The state supposedly now has universal health care for children — but it turns out that it won’t be so easy to find out whether the public money to pay for it actually goes to the kids.
That’s because the money to insure uninsured kids goes through HMOs, or MCOs (managed care organizations), as they’re now called in Connecticut. These private MCOs run the state’s HUSKY program, which insures low-income families.
The General Assembly increased funding to two dozen health care programs in its latest biennial budget, including six that relate to the HUSKY program of health coverage for uninsured children.House Speaker Jim Amann declared that, while the legislature wasn’t following Massachusetts and California and passing universal health care for Connecticut, the plan he put forward would at least cover all the state’s 71,000 uninsured children
But some advocates wonder if that money will go to the kids or to line the pockets of private managed care companies. They’re concerned about a lack of transparency in the system.
The HUSKY programs got a combined $120 million increase for the two fiscal years starting July 1, 2007.
New Haven legal aid lawyer Sheldon Toubman is one of those advocates concerned about transparency. He’s been fighting HMOs to reveal how they spend public dollars they receive for health care for the poor; the fight is ongoing. Since HMOs don’t reveal how they spend the money, he argues, the public won’t be able to tell how the new health care plan for kids — which also runs through MCOs — is actually administered. (Toubman filed a lawsuit on the public disclosure issue back in 2005, eventually winning the support of the Rell administration; the HMOs argue that they are private entities and exempt from freedom of information law, even when spending public money.)
“On the eligibility side,” Toubman said of the latest two-year budget, “we increased parents’ eligibility [for HUSKY] to 185 percent and pregnant women up to 250 percent of poverty up from 185 percent, which indirectly helps kids. We put newborns on HUSKY for a four-month window while the state figures out if they’re eligible.”
Regarding access to care, he said, “There’s $20 million [each year] additional for kids’ dental care. How do you make sure the money goes to provide care when the MCO’s [managed care organizations] get paid a fixed capitated rate [rate per child] and they set their own rates and DSS [Department of Social Services] doesn’t know how much they’re paying and the MCOs say it’s a secret?”
“There’s a severe access to services problem and part of it is the crappy rates providers are paid,” Toubman says. The General Assembly is trying to address that by raising Medicaid rates for physicians 50 percent, for clinics, and for dental and vision coverage each 20 percent, and for hospitals 18 percent. But, he continues, “There’s no transparency.” He said if the General Assembly appropriates more taxpayer money to address the problem of low provider rates for 310,000 people in the state, there’s no way to know if the money just goes into more profits and administrative overhead.
State Sen. Toni Harp (pictured) of New Haven chairs the Managed Care Council, made up of legislators, health care advocates, managed care companies, and officials from the relevant departments within state government, such as the Department of Social Service, which oversees MCOs.
She put a somewhat different spin on the matter. “First of all, the money was not appropriated for managed care per se; most of the rate increases were appropriated to increase rates a specific amount. He [Toubman] is right to be concerned, but that’s why we decided this time to put the money in the rates, in fee-for-service [such as the 50 percent increase for physicians], because that drives the rates for managed care.”
Harp added that by 2009 the state is going to carve out dental coverage from managed care, “so we can control it more. For the short term there may still be a problem because we don’t set rates anymore as a state; we give the money to managed care, and the state can’t enforce a rate structure for managed care companies. DSS doesn’t tell managed care companies what rates they have to pay the doctors and service providers, but the base rate is always the fee for service Medicaid rate. So when we raised the floor, that means the managed care companies also must raise their floor. That’s our strategy — rather than giving them money; we’re increasing fee-for-service rates, which puts pressure on them to increase at least the lowest level rates. We wanted to make sure there was stress on the system to make it very difficult not to raise their rates to doctors, and we did that by raising the floor.”
Harp said the state, by increasing funding to so many health programs, has drastically reduced the number of uninsured kids in Connecticut. But she also noted the “lack of transparency [that] legal aid has been fighting.”
Harp said given the current system, there are two ways to investigate problems. “We need to hear from the public if they’re not getting appointments, and from providers if their payments don’t reflect the rate increases we passed. The way we learn about problems is people call the Managed Care Council, and we have the ability to look into them.”
DSS spokesman David Dearborn wrote in an email message that the department “is continuing to negotiate the acceptance of FOI [Freedom of Information] compliance by HUSKY managed care organizations. The managed care contractors have been offered a 2 percent budgeted increase, retroactive to July 1, as part of a contract extension while we work through the larger issue determining specific provider rate increases in fee-for-service Medicaid and managed care Medicaid [HUSKY A] and State Children’s Health Insurance Program [HUSKY B managed care].
“That 2 percent offer was tied to their acceptance of the Governor’s preferred language on FOI — meaning that MCOs would agree to be subject to the Freedom of Information Act. So far, however, only Wellcare [known as Preferred One in the HUSKY program] has accepted the FOI contract amendment and the 2 percent. The others seem to be holding out while the question continues in litigation.”
ok still not getting it? $120 million for 2 years which is an increase amount. So how much is the state putting into these programs as a whole?? A large chunk of change!! I do not understand why this money can not be redirected to start a Individual Payer program?? We keep forgetting about the Middle class poor!! The ones that can not qualify for these programs!! The ones that do not have Heath Care!! I have insurence but who's to say someday my claim is going to be turned down and I can lose it all! Univeral for all is the only way and the funds that go into these programs should be used to start that!
I am sorry but if these companies weren't hiding something this the information would of been given right off the get go! They are robbing our tax dollars!! Get rid of them!