September 3, 2012

CT Is “Hell-Yes’’ On Medicaid

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Governors in some of the states with the highest rate of uninsured people – including Louisiana, Texas, and Florida – insist they’ll opt out of the Medicaid expansion offered under the Affordable Care Act – or Obamacare. One political website (Politico.com) calls them the “hell-no” states.

Put Connecticut, then, squarely in the “hell-yes” category.

The Nutmeg State was first in the country to opt in to Medicaid expansion in June 2010—under then-Gov. M. Jodi Rell, a Republican.

Health and Human Services Secretary Kathleen Sebelius announced the opting-in with great fanfare, and Rell said the extra help from the federal government would allow the state to “provide increased medical benefits for them [single adults] through Medicaid while relieving the burden on state taxpayers.” The move also was supposed to save the state money—$53 million in the first year alone.

So far, that has been the case, says state Healthcare Advocate Victoria Veltri. Upon the announcement, some 45,000 childless adults with low incomes were moved from the state-funded State-Administered General Assistance (SAGA) program, Veltri said.

Another 35,000 or so have joined since, with more expected.

Instead of paying the entire cost of the program, Connecticut splits the cost with the federal government until 2014, when the feds will pay 100 percent. Coverage includes costs of hospital services – both inpatient and out-—as well as mental health services, prescriptions, immunizations, and emergency services.

The state has roughly 377, 000 uninsured residents – 85 percent of whom are adults, according to the Kaiser Family Foundation.

“It’s been a great change for coverage,” said Veltri. “We have a lot of people at very low incomes in Connecticut. This has almost doubled the number of people inside the program.”

Saying ‘no’ or ‘probably not’ to Medicaid expansion bucks several trends. According to an August report from Kaiser Foundation, when federal funds are made available, states tend to insure their uninsured residents – and that’s regardless of state budgetary pressures, or the overall economy.

Save for a few holdouts, nearly all states joined the Medicaid program within four years after it was created in 1965. The program was designed to be administered by each state, which had – beyond certain mandatory benefits – more than a little say in how their particular Medicaid programs looked.

That holds true, to an extent, with the expansion.  Advocates for the disabled complained that Connecticut’s early income rules made ineligible mentally ill and disabled adults, between the ages of 19 and 26, who live with their parents. The Department of Social Services is revising that plan.

Obamacare gives individual states the option of changing Medicaid enrollment requirements to include anyone 133 percent above the federal poverty line. (With new methodology suggested by the federal government, that rate is more like 138 percent, so an astute reader of the reports will see both figures quoted.)

That change means that nationally, 15 million uninsured people, more than half under the age of 35, could be placed on the Medicaid rolls, according to a new study by The Commonwealth Fund.

And in July, the Harvard School of Public Health released a report that said expanding Medicaid to low-income adults improves health and reduces deaths. The study – which will be published in the New England Journal of Medicine later this month—looked at three states – Arizona, Maine, and New York – which recently expanded Medicaid eligibility to childless adults between the ages of 19 and 64.

In those states, mortality declined “significantly” – or about 6 percent, particularly among minorities and older adults. The higher the poverty rate, the greater the mortality reduction.

States that opt out will continue to have residents who are uninsured, and who often, when ill, will seek medical care through emergency rooms at premium cost.

“Luckily – and I say this almost every day – we live in Connecticut, and we understand the importance of covering our low-income population,” said Veltri. “I can almost guarantee you’re going to spend way more in other health care costs if you don’t go with Medicaid expansion. Maybe some of these states will rethink their decision.”

To read more about Connecticut from the Kaiser Family Foundation click here

To read the Harvard School of Public Health’s study click here.

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