[Connecticut] Fewer people on state health care despite rising poverty

from The Journal Inquirer

By:Keith M. Phaneuf, Journal Inquirer

State officials have tried several approaches in recent years to control the cost of the Connecticut's health insurance program for poor families.

There have been monthly premium hikes, new co-payments, changes in eligibility rules, cutbacks in outreach spending, a complex application process, and even legislation to block prescription requests from those who fail to pay.

Even though some of these measures later were rescinded as families pulled their children from the "Husky" health insurance program in the thousands, private advocates say the damage has been done.

Though a federal welfare law change appears responsible for some of the shift, other needy families who left Husky because they couldn't afford it simply never came back, advocates say.

Despite recent census data showing the number of uninsured Connecticut residents is on the rise, enrollment in Husky has dropped by 25,000 people over the past year, including about 18,000 children.

"In many ways, Husky is a very fragile program, and a change can have an exponential negative consequence," said Sharon Langer, senior policy fellow for Connecticut Voices for Children.

A New Haven-based nonprofit group, Connecticut Voices also has worked for the state-funded Children's Health Council and Hartford Foundation for Public Giving to assess the Husky program.

Connecticut Voices issued a report this week, based upon U.S. Census data, showing that 326,000 families in the state, about 9.3 percent, live below the federal poverty level. For a family of four, that means an annual income of not more than $19,961. That's up from 7.5 percent in 2001.

That same report also showed 11.3 percent of Connecticut residents, about 394,000 people, including 68,000 children, were without health insurance for all 12 months of 2005. That compares with 10 percent in 2001.

So if poverty is growing along with the need for health insurance, why did people leave the Husky program?
For one thing, Langer says, the program has been far from stable over the past three years, particularly in terms of the contributions it asks of recipients.

"Husky," or Health Care for Uninsured Kids and Youth, has been in place since 1998 to market and expand Medicaid coverage for children from poor families. And since 2001, Husky has provided insurance for a wider pool of adults than basic Medicaid does.

State government will spend an estimated $700 million this fiscal year providing insurance for just over 299,000 people, including 216,000 children and 18-year-olds. Husky eligibility rules classify 18-year-olds as children.

Most pay no monthly premiums. Families earning 235 percent or more of the federal poverty level - for a household of three that's about $37,800 per year - pay up to $50 per month.

But in 2003, with the economy in recession and the state budget nearly $1 billion in the red, state legislators and then-Gov. John G. Rowland ordered many changes:

* A $3 co-payment for medical services and $1.50 for prescriptions.

* New monthly premiums ranging from $30 to $75 for families above 185 percent of the poverty level.

* An end to "presumptive eligibility" that allowed parents to get treatment for their children immediately while applications to join Husky, which can take six weeks to process, were considered.

Most of these changes were repealed in 2004, and all by 2005.
But lawmakers and Gov. M. Jodi Rell went down the same path in June 2005, again approving monthly premiums ranging from $30 to $75 for families above 185 percent of poverty.

By late October 2005, nearly 2,200 children were being removed from Husky by parents who cited the increased premiums as a problem, even though they hadn't been implemented yet.

One month later, Rell and the legislature rescinded the premium hikes in special session.
In July 2005, the state ended the practice of allowing Husky applicants simply to sign a sworn statement of their earnings, which would subsequently be investigated. The new requirement was that at least four paycheck stubs had to be submitted as further proof.

That requirement was repealed one year later, again after numbers showed Husky applicants walking away from the program.
Langer said there is a misconception about recipients of state aid, adding that many find it difficult to accept. As a result, they may find it embarrassing to return to a public assistance program, particularly after leaving it once because they couldn't afford it.

"As a society, we constantly communicate a mixed message," she said. "There is a lot of talk about personal responsibility, but we want people to feel they can turn to others for help. The reality is many families sometimes find themselves in situations where they do need help."

State government used to spend about $4 million annually to market the Husky program, including television and radio public service announcements and various grassroots promotions through health clinics and other community-based care providers.

Husky outreach spending has dwindled steadily since then and according to the legislature's Office of Fiscal Analysis, it stood at $850,000 last fiscal year.
After Connecticut Voices issued its report on families in poverty this week, Rell ordered the Department of Social Services to redirect about $1 million in savings from the declining Husky enrollment to expand marketing efforts.

"Connecticut Voices for Children is right, too many parents are not renewing coverage for their children or not signing them up in the first place," Rell said. She added that allowing children to be uninsured "is simply not acceptable in a state that already offers great health benefits for children at little or no cost."

The Republican governor's Democratic opponent in this fall's gubernatorial race, Mayor John DeStefano Jr., said Rell's response is ironic.
"What the governor is not saying is that she is now responding to a crisis that she helped create," DeStefano spokesman Derek Slap said.

Some of the steep decline in Husky enrollment could be attributed to a change in federal welfare rules, according to Michael P. Starkowski, deputy commissioner of administration for the state Department of Social Services.

Households on the federal Temporary Aid to Needy Families also receive health insurance through Husky. Because Husky effectively is an expanded Medicaid health insurance program, it is supported both with federal and state dollars, and subject to certain federal rules.
But in July 2005, federal law changed, requiring that families coming off welfare remain eligible for state health insurance for one more year, down from an earlier transitional cushion of two.

That meant July 2006 was the first month that a new pool of families would be removed from Husky earlier than normal. Starkowski said an estimated 15,000 people were removed from the rolls all at once two months ago.
But he also added that the various changes to Husky contribute to some clients and potential clients walking away.

"The governor has instructed us to get back to community outreach," Starkowski said, adding he's hopeful a strong grassroots effort working with local care providers will increase enrollment.

Further information about the Husky program can be obtained by calling the Department of Social Services toll free at 1-877-CT-HUSKY, or by visiting the program's Web site at:
www.huskyhealth.com