More from the Consumer Helpline

I received a phone call on Tuesday from a Communications Officer in the Commissioners Office of the Department of Social Services. She was concerned about my blog posted on Monday, which mentions the difficulty I had with the general phone number at one of the DSS regional offices. She explained that there is a toll free number on the DSS website to which I should have referred this consumer, rather than the general phone number for that office. I explained that I had worked for DSS as an eligibility worker for seven years and had never heard of this number. She replied that it is right on the website (with a bit of a tone, I might add). To which I replied that I didn’t have internet access while I worked there (or rather it was limited and we were instructed not to use it). The phone number we always gave to clients when they had called the wrong office was the general number for that office. I even asked a few current DSS employees, who didn’t know about this 1-800 number and said they also refer clients to the general number for the office nearest them. (As an aside, the general number in the Hartford office was so busy sometimes that desperate clients would dial a random extension just to be connected to a person. We even received an email instructing us to look up phone numbers for the clients’ workers and not transfer them back to the general number).

The Communications Officer proceeded to instruct me in all of the toll free numbers for DSS, including those for HUSKY and Charter Oak. First she told me that the client should have a worker she could call. Again I relied on my experience from DSS and said that I know there are times that an application isn’t entered right into the system, so the client wouldn’t know who that worker is. What I was really looking for when I originally called the general DSS number was an intake supervisor for the client to talk to, to see if the application had been received and assigned to a worker.

After all of this information sharing, the Communications Officer asked, “So you’re going to take it down, right?” “The blog? No,” I answered, I’m not going to take it down because that was the experience I had trying to find information from DSS and that was the experience the client had as well.”

I tried the 1-800-842-1508 number and was not able to speak to a person. I could push buttons for various program areas and was provided with some general information about programs but there no way to speak to an actual human being. I could, however, leave a message for someone to get back to me. Interestingly enough, the phone line did tell me that, “In order to serve you better we encourage you to contact the [regional] office by telephone or mail whenever possible.”

I have to say, I was a little angry that I was asked to remove the blog. I was also a little angry at the Communications Officer’s condescending tone, which suggested that everything she was telling me was common knowledge and apparently I just didn’t know where to look for the proper information. My closing thoughts are that, in this Thanksgiving season, I am grateful for many things, one of which is my freedom of speech.
Jen Ramirez

PCCM advocates forced to walk out of meeting

Yesterday’s PCCM working group meeting at DSS did not go well. DSS had no agenda for the meeting which started twenty minutes late. Advocates asked for an explanation of the department’s sudden decision to reverse course from the months-long policy of starting the program statewide to a far weaker program limited to two smaller communities. We were told they had no explanation. When we asked staff to call and see if the Commissioner could come down to the meeting to deliver an explanation, staff refused to make that call. DSS had no response to advocates’ assertions that the illegal reversal contradicted the statewide plan required under law submitted by DSS and approved by the Human Services and Appropriations Committees without revision. They also had no response to the assertion that this sudden reversal violated the good faith efforts of advocates working for months collaboratively and diligently to recruit providers and build support for HUSKY. Asked to confirm a promise made at a morning meeting with policymakers that PCCM would be statewide in three to six months, DSS answered that there is no timeframe for any potential statewide expansion. One petulant comment made was “I never wanted to have this meeting.” Asked why advocates should continue to meet with DSS and labor to make the program a success, we were given no answer. And the meeting ended.
Ellen Andrews

From the consumer helpline

I started working with the CT Health Policy Project a few weeks ago and I’ve been familiarizing myself with the types of calls that come into our consumer helpline. So far, what I’ve observed is that for people without health insurance, their options are usually limited. The system of care available to them is fragmented and uncertain as well as full of hoops to jump through. There are lengthy applications to fill out and numerous verifications to provide.
For one consumer who called, I tried contacting the Department of Social Services to find a direct number for her to call with her question about an application. I called DSS’s general number several times over a period of a few hours and was hung up on, the number was busy, or it rang indefinitely. When I finally got through to a person and asked for the phone number for a consumer to call about a new application, I was told that it was the number I had just been calling. I asked if there was someone else this consumer could call and was told the consumer has to call the general DSS information number. Now this consumer will have to deal with the same frustrations I faced, just to ask a simple question. Yet another barrier for an uninsured person to deal with before they can access health care.
Jen Ramirez

Charter Oak “pettiness”

To root out the sources of “negativity” about the Governor’s troubled Charter Oak program, on Friday DSS Commissioner Starkowski made very broad requests, under Freedom of Information laws, for any documents pertaining to Charter Oak from a long list of public officials including Sen. Jonathan Harris, Rep. Peter Villano, Sen. Toni Harp, Health Care Advocate Kevin Lembo, Child Advocate Jeanne Milstein, and Attorney General Richard Blumenthal. The letter specifically asks for all communications with Anthem and with consumer advocate Sheldon Toubman. (DSS has a history of trying, and failing, to silence advocates who disagree with them). It is highly unusual for government officials to use FOI to obtain documents from other officials. The request is extremely broad; if advocates (who have to use FOI to get information) submitted such an extensive request, we would receive a testy phone call from DSS’ FOI officers.
Today’s Editorial in the New London Day characterizes the administration’s move as “petty”.
Yesterday afternoon the Governor reportedly sent a letter asking all parties to work together to support Charter Oak and calling a meeting to discuss the issue next Tuesday. We’ll see if the drama is over.
Ellen Andrews

AG, Health Care and Child Advocates call on Governor to separately re-bid HUSKY and Charter Oak contracts

In a press conference today, Attorney General Richard Blumenthal, State Health Care Advocate Kevin Lembo, and State Child Advocate Jeanne Milstein commended the Governor for her decision Friday to de-link the HUSKY program of health coverage for families from her Charter Oak Health Plan for uninsured adults. The officials also called on the Governor to re-bid the programs as the delinking substantially changes the structure of both programs. In Friday’s Medicaid Managed Care Council meeting, a representative from Anthem, with a large provider network serving most HUSKY families, stated that their health plan might have chosen to bid on HUSKY if it were not linked to Charter Oak. ConnectiCare previously stated in a letter to DSS that they would have bid on Charter Oak if it weren’t linked to HUSKY. Re-bidding could significantly increase health plan and provider options for both HUSKY and Charter Oak consumers. The two new current health plans, AmeriChoice and Aetna Better Health, have been unable to develop an adequate provider network after months of recruitment. Without re-bidding, the Attorney General warned that plans such as Anthem could sue the state for changing the terms of the contract after it was awarded.
Ellen Andrews

Governor delinks HUSKY from Charter Oak, guts PCCM

Friday afternoon Governor Rell announced that she will reverse two long standing policies that jeopardized health care for over 340,000 CT residents in the HUSKY and Charter Oak programs. Providers will now be able to contract with the new HUSKY HMOs to provide services only to HUSKY families and not Charter Oak members. The state will also continue to contract with Anthem, allowing access to a far larger network of providers than any of the three HUSKY HMOs has been able to develop. Her announcement came just hours after DSS received strong criticism at the Medicaid Managed Care Council meeting from legislators, advocates and providers that both policies were creating widespread confusion and barriers to care that threatened both programs. A letter from five members of CT’s Congressional delegation was also released at the meeting asking CMS to halt enrollment into the two new HUSKY HMOs because of inadequate provider networks.

Also at the meeting, in direct contrast to the on-going good faith efforts of advocates and DSS staff on the PCCM working group, DSS announced their plan to only implement PCCM in two communities – Waterbury and Willimantic – rather than statewide as had been promised to advocates working diligently recruiting providers and families to make this program a success. This decision also violates the terms of DSS’ plan submitted to and approved by the Appropriations and Human Services Committees. Advocates voiced deep concerns about this sudden decision, delivered with only five minutes left in the meeting, given that 300 CT providers across the state applied to participate in PCCM, and that this program is the first evidence of energy and interest on the part of providers to participate in the program and provide care to HUSKY families in many years. Advocates are left to wonder how important policy decisions are made at DSS and whether good faith participation in DSS working groups is productive.
Ellen Andrews

CT health plan comparisons

US News and World Reports has published their annual national comparison of HMOs. CT has two commercial HMOs listed in the top 20 “Honor Roll” – Health New England (#6) and Anthem Blue Cross Blue Shield (#7). Health New England is not listed as a managed care organization on the CT Insurance Dept.’s website. A call to their offices found that their network is limited mainly to Western Massachusetts, and the only CT members they cover are in employer self-funded plans. No CT Medicaid or Medicare plans made either the “Honor Roll” or the top 10 for our region. There are several helpful articles with the rankings including “How safe is your health care?” and “When your insurer won’t pay up”.

Last month, CT’s Insurance Dept. published their annual comparison of managed care plans in the state. Lots of interesting information, for example – a patient survey found that in the last year between 41% (Aetna) and 61% (HealthNet) felt that they always got the non-urgent care they needed when they needed it. On most measures, Anthem performed at about the CT HMO average, with the exception of beta blockers prescribed after a heart attack – Anthem’s performance was lowest at 44%; the CT average was 64% and Aetna reached 100%.
Ellen Andrews

New law allows children to stay on their parents’ policies until age 26, but there’s a catch

A new law takes effect January 1, 2009 that allows children to stay on their parent’s health policies to age 26. As young adults are at highest risk of being uninsured, this will be an important option to reduce CT’s uninsured. Previously, children were only covered on their parent’s policies until age 19 or 23 for full-time students. Under the law, unmarried children living in CT (not necessarily living with their parents) or out of state as full time students, without group coverage through employment can stay on their parents’ health insurance until the policy anniversary date after they turn 26.

However, there are few caveats families need to be aware of. The law only applies to the 49.5% of CT residents covered by state-regulated, fully-insured health plans. Consumers should check with their employers to see if their plan is covered by the law. It does include the state employee plan including medical and prescription coverage but not dental. The other big catch is that parents may be taxed, for both federal and state taxes, on the value of their child’s coverage. For state employees that value varies between $4,533.60 and $7,199.76/year for one child. There are five tests to determine if a child’s benefits will be taxable. While this is an important new option for young adults to remain insured, families need to consult with their employer, their tax advisor, and to research other coverage options to be sure they are getting the best deal.
Ellen Andrews

PCCM applications rolling in

They are still counting provider applications at DSS for participation in PCCM, but early returns are encouraging. Dozens of providers have applied, including physicians, nurse practitioners and physician assistants, from across the state. All but one community health center has applied. We’ll let you know when we have a definitive list for the opening of the program January 1st. It is important to know that providers can still apply, they just may not be in the network as of Jan. 1 – DSS has promised to get people into the program as quickly as possible. Participating providers can join the PCCM Provider Advisory Group and guide the program’s design including operations, provider feedback and program evaluation. For an application, click here.
Ellen Andrews