CT is Bringing Health Insurance to More Children and Families

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Information about CT is Bringing Health Insurance to More Children and Families

Published on October 19, 2007

Author: nashp

Source: slideshare.net

Description

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Kristin Dowty

CT is bringing health insurance to more children and families “ My goal is to make sure that every adult and child in Connecticut has access to health insurance.” - Governor M. Jodi Rell (12/26/06)

HUSKY – 10 years strong October 1997 - historic legislation signed HUSKY into law with the support of every member of the General Assembly 2007 – Continued commitment Encourage renewal of existing families Reach out to new families who are eligible Expand programs to cover more individuals and families

October 1997 - historic legislation signed HUSKY into law with the support of every member of the General Assembly

2007 – Continued commitment

Encourage renewal of existing families

Reach out to new families who are eligible

Expand programs to cover more individuals and families

CT’s health care picture today Approximately 222,000 residents have no health insurance. [OHCA data, 2006] Although CT has large populations covered by public assistance programs, many are too old for HUSKY, too young for Medicare, and not eligible for Medicaid or SAGA. HUSKY A & B - 310,000 Medicaid FFS – 88,600 Medicare – 600,000 SAGA – 32,300

Approximately 222,000 residents have no health insurance. [OHCA data, 2006]

Although CT has large populations covered by public assistance programs, many are too old for HUSKY, too young for Medicare, and not eligible for Medicaid or SAGA.

HUSKY A & B - 310,000

Medicaid FFS – 88,600

Medicare – 600,000

SAGA – 32,300

Changes in the health insurance environment CT Changes between 2004 – 2006 Employment based coverage increased from 64% to 66.5% Public coverage declined from 26.2% to 23.3% Number of uninsured grew slightly from 5.8% to 6.4%

CT Changes between 2004 – 2006

Employment based coverage increased from 64% to 66.5%

Public coverage declined from 26.2% to 23.3%

Number of uninsured grew slightly from 5.8% to 6.4%

Connecticut’s uninsured 66% of uninsured families have incomes under 300% of the FPL 53% of the uninsured are under age 40 55% of the uninsured are minorities with Hispanics comprising 34% 66% of the uninsured are single or living with a partner

66% of uninsured families have incomes under 300% of the FPL

53% of the uninsured are under age 40

55% of the uninsured are minorities with Hispanics comprising 34%

66% of the uninsured are single or living with a partner

Connecticut’s uninsured 61% of the uninsured are working adults 49% of the uninsured work for employers with less than 25 employees 57% of “Mom & Pop” employers (<10 employees) do not offer insurance 25% of the uninsured may meet the current Medicaid, HUSKY or Medicare eligibility requirements

61% of the uninsured are working adults

49% of the uninsured work for employers with less than 25 employees

57% of “Mom & Pop” employers (<10 employees) do not offer insurance

25% of the uninsured may meet the current Medicaid, HUSKY or Medicare eligibility requirements

HUSKY A – Medicaid managed care Children to 185% FPL Parents/Caretakers to 185% FPL 19 & 20 year olds up to MNIL Pregnant Women to 185% FPL (soon to be 250% FPL) 1 year TMA Rich benefit package No cost to clients Children up to age 19 Enrollment as of 9/07- 209,544 children & 93,523 adults

Children to 185% FPL

Parents/Caretakers to 185% FPL

19 & 20 year olds up to MNIL

Pregnant Women to 185% FPL (soon to be 250% FPL)

1 year TMA

Rich benefit package

No cost to clients

Children up to age 19

Enrollment as of 9/07- 209,544 children & 93,523 adults

HUSKY B – SCHIP managed care All children covered regardless of income 186% - 235% FPL, small co-pays, no premiums 236% - 300% FPL, small co-pays, $30/$50 monthly premium 300% FPL, small co-pays, full premium to $222 monthly Children up to age 19 Comprehensive benefit package modeled after State employees benefit package Enrollment as of 9/07 – 16,865 children

All children covered regardless of income

186% - 235% FPL, small co-pays, no premiums

236% - 300% FPL, small co-pays, $30/$50 monthly premium

300% FPL, small co-pays, full premium to $222 monthly

Children up to age 19

Comprehensive benefit package modeled after State employees benefit package

Enrollment as of 9/07 – 16,865 children

New initiatives to enroll children HUSKY Health 2007 Initiatives Local and statewide HUSKY outreach Enrollment and retention of school-age children Coverage for uninsured newborns

HUSKY Health 2007 Initiatives

Local and statewide HUSKY outreach

Enrollment and retention of school-age children

Coverage for uninsured newborns

Local and Statewide HUSKY Outreach $1.1 million grants for outreach contracts Community-based outreach (5) Regional outreach (2) Statewide outreach (1) Statutorily defined “Priority School Districts” (15) State Department of Education’s 6 Regional Educational Service Centers

$1.1 million grants for outreach contracts

Community-based outreach (5)

Regional outreach (2)

Statewide outreach (1)

Statutorily defined “Priority School Districts” (15)

State Department of Education’s 6 Regional Educational Service Centers

Local and Statewide HUSKY Outreach Outreach strategies for enrollment and retention Door to door; person to person Telephone contact with follow-up Local media - radio, TV, newspapers, posters, web-sites Seminars/presentations, multi-lingual Employers with low-wage workers, health clinics, community centers, faith-based organizations, job centers, town social service offices

Outreach strategies for enrollment and retention

Door to door; person to person

Telephone contact with follow-up

Local media - radio, TV, newspapers, posters, web-sites

Seminars/presentations, multi-lingual

Employers with low-wage workers, health clinics, community centers, faith-based organizations, job centers, town social service offices

Enrollment & retention of school-age children Priority School Districts Collect & track student insurance information Provide HUSKY information and application assistance to families of uninsured students Follow-up with families SDE’s Regional Educational Service Centers Implement training program to provide education on the HUSKY program to school professionals including social workers, nurses, counselors and teachers

Priority School Districts

Collect & track student insurance information

Provide HUSKY information and application assistance to families of uninsured students

Follow-up with families

SDE’s Regional Educational Service Centers

Implement training program to provide education on the HUSKY program to school professionals including social workers, nurses, counselors and teachers

HUSKY Outreach Evaluation Process Measures, self-reported by contractors: # of presentations and materials distributed # of families and children reached # of application and renewal assistance # of unsuccessful efforts and reasons why (e.g. undocumented)

Process Measures, self-reported by contractors:

# of presentations and materials distributed

# of families and children reached

# of application and renewal assistance

# of unsuccessful efforts and reasons why (e.g. undocumented)

HUSKY Outreach Outcome Measures Applications & Renewals – tracked by ACS and DSS # of submitted applications # of successful applications Increase in % of returned renewals Increase in % of successful renewals Increase in overall enrollment Anecdotal/Qualitative Feedback from Consumers

Applications & Renewals – tracked by ACS and DSS

# of submitted applications

# of successful applications

Increase in % of returned renewals

Increase in % of successful renewals

Increase in overall enrollment

Anecdotal/Qualitative

Feedback from Consumers

Covering uninsured newborns Cover all uninsured newborns born in CT hospitals or participating border hospitals Partner with CT & border hospitals for notification Expedite eligibility determination of all uninsured newborns DSS will pay the first 4 month’s premium, if required

Cover all uninsured newborns born in CT hospitals or participating border hospitals

Partner with CT & border hospitals for notification

Expedite eligibility determination of all uninsured newborns

DSS will pay the first 4 month’s premium, if required

Other new initiatives Pregnant woman expansion Family planning program Primary Care Case Management Pilot Premium Assistance for ESI Charter Oak Health Plan

Pregnant woman expansion

Family planning program

Primary Care Case Management Pilot

Premium Assistance for ESI

Charter Oak Health Plan

Pregnant woman expansion Cover pregnant women to 250% FPL Full Medicaid benefit package including transportation No out-of-pocket costs Newborns automatically deemed eligible for 1 year

Cover pregnant women to 250% FPL

Full Medicaid benefit package including transportation

No out-of-pocket costs

Newborns automatically deemed eligible for 1 year

Family Planning Program Increase availability of effective contraceptive methods Decrease the number of unintended or mistimed pregnancies Increase the spacing between pregnancies Increase access to primary care

Increase availability of effective contraceptive methods

Decrease the number of unintended or mistimed pregnancies

Increase the spacing between pregnancies

Increase access to primary care

Family Planning Program Family income to 185% FPL, ineligible for Medicaid No asset test Females - ages 14 – 55 Males – ages 14 – 60 US Citizen or qualified immigrant

Family income to 185% FPL, ineligible for Medicaid

No asset test

Females - ages 14 – 55

Males – ages 14 – 60

US Citizen or qualified immigrant

Family Planning Program Family planning services including annual physical exam diagnostic and laboratory testing immunizations treatment of STDs medications required incidental to family planning procedures contraception management including devices, prescription and non-prescription contraceptives tubal ligation and vasectomy

Family planning services

including annual physical exam

diagnostic and laboratory testing

immunizations

treatment of STDs

medications required incidental to family planning procedures

contraception management including devices, prescription and non-prescription contraceptives

tubal ligation and vasectomy

Primary Care Case Management Pilot program May attract more provider participation PCPs work with one entity, rather than 4 MCOs FFS reimbursement plus PMPM fee for care management Integrated disease management program

Pilot program

May attract more provider participation

PCPs work with one entity, rather than 4 MCOs

FFS reimbursement plus PMPM fee for care management

Integrated disease management program

Premium Assistance Program Promotes family coverage Required to enroll self & dependents if insurance is available and meets certain conditions For employed HUSKY A clients DSS accountable for premium contribution, deductibles, co-payments and full Medicaid wrap around coverage

Promotes family coverage

Required to enroll self & dependents if insurance is available and meets certain conditions

For employed HUSKY A clients

DSS accountable for premium contribution, deductibles, co-payments and full Medicaid wrap around coverage

Charter Oak Health Plan – covering uninsured adults Coverage through a private model No asset test No pre-existing conditions No individual or employer mandate Participation is voluntary Payments from members to MCOs Payments from members to MCOs Deductible - $1000 max State investment is premium subsidies on a sliding scale – up to 300% FPL $1 million lifetime benefit max 6 month crowd-out

Coverage through a private model

No asset test

No pre-existing conditions

No individual or employer mandate

Participation is voluntary

Payments from members to MCOs

Payments from members to MCOs

Deductible - $1000 max

State investment is premium subsidies on a sliding scale – up to 300% FPL

$1 million lifetime benefit max

6 month crowd-out

For more information Kristin R. Dowty, HUSKY Program Phone: 860-424-4805 Email: [email_address]

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