
But Moore desperately wants to avoid a nursing home, so she said she’ll try to get by without Roberts at her side.
“It’s going to be very hard. Eating cold, canned food. Can you imagine? But I have to make it work,” said Moore.