Op-Ed -- CT Medicaid: Don’t Mess With What’s Working

In an unusual twist, two prominent legal aide attorneys highlight Medicaid’s exceptional performance in improving quality, expanding access to care and controlling costs in a New Haven Register op-ed yesterday. CT’s Medicaid program is remarkable in actually lowering the cost of care for members, while improving the care they receive.  Legal aid’s role is not usually to compliment the state, but these two attorneys felt compelled to applaud the accomplishments. Other states should take notice. Read more

22,166 CT residents sharing $1.8 million in ACA premium rebates

Over $469 million in 2014 insurance premium rebates will soon be going back to US consumers including 22,166 CT residents, according to CMS. CT rebates will average $177 per family. Since 2011, under the Affordable Care Act, insurers are required to spend at least 80% of individual and small group insurance premiums on medical care or activities that improve health. Large group insurers must spend at least 85% of premiums on health care and activities.  Under the law, insurers that do not meet this standard must rebate excess administrative costs to consumers. Over $2.4 billion has been returned to US consumers since 2011. Rebates come either directly to consumers or to their employers to benefit employees.  Since 2011 the percent of compliant, fairly priced coverage has increased every year, necessitating fewer rebates.

Fate of terminated HUSKY parents troubling, implications for families staying together

At Friday’s Medicaid Council meeting we learned that 167 of the 1,215 HUSKY parents that lost coverage last year were able to buy insurance from the health insurance exchange. Unfortunately 32 former HUSKY parents initially signed up for insurance through AccessHealthCT, but later lost coverage because they didn’t pay their premiums. It is not clear if they found other coverage or weren’t able to afford coverage at all and are now uninsured. It is unclear how many have been able to stay on HUSKY because they remain eligible in another category. At least three HUSKY parents cut off the program left their original households and now are eligible as single households. Council members expressed concern about the potential implications of the cuts for keeping families together. Another 18,389 HUSKY parents are scheduled to lose coverage on July 31, 2016 unless the state reverses the cuts.

We also heard that the backlog of pdf applications is now gone, so application delays should be far lower. Total Medicaid eligibility has fluctuated over the last year because of the pdf problem, the shift to MAGI income eligibility and HUSKY parents’ cuts. As of last month, 716,833 state residents were enrolled in Medicaid.

RFP open for state health planning grant

At today’s Health Care Cabinet, we heard about the RFP for health care planning made possible by passage of SB-811 this year. Section 17 of the law directs the Cabinet to compare mechanisms to improve health care value in Connecticut looking to other states and assessing what would work best here. The plan for the grant is thoughtful, focuses on engaging all stakeholders to collect the best ideas, and improving communications across CT’s health care landscape. The plan holds great promise to address the shortfalls of past and current reform efforts. Advocates sent a letter in July supporting the project and offering our help.

We also heard from SIM about a CMS-led summit meeting and strong federal pressure toward narrowly defined, strong payment models. It was pointed out that evidence of effectiveness to date for these new payment models is very sparse and mixed. While CT should learn from federal and other states’ experience, we have to chart a course that makes sense for our state. Our Medicaid program has reversed our history of poor performance and is now saving money, improving quality, increasing access to care, and improving consumer experience of care. No one wants to jeopardize that progress. SIM leaders disagreed saying that CT can chart its own course, but that course will align with federal directives.

After moving public testimony, FDA committee advises stronger warnings on fluroquninolons

Last Thursday two FDA Advisory Committees heard hours of moving public testimony on Fluoroquinolon—Associated Disability (FQAD). We also heard doubts about the effectiveness of this class of antibiotics that is prescribed over 30 million times in the US each year. FQs were first approved by the FDA many decades ago, before better effectiveness tests. New studies question the effectiveness of FQs in treating infections compared to placebo. At the hearing, FQAD sufferers and family members described serious, but somewhat rare, neuromuscular, psychiatric and cardiac effects and deaths from taking just a few pills, generally in previously very healthy, active people. Many were given the drug as a precaution, and never had an underlying infection. We also learned that previous changes to strengthen warnings on the drug label have been ineffective; prescribers and consumers were unaware of the risks. Drugs companies that developed FQs minimized the risks and questioned the integrity of disability reporting, because most reports come directly from consumers rather than professionals. The committees recommended even stronger label language, including the risks of disability, but also asked the FDA to consider a public/prescriber education campaign about the risks, measures to ensure FQs are used only as second line therapy, and to promote informed consent by consumers using the medication.

Funds available to pay medical bills for Hartford area residents

There are funds available to cover Hartford area residents’ medical bills that aren’t being spent. Responding to requests, Nelson and Elsie Brainard started the fund in 1957 to help people “of modest means” facing unemployment and bankruptcy because of high medical bills. The Fund now spends hundreds of thousands each year covering bills, but as the end of this year approaches, there is still money available. Of course there are qualifications – the Fund pays bills for medical care of adults that aren’t eligible for public programs facing financial hardship due to a serious or chronic medical condition. The bills must be at least $3,000 and patients must pay some part of the bill. The Fund works with 12 area agencies to assist people applying for funds. For more, go to the Brainard Fund brochure or call 211 and ask.

November web quiz: CT health coverage

Test your knowledge of health care coverage in Connecticut. Take the November CT Health Policy Webquiz.

CT health reform progress up slightly this month

CT’s progress toward health reform inched up this month to 25.7%, ending a four month decline. New Medicaid numbers confirmed that per person costs continue to decline, long after the initial savings from switching away from capitated insurers. The continued progress suggests that structural changes like patient-centered medical homes, quality incentives and intensive care management are working. In other good news, we got an additional, badly-needed six months to allow thoughtful Medicaid redesign, allowing CT to avoid costly past mistakes and preserve progress. Officials continue to consult with stakeholders in the design. Unfortunately the good news was balanced by Medicaid provider cuts, SIM’s efforts to force a poorly designed CCIP plan on Medicaid, the inability to find funding for the collaborative Health Neighborhood shared savings plan, and disappointing new Census numbers about CT’s uninsured rate. The CT health reform progress meter is part of the CT Health Reform Dashboard.