Roughly 68,000 seniors and disabled residents will lose access to a Medicare financial assistance program January 1, when income eligibility requirements change under the newly enacted state budget.
Currently, through the Medicare Savings Program, the state Department of Social Services (DSS) pays Medicare Part B premiums for low-income elderly and disabled adults earning less than 246 percent of the federal poverty level, or about $29,667. Part B covers things like doctor visits, lab tests and outpatient care. Those earning less than 234 percent of the poverty level, or about $28,220, can receive additional help covering co-pays, deductibles and prescriptions.
In the new year, only those earning less than 100 percent of the poverty level—or $12,060—will qualify to receive all benefits under the program, and those receiving subsidies for premiums alone must earn less than 135 percent of the poverty level to be considered for eligibility. The Medicare Savings Program gives enrollees access to some benefits of the Medicaid program, which is a federal-state partnership.
“People are alarmed. They’re scared,” said Kristen Noelle Hatcher, managing attorney of the benefits unit at Connecticut Legal Services, a poverty law practice. “This is life-changing for a lot of them.”
Once the change occurs, the new income eligibility will be at the federal minimum, the same level used by 45 other states, according to DSS. Connecticut will remain one of only eight states that do not have an asset test for eligibility, according to the department.
Most people likely won’t know they are losing coverage until they receive written notices next month, according to Rosana Garcia, policy associate at the Universal Health Care Foundation of Connecticut, an advocacy group.
The change will force some seniors and disabled people, many of whom live on fixed income, to make tough decisions, Hatcher said. Some may skip medication doses, pick and choose which doctor appointments to attend, and make other sacrifices.
“They’re going to be having to make choices on what to spend their money on,” Hatcher said. “They do what they need to do to get by.”
Jonathan Miller, 27, of Meriden, worries he won’t be able to afford medications and treatments for his cystic fibrosis. His symptoms became so severe three years ago that he can no longer work. The Medicare Savings Program, which he joined in June, covers his premiums and prescriptions.
“I will be drastically impacted,” said Miller, who receives Social Security disability income and supplemental money from a long-term disability policy. “My income is too high to qualify for any other state-funded health coverage.”
Looking ahead, he said his best option would be to gain coverage under MedConnect, a Medicare plan that lets disabled individuals earn up to $75,000 a year in income as long as they are employed. He is actively job hunting, even though working is physically difficult for him and against his doctors’ advice.
He may also be able to get a Medigap plan, private coverage that supplements original Medicare benefits, he said. But he worries about the expense as well as the time it could take to get approved and enrolled.
He also doesn’t know whether his Medicare Savings Program access will be gone as of Jan. 1 or whether he may be able to keep it until June, since he was approved last June for a year of eligibility.
“I don’t have the luxury of waiting to find out. I can’t risk going a day without coverage,” said Miller, who spends four to five hours a day managing treatments and medications. A single trip to the hospital would cost him thousands of dollars out of pocket, he said.
In addition to the Medicare changes, the new budget also reduces income eligibility for HUSKY A, the program that provides coverage to low-income children and their parents or caregivers. Currently, adults in families earning 150 percent of the federal poverty level, or about $36,900 for a family of four, or less are eligible. The new budget will limit eligibility to adults in families earning less than 138 percent of the federal poverty level, or about $33,948.
Pregnant women and children enrolled in HUSKY A won’t be impacted by the cuts, according to DSS. Additionally, most HUSKY A recipients who will be affected won’t feel the impact until 2019, according to DSS, because they meet qualifications that require the state to provide them with 12 months of Transitional Medical Assistance.
The income level reduction will bring the state in line with most other states, according to DSS, and will make income eligibility for HUSKY A the same as that for low-income adults under HUSKY D, according to DSS.
This is the second time the HUSKY A eligibility income level has been dropped in recent years; it was lowered two years ago in the last state budget, Garcia said. It’s now at the federal minimum, she added.
“Our big concern is what will people do for coverage,” she said, noting many on HUSKY A can’t afford to buy insurance plans on the exchange, even with available subsidies.
In all, the latest biennial state budget cuts more than $120 million in funding from Medicaid and Medicare over the 2018 and 2019 fiscal years, according to Connecticut Legal Services.
Other Medicaid cuts in the budget include: reducing the primary care enhanced reimbursement rate, eliminating home health add-on payments, and capping adult dental coverage for non-emergency services at $1,000.
The cuts may not be as cost effective as lawmakers hope, Garcia said, particularly if patients resort to more costly emergency room care once situations become dire.
“People are not going to get the care they need. When things are really in crisis mode, they’re going to go to the ER and that’s not a sustainable way to provide health care,” she said. “It just feels like we’re really not living up to our promise to people.”