In a major win for advocates, the legislature this session passed Medicaid reimbursement for hiring community health workers. But funding for other notable proposals — including easing of eligibility criteria for HUSKY C, increasing reimbursement for specialists and expanding eligibility to HUSKY for immigrants — fell far short of supporters’ demands.
Medicaid, known as HUSKY in Connecticut, provides health coverage to people with incomes below certain thresholds. Over a quarter of Connecticut residents currently receive coverage through Medicaid.
During the legislative session that ended last week, the Connecticut General Assembly proposed several changes to the state’s Medicaid program. Here’s an overview of what those proposals were and where they ended up.
Community health workers
The legislature passed a bill that taps the Department of Social Services to design and implement Medicaid reimbursement for the roles of community health workers.
Community health workers, also known as outreach workers, health coaches, patient navigators and promotores de salud, help people navigate health care and social services. They have an encyclopedic knowledge of all the resources available to residents in need, and they are experts in navigating the obstacles that can come up when trying to access them.
Currently, the funding for their roles is piecemeal and largely sustained through grants, which can be insufficient and unreliable. Medicaid reimbursement would provide a reliable stream of funding that will enable organizations to hire more community health workers full-time.
“Everyone agreed that we needed to pay for community health workers through Medicaid, the question was how,” said Sen. Matt Lesser, D-Middletown, co-chair of the Human Services Committee. “It was a long time coming.”
Millie Seguinot, executive director of Community Health Workers Association of Connecticut, said the sustainable funding will make a critical difference to the workers and the organizations that employ them.
“This is equity,” said Seguinot. “We talk about equity for patients and for communities, but now we are talking about equity for the workforce.”
The legislation charges DSS with designing and implementing the Medicaid reimbursement policy for community health workers, but does not specify a date by which reimbursement must take effect.
As government officials think about how to design and implement the policy, Seguinot said it’s important to consider the community health workers who work in non-clinical settings.
“Keep in mind that community health workers are in different settings. They can be at schools, they can be with nonprofit organizations, they can be dealing with housing, transportation, education, seniors, children. We are everywhere,” said Seguinot.
Seguinot acknowledged the work that’s ahead, but said she’s grateful to the allies and champions, including legislators, employers and nonprofit organizations, that made it happen.
“I’m grateful because they believe that the work we’re doing deserves to be recognized. And one way to recognize this is to provide sustainable funding,” she said.
HUSKY C income and asset limits
HUSKY C provides Medicaid to people who aren’t working and are over 65, blind or disabled. The state’s current eligibility criteria for the program requires 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, or FPL. Individuals must have less than $1,600 in assets, and couples must have under $2,400.
The budget earmarks $8.5 million in FY 2025 to increase the income limit for HUSKY C to $1,267 per month, or 105% of FPL. HUSKY C recipients and advocates say that doesn’t go nearly far enough.
“Why not just make it the same as the HUSKY D?” said Jodee MacDonald, a Stamford resident who used to be covered through HUSKY C.
HUSKY D, the program for non-disabled adults under 65, has an income limit of 138% of FPL, currently $1,677 a month, and no asset limit.
MacDonald has polycystic kidney disease and has spent nearly two decades navigating Medicaid to ensure she keeps her coverage. She said the HUSKY C income limits make it nearly impossible to qualify for coverage while still having enough money to eat and pay rent.
Over the last year, she managed to find a job for a few hours a week and qualify for MedConnect, the Medicaid program for people with disabilities who are working, which has much higher income and asset limits than HUSKY C.
The legislature considered two proposals to raise the income and asset limits for HUSKY C. The first proposed an income limit of $1,465 per month and asset limits of $3,600 for a single person and $5,400 for a couple.
The second aimed to bring the HUSKY C income limit up to the same level as the HUSKY D and the asset limits up to $10,000 for an individual and $15,000 for a couple.
Neither proposal made it to the floor for a vote.
“The governor won a lot of support from suburban voters last year and he may be speaking to a different constituency,” said Lesser when asked why the issue has failed to gain enough traction to cause meaningful increases in the eligibility criteria.
“I would love for Ned Lamont to … live on my health care,” said MacDonald. “I want to give him my insurance for a week and I’ll take his.”
Rate increases for specialists
Medicaid “reimbursement rates” establish how much providers get paid to treat patients on Medicaid. In 2007, Connecticut set the Medicaid reimbursement rates for most physician services at 57.5% of the Medicare rate at the time.
The rates have not been broadly adjusted since, though certain providers, including primary care physicians and OBGYNs, have received rate increases.
“It becomes almost impossible for certain specialties to see these patients because it actually costs money for physicians to see these patients,” said David Hass, a gastroenterologist and president of the Connecticut State Medical Society, who said most physicians who treat Medicaid patients see it as a social responsibility, even though it’s not financially sustainable.
The budget authorized $3 million in American Rescue Plan Act funds for a study on Medicaid reimbursement rates. It also provides $7 million to increase the Medicaid rates paid to specialist physicians and $5 million to increase the rates paid to ambulance providers.
The $7 million included in the final budget represents only a quarter of the funding proposed for rate increases earlier in the session.
The Appropriation Committee’s budget proposal had earmarked $9.2 million in fiscal year 2024 and $18.3 million in fiscal year 2025 to fund an increase in Medicaid reimbursement rates to 65% of Medicare rates by January 1, 2024. But, the measure didn’t make it into the final budget.
“It just hasn’t been a priority for some of the decision makers,” said Lesser, who explained that he and others this session focused on making the issue a priority within the rank and file legislators.
“I applaud the legislators for prioritizing it. And I would say, as president of the State Medical Society, [I’m] disappointed that this didn’t seem to be a priority for OPM or for the governor’s office,” said Hass.
During a press conference last week, Office of Policy and Management Secretary Jeff Beckham said that the state plans to address this issue further.
“We’re well aware that the rates need to be updated and we have a plan to do that next year,” said Beckham, explaining that the state was looking to the funded study to provide direction on how to make those increases.
HUSKY C for immigrants
As part of the budget, the legislature passed a pared-back version of a proposal to broaden Medicaid eligibility for Connecticut children without permanent legal status.
Current law allows children 12 and younger to access the benefits. The measure will extend HUSKY coverage to children 15 and younger regardless of their immigration status, so long as their families meet the qualifying income limits for Medicaid.
Children 15 and younger not only are allowed to enroll in the program — they also can keep the coverage through age 19.
The expansion takes effect on July 1, 2024. Some applauded the steady increases to the eligibility age.
“It’s good that they’re increasing the age,” said Olga Gutiérrez, a resident of Bridgeport. “The kids are the first priority.”
Gutiérrez and her family came to the United States from Honduras. They do not have access to insurance coverage because of their immigration status.
But, for others, the progress is too slow.
“While we appreciate that our elected officials have been committed to steady progress, it really is too slow,” said Carolina Bortolleto, a volunteer with the HUSKY for Immigrants Coalition and a co-founder of Connecticut Students for a Dream.
A measure introduced earlier in the session proposed expanding coverage to everyone 25 and younger, regardless of immigration status. The Affordable Care Act allows children and young adults to remain on their parents’ insurance plans through age 26, and the idea was to mirror that policy. The measure did not move forward.