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The CT Health Insurance Exchange staff’s presentation to the Medicaid Council Friday described the “opportunity” under the Affordable Care Act for significant state savings by shifting HUSKY parents into the exchange. They described subsidized premiums ($45 to $243/month), some caps on out of pocket costs, and a list of covered services. However, with questioning from legislators, providers and advocates, the rest of the story emerged. Now those low-income, working HUSKY families (this year $31,809 to $42,643 for a family of four) pay no premiums and benefit from a comprehensive benefit package covering important services that the exchange does not cover or charges more for. A legislator confirmed that the ACA does not require the state to cut HUSKY parents off the program and that the state always had that “opportunity”. It was also noted by a questioner that, many low-income working families are just getting by on what they make and paying even subsidized premiums is not realistic; their alternative, if HUSKY is cut, is to pay a $95 tax penalty the next April that will be very difficult to implement in any case. So for policymakers the “opportunity” is to cut people off HUSKY, save the state some funds, but force tens of thousands of CT working parents into paying much higher costs or into uninsurance.

Luckily there is another ACA option – the Basic Health Plan — that saves the state millions and gives those families, and thousands more, comprehensive coverage with little or no cost. Several economists have crunched the numbers and found that available federal subsidies would more than cover the costs of care for the population with funds left over to raise provider rates. When asked about the BHP option they had not included in their presentation, exchange staff answered that the feds have not yet released regulations on the option and that they have heard that some other states are not planning to use the option.

In other news, we learned that some primary care Medicaid providers who do not work under the direct supervision of a physician may not qualify for the ACA increase in rates to Medicare levels, to become effective Jan. 1, 2013. We were also given information on January 1st increases in Charter Oak and unsubsidized HUSKY B premiums. Charter Oak rates are increasing 32% for all — to $589/month for people who enrolled after June 2010. HUSKY B rates are increasing 16% from $270.36 to $314/month for families who do not receive subsidies (over 300% FPL). We will receive new enrollment numbers next month to know how many people these rates affect.

We also heard from Commissioner Bremby about strong measures his office has taken about problems in processing applications and voter registrations at the Hartford DSS office. He described plans to upgrade enrollment and other systems as well as enhanced monitoring that will help ensure this never happens again.