Medicaid Managed Care Council update

At yesterday’s Council meeting DSS announced that PCCM finally has a name – HUSKY Primary Care – and a brochure for marketing. The program will be available to more consumers and providers in Willimantic and Waterbury soon.

SAGA spending is up 13.5% this year over last, however enrollment grew by 16.3% from May 2008 to May 2009. In particular, spending on dental care increased significantly due to small increases in rates and far more participating providers. The report on numbers of consumers seeking care from out of network providers was interesting. Both Aetna and AmeriChoice had significant numbers of requests for primary care providers (PCP), suggesting an inadequate network. CHN, which has 64% of HUSKY enrollment, had no out of network PCP requests. The most common reason families change plans, by far, remains “PCP not in plan.”

Charter Oak enrollment appears to be leveling off, dropping slightly to 8,179 members as of June 1st. Total HUSKY/Charter Oak applications also appear to be down – unexpected given the rise in unemployment. Clients disenrolling from Charter Oak, failing to pay premiums, was up sharply in May almost doubling from the previous two months’ numbers. Disenrollments were highest among those with incomes below 150% FPL (premiums are $75/month + $150 deductible for an individual + copays) and 185 to 235% FPL (premiums are $175/month + $400 deductible + copays). Disenrollment from HUKSY Part B for failure to pay premiums was up sharply, and not surprisingly most families contacted say they are having a hard time paying the bill. Members noted the impact of these financial burdens on consumers in the current system and concerns about budget proposals to increase cost sharing.

DSS is applying for a HRSA grant to expand mental health and substance abuse capacity in Charter Oak.

CMS has asked several questions in response to the state’s HUSKY waiver application including financial issues and questions about access to care under PCCM. DSS will be sharing a copy of the questions and their responses with the Council.

Advocates and providers expressed concern about proposals to change the HUSKY definition of medical necessity – the standard that determines if a treatment is approved. That change is estimated to save $4.5 million next year and $9 million the year after. Advocates are troubled by the lack of specificity in how that change would be implemented and worry that patients will not be able to get the care they need, damaging their health and ultimately costing the state more. The new medical necessity definition was drafted by a group of physicians at UConn.

Several personal notes: The Council recognized three retiring DSS staff – David Parrella, Rose Ciarcia and Kevin Loveland – who are leaving at the end of this month. They will be sorely missed. But in good news, Commissioner Starkowski appeared at the meeting, looking very well. It is good to see him back and healthy.
Ellen Andrews