June CT Health Policy web quiz

Test your knowledge of small group health insurance in CT. Take the June CT Health Policy Web Quiz. This month’s quiz was written by Selina Tirtajana, CTHPP intern, Summer 2009.

Unemployment up, but not for health care

Friday’s national unemployment numbers for May were up to 9.4% from 8.9% in April. Since December 2007 when this recession began, 7 million more Americans are unemployed. A study published in January by the Urban Institute estimated that if unemployment reaches 10% this year, 13.2 million Americans will lose employer-sponsored coverage, Medicaid and SCHIP will rise by 5.4 million and the uninsured will rise by 5.8 million. HUSKY enrollment is up almost 20,000 from May of 2008 to May of this year. In other bad news, the average US workweek continued to decline and the number of Americans working at part time jobs for economic reasons (involuntary part time workers) was 9.1 million. Part time jobs are far less likely to come with health benefits. However if there is a silver lining, health care jobs increased by 24,000 between April and May.
Ellen Andrews

New OLR reports on PCCM, HUSKY employers

According to OLR, in 2004 when Oklahoma switched from HMOs to PCCM to run their Medicaid managed care program, the state saved money and access to primary care improved. An evaluation of OK’s program by Mathematica found that under PCCM the number of participating primary care providers rose 44%, patients’ office visits nearly doubled, avoidable hospitalizations dropped, consumer satisfaction rose, and ER visits dropped by 5% while nationally Medicaid ER visits rose by 9%.

OLR also updated their report on employers of HUSKY Part A enrollees and parents. Wal-Mart tops the list again with 3,741 HUSKY workers and dependents, up 68% from the 2005 report. Next are Dunkin Donuts with 3,153 (up 119%), Stop and Shop with 2,372 (up 19%), MacDonald’s with 1,915 (up 48%), First Student (transit co.) with 1,471 (up 160%), Target with 1,158 (up 253%), and Care 4 Kids with 1,021 (up 123%). The only companies that dropped on the list from 2005 to 2009 were Laidlaw Transit and Shaw’s. New to the top 25 HUSKY employers list are Macy’s, Kohl’s, Dattco (transit co.), Yale-New Haven Hospital, and Home Goods.
Ellen Andrews

Patient-centered medical home briefing

Medical homes have been featured prominently in federal and state health reform plans. Join us for a policymaker briefing on what the patient-centered medical home concept is and how it might work in CT on Friday June 19th at 12:30 pm in the Old Judiciary Room at the State Capitol in Hartford. Speakers include Suneel Parikh, MD and Robert Fortini from the Queens-Long Island Medical Group -- the first NCQA-accredited medical home, Lee Partridge of the National Partnership for Women and Families, Vera Tait MD, from the American Academy of Pediatrics, Shafiq Qaadri, MD, MPP, Ontario, and Pat Baker of the CT Health Foundation. The CT reactor panel will include Sandra Carbonari, MD, Tom Woodruff, from the Office of the State Comptroller, Kristin Boucher, RN, Rose Stamilio of St. Francis Care, Claudia Gruss, MD, Joanna Douglass, BDS, DDS, and Rep. Betsy Ritter. For directions to the Capitol, click here. The briefing is made possible with a grant from the CT Health Foundation.

HUSKY rate audit released

The audit of large rate increases granted to the HUSKY HMOs last year has been released. Accounting firm Milliman found that the state overpaid the HMOs between $41 and 39 million. The Governor has already incorporated over $50 million in savings from re-negotiating HMO rates based on this report in her latest budget proposal. The audit also raised concerns about the soundness of rate setting practices and assumptions including trend adjustments, data re-basing, guarding against double-counting, and incomplete documentation. The report summary includes concerns about lack of transparency and accountability; the entire $4 billion Medical budget is included in only one line item. Advocates argue that the $50 million in savings can be used to avert cuts to HUSKY families including copays, dental care, medical interpretation, medical necessity, and elimination of coverage for immigrants. The funding could also be used to improve health care in CT by covering smoking cessation in HUSKY, improving primary care rates, providing incentives for quality care, or removing the onerous requirement that Charter Oak Health Plan applicants be uninsured for six months or pay one third of their incomes on insurance.
For press reports, click here, here and here.
Ellen Andrews

From the Consumer Helpline

I am working with a consumer who called our helpline to ask for help with medical debt from two hospitals. When he was in Bristol Hospital he applied for financial assistance but he was denied because he didn’t want the Department of Social Services (DSS) to put a lien on his house. It is a requirement of most hospital financial assistance programs that the consumer has to apply for SAGA medical and it is a DSS requirement that if you are a homeowner and you want SAGA medical, they put a lien on your home to recoup the medical costs. I explained this to the consumer who also said he is disabled, although he isn’t currently getting Social Security Disability (SSD). People who are disabled can apply for Medicaid (also through DSS) and a lien is not put on your home. The problem is that since he isn’t currently getting SSD, there is a lot of paperwork for him and his doctor to fill out to determine that he is disabled for the purposes of getting Medicaid. On top of that he will also have to apply for SSD.

The consumer had been paying $10 a month to Bristol Hospital but now they sent him into collections. He said no one from the hospital ever returned his calls to say if $10 a month was acceptable and he thought it was ok since he didn’t hear anything back from them. He also disagrees with the total amount of the Bristol Hospital bill because they are billing him for a CAT scan he didn’t receive. When he called the hospital again to try to straighten this out, they told him to call the collections agency, who told him to call the hospital. I was able to get a name and phone number for the person at the hospital that he needs to talk to look into this. So far, the calls he’s made there haven’t been returned.

The other hospital he has bills from told him he isn’t eligible for financial assistance because he was never admitted to the hospital. He also isn’t eligible for a reduction to pay the “cost” of care (the actual amount that the hospital care costs as opposed to the increased prices the uninsured are usually charged), even though he is below 250% of the federal poverty level, because he didn’t complete the DSS application for SAGA medical.

When he left my office after an appointment, he had a long to-do list, including applying for SSD, applying for Medicaid (which included about 20 pages of medical paperwork for him and his doctor to fill out), contacting the hospital to straighten out the billing error, writing a letter to the collections agency to dispute the bill, and calling his state Senator’s office to see if they could help him. It is a full time job to be without health care when you have health issues and unpaid medical bills. For advice on managing hospital debt see our tip sheet.
Jen Ramirez

SustiNet and budget updates

Saturday HB-6600, AAC the Establishment of the SustiNet Plan, passed the Senate on a vote of 23 to 12. The bill passed as it did in the House, without further ammendment. The Health Care Partnership bill, HB-6582, which self-insures the state employee plan and allows municipalities, small businesses and non-profits to participate in the plan, also passed Saturday. Both bills passed the House last Wednesday and now move to the Governor’s desk.

The CT Health Policy Project has published an analysis of the Governor’s latest budget proposal and its impact on health care. Her proposal includes a reduction of just over $50 million in each year to the HUSKY HMO capitation rates based on an audit of those rates by the Office of State Comptroller.
Ellen Andrews