Medicaid Council update

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Today’s Medicaid Council focused on the SIM planning process working to reform CT’s health system across payers. The project is planning a large public input solicitation over the next few months through the Health Care Cabinet. The project is working to engage consumers and develop a person-centered lens for policymaking. We’ll have more on SIM, opportunities and concerns, in coming blog posts. DSS gave an update on policy changes passed in the legislative session. Concerns centered on the elimination of spend down eligibility for LIA members, linked to the large expansion of Medicaid eligibility for that group as of Jan. 1st, requirements for prescription drug step therapy, and implementation of ER copayments of $7.90 for non-urgent visits. For the latter, hospitals must ensure that the medical problem wasn’t urgent, and that an alternative non-urgent care source was available before charging the copay, and that the hospital must make a referral to an alternative. Concerns were also raised about very high rates of Charter Oak members failing to pay premiums over the last year, approaching 20% of the total population in some months. Charter Oak monthly premiums are not widely different from what many will pay on the exchange. While Charter Oak is going away as the exchange comes online, the experience provides important clues to ensuring the exchange is successful.