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DSS may take advantage of a legislative error and try to implemented premium assistance for HUSKY, according to the department at Friday’s Medicaid Managed Care Council meeting. Two years ago, the agency’s proposal for premium assistance was rejected by legislators in budget negotiations, as it had been for four years in a row. However due to an error, one section of the bill was not deleted and the option passed into law. Thankfully, leadership at the department realized that implementation of premium assistance would be a nightmare for clients and for DSS. But apparently, the department is again considering this imprudent program.

Premium assistance would require HUSKY families with an employer offer of coverage to sign up and drop HUSKY. The idea is to leverage the money employers are spending on benefits to reduce the state’s burden. It sounds fine if that’s as far as you look, but other states have found it to be very difficult to administer and difficult for consumers to navigate. And those are states with efficient and well-performing Medicaid managed care programs, unlike CT which has had trouble running plain old vanilla HUSKY.

To enroll a family in premium assistance, the state would have to certify in every case that the employer’s coverage is a better value than HUSKY – very unlikely as Medicaid rates are lower than most commercial insurance. And as commercial insurance costs have increased far faster than HUSKY, even cases where it is cost effective for the state this year may not be next year. Families would be left searching for new doctors that take the HUSKY HMOs, which is hopeless. HUSKY families unlucky enough to be forced into premium assistance would have to pay out of pocket for deductibles, premiums, copays and for any services or drugs that their employer’s package doesn’t cover but HUSKY does. They would then apply to DSS for reimbursement. This places an enormous hardship on low-income families to up-front potentially thousands of dollars and wait for government to reimburse them. And given how poorly DSS has administered HUSKY so far, consumers could be forgiven for having some reservations about this arrangement.

This only touches on the problems with premium assistance. The few states that have implemented the program are drawing back. Many realized that the extra administrative costs overwhelmed any small savings. Many are finding it more and more difficult to find qualifying employer coverage cases. Overall, premium assistance would require massive resources at DSS when they should be devoting all their time to fixing the program they have.

If they have time on their hands over at DSS, maybe they could step up their ambivalent attempt at implementing PCCM, a program that most other states have easily implemented, saving money, engaging new providers, and improving health outcomes for their states’ Medicaid families.
Ellen Andrews