CT Medicaid Home & Community Services spending up, but that’s what we want
Recently, Connecticut Medicaid per member costs have grown significantly while enrollment is easing, according to the latest state financial report.
Since switching from managed care organizations in 2012 to focus on care management, Connecticut Medicaid spending had stabilized while enrollment expanded significantly. With COVID, enrollment grew and per member costs dropped.
Post-COVID enrollment has dropped and per member costs have increased.
Rising pharmacy and home & community based services are driving up per member costs. Pharmacy accounts for 74% of rising costs driven by reduced rebates and expensive new drugs.
Long term services and supports (LTSS) care account for 23% of rising costs. This was intentional. Long-standing policies in Connecticut Medicaid and at CMS support fragile members remaining at home if possible and if they wish. Rebalancing of institutional care with home & community based care has led to an increase in home-based care spending. However, costs for home & community care in Connecticut are rising at just half the national rate. Community First Choice program costs areexpanding the fastest among LTSS services.
Connecticut Medicaid is very efficient. Administrative burden in the program is four-fold lower than Connecticut commercial large group plans. This is likely because, unlike most states, Connecticut Medicaid no longer uses private, for-profit insurers to run our program.
Connecticut also spends less of our state budget on Medicaid than most states. That lower spending frees up $2.8 billion in the state budget for other Connecticut priorities.