A coalition of mental health providers who treat transgender people in Connecticut has complained for months that the state Department of Social Services (DSS) has imposed what they call unnecessary and overly restrictive requirements on patients seeking gender-affirming surgery. The changes affect low-income patients on the state’s Husky health insurance. Before covering genital surgery to treat gender dysphoria – the psychological distress that can result from an incongruence between one’s sex assigned at birth and their gender identity – DSS now requires proof that the person has lived for at least a year in the new gender and has come out to family and friends. DSS accepts a legal name change as proof. In March, DSS imposed a blanket denial of gender-affirming surgery for anyone under 18 and began requiring two letters from mental health professionals assessing transgender patients before some surgeries would be covered, Alexandra Solomon, a clinical social worker with a therapy practice in Glastonbury and one of the leaders of the coalition, said.
HUSKY members in a person-centered medical home (PCMH) practice are more likely to get recommended preventative health services and less likely to visit the emergency room, according to Department of Social Services (DSS) data. A PCMH is a medical practice that provides comprehensive and coordinated care. That can mean helping a child get an appointment with a behavioral health clinician; making sure a patient’s apartment is free of asthma triggers; and many other services hard to get in time-crunched primary care offices. Medical homes must also provide a high level of accessibility through measures like extended hours, electronic or telephone access or rapid appointment scheduling. The state instituted HUSKY PCMHs in 2012 with an eye toward improving care for patients with chronic conditions, according to Kate McEvoy, director of the Division of Health Services at DSS.
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 number of low-income Connecticut children receiving dental sealants, a treatment to prevent tooth decay, has grown in recent years and the state’s participation rate outpaces the nation. In 2016, 44,497 (19.6 percent) of the 226,111 children ages 5 to 16 enrolled in the Connecticut Dental Health Partnership had sealants placed on molars, up 9 percent from 2011, according to the state Department of Social Services. Nationally, in the 2015 fiscal year, 14.9 percent of eligible children – 2.7 million out of more than 17 million – received sealants, according to the Centers for Medicare and Medicaid Services. State officials and dental providers make a concerted effort to educate families about the importance of sealants, said Donna Balaski, director of dental services at DSS. “Sealants are shown to be an effective treatment for preventing disease,” she said, and is part of a broader DSS strategy to teach families about overall dental health.
Low-income women in Connecticut who have just given birth and know they don’t want to get pregnant again anytime soon are now offered a long-acting birth control option postpartum. Medical providers say the policy by the U.S. Department of Health and Human Services will reduce the number of unplanned pregnancies, as well as lead to better maternal health outcomes by ensuring pregnancies are spaced a healthy length of time apart. Connecticut’s HUSKY program is one of 26 state Medicaid programs nationwide that reimburses hospitals for administering long-acting reversible contraception (LARC)—namely, intrauterine devices (IUDs) and subdermal implants—to Medicaid patients. HUSKY started reimbursing for the devices last year. “It’s a great thing,” said Dr. Elizabeth Purcell, an obstetrician and gynecologist practicing in Hartford.
Medicaid will reimburse some health centers in the state for providing patients with access to medical specialist through electronic consultations, which some providers believe will increase low-income patients’ access to care. “The impact is potentially huge,” said Dr. Daren Anderson, director of the Weitzman Institute, which is the research and quality improvement arm of Community Health Center Inc. (CHC). CHC is a Middletown-based network of 13 health centers that includes facilities in New Britain, Stamford, Norwalk, Clinton, and Old Saybrook. An e-consult enables a primary care doctor to contact a specialist—for a second look at patient’s echocardiogram, for instance—and securely send part or all of a patient’s medical records electronically. The specialist then replies to the primary care doctor within a few days (but more typically within just a few hours), reducing the need for a patient visit to the specialist.
A dentist will pay $55,000 to settle claims he defrauded the state’s Medicaid program, Attorney General George Jepsen announced Monday. Dr. Thomas DeRienzo, a licensed practicing dentist in Southington, will pay the money to settle civil healthcare fraud allegations that he submitted fake claims for Medicaid payments. Jepsen alleged that DeRienzo carried out a “long-term scheme” in which he submitted claims to the state Department of Social Services, which administers Connecticut’s Medicaid program, for dental services he did not provide to patients enrolled in the Connecticut Medical Assistance Program (CMAP). CMAP, run by DSS, includes family, children’s and low-income Husky programs.
Jepsen accused DeRienzo of submitting claims to DSS for resin-based composite fillings that he never gave to CMAP patients. In addition to agreeing to pay $55,000 to resolve those allegations, DeRienzo has entered a separate agreement with DSS in which he is permanently barred from participating as a dentist in the CMAP, according to Jepsen.
Reached at his practice Monday, DeRienzo denied any wrongdoing.
Thousands of low-income adults and children have gained access to dental services in recent years as the number of dentists accepting Medicaid and HUSKY patients has soared, according to state data. At the end of last year, there were 2,002 dentists who accepted Medicaid or HUSKY plans. That’s nearly three times the 703 dentists who accepted Medicaid or HUSKY on Dec. 31, 2008, according to the state Department of Social Services (DSS). “That’s a pretty expansive network,” Donna Balaski, director of dental services at DSS, said of the 2014 figure.
At the Governor’s House Rehabilitation & Nursing Center in Simsbury, 17 of the nursing home’s 73 beds sat empty this spring – a 23-percent vacancy rate that would have been unlikely five years ago. The home’s occupancy has fallen despite its above-average health care quality scores in the federal government’s rating system. “There are a lot of factors – a lot of initiatives out there now to keep people out of nursing homes,” said Keith Brown, the home’s administrator. “And with the increase in home care, we’re seeing a more frail resident population. So we have fewer residents, with higher acuity.”
The Simsbury home is not unique: Nearly a third of Connecticut’s nursing homes are less than 90 percent occupied, with Litchfield and Tolland counties bearing the highest vacancy rates, an analysis of state data shows.
Selenia Velez remembers the near-daily phone calls from the pre-school, alerting her that her 2-year-old son had acted out aggressively and needed to be picked up immediately. The calls went on for months, as Velez, 27, of Hartford, and her husband bounced between the pre-school and their son’s pediatrician, who recommended that they take him to a psychiatrist for an evaluation. But the psychiatrist was booked and held them at bay, as Velez watched her son’s behavior deteriorate. “We just felt hopeless,” the mother of four recalls of her oldest son, now 7. “It was one of the most heartbreaking things you can go through as a mother.