Medicaid update – plans to “transition” 17,688 HUSKY parents off the program, serious SIM/CCIP problems jeopardize Medicaid redesign

Print Friendly, PDF & Email
Friday’s Medicaid Council meeting focused on implementation of last year’sbudget provision that will end coverage for 17,688 HUSKY parents on July 31stof this year. DSS reported on efforts to assure that people still eligible for Medicaid in other categories do not lose coverage. Of the 1,215 parents who lost coverage last year due to the cuts, almost half (47%) were able to continue coverage in Medicaid. Only one in seven (14%) was able to afford and purchased coverage through AccessHealthCT, CT’s health insurance exchange. 52 parents selected an AccessHealthCT plan but cancelled or disenrolled, likely due to cost. Council members voiced deep concerns about ineffective notices, and children losing coverage when their parents do. Many children lost coverage in 2003 when the state last cut coverage for HUSKY parents even though children’s eligibility levels did not change. Council members offered to help get out the message that even if parents lose coverage, children should stay on the program. The Council asked DSS and AccessHealthCT to come back with a plan for outreach and assistance for members losing coverage.

Members of the Care Management Committee reported on MQISSP progress — the “mighty undertaking” to redesign Medicaid to incorporate integrated care networks and the potential for shared savings back to those networks. The committee has been working very hard and very collaboratively to ensure the program is feasible, but also protects both members and taxpayers. To have an RFP released this summer, we must finish our work in just a few weeks. However, two weeks ago a SIM committee dropped a 66-page set of standards for Community and Clinical Integration Standards for the Medicaid provider networks, with little opportunity for input. Beyond process concerns and questions about the evidence-base for the standards and priorities, concerns were raised that the standards are both extremely prescriptive and extremely vague in different places. The standards duplicate many successful programs and collaborations already in place, would place a large burden on overwhelmed primary care providers, places a large and ill-defined liability on networks, and would be controlled by SIM which is not subject to the State Code of Ethics nor does the agency focus on the unique features of the Medicaid program. In our hastily-scheduled Care Management Committee meetings to address the issue, members did not have time to fully outline all our concerns.  There is no funding source for networks even willing to take on this massive mandate. Advocates have urged policymakers to either delay implementation of CCIP standards until they can succeed, until other SIM payers require them in their network contracts, delay the RFP entirely, or make the CCIP standards optional for networks, as is the case for successful programs in other states.