No sooner had Jason Bartlett been elected as a new state legislator, running on a universal health care platform, than he heard from a mom who could no longer afford HUSKY insurance for her young daughter.
Even before he was sworn in, Bartlett learned how sometimes it takes an elected official to get a family the health care they’re entitled to under law. Last week, he brought up the family’s case when he grilled government bureaucrats at a legislative hearing on the state’s HUSKY health insurance program for low-income families. Bartlett also at the hearing floated a proposal to force HMOs to fully disclose how they are spending public dollars in managing the HUSKY program. And this week Bartlett led a group of freshman legislators pushing the legislature to set aside the money now to support whatever version of universal health care is eventually adopted.
Read on for the latest installment of State Rep. Bartlett’s continuing Independent diary about a rookie legislator’s experiences tackling the health-care crisis.
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I had a constituent, “Peggy,” whose daughter was removed from HUSKY, the state’s health insurance program for children of low-income families, for two months. They wanted a premium of $250 a month, which mom could not afford. She contacted me just days before I was sworn in, looking for help.
Eight months earlier, Peggy took the father to court for child support. The judge ordered him to pay $10 a month toward HUSKY as well as $800 a month in child support. The father ignored the order.
Noting her supposed increase in income, Peggy received a letter from HUSKY stating that she had to switch from HUSKY A to the more expensive HUSKY B plan, with a premium payment of $250 a month. She called them up and said, “I haven’t had a change in income. Why do I have to switch?” The caseworker asked for her income again, which she provided. They went back and forth to no avail. Peggy felt even if she had the child support income from dad she could not afford the premium, never mind that she wasn’t receiving it. Peggy’s daughter was terminated from HUSKY as of October 31, 2006.
A week before the New Year, prior to my being sworn in, Peggy shared her experience with me and gave me all supporting documents she had from the state. I called the House Majority Leader’s office and asked, “What could we do?” The Majority Leader’s staff put me in touch with the legislative liaison at the Department of Social Services (DSS), which contracts with private HMOs to run HUSKY. I explained the situation to the liaison, who said she would do a thorough investigation.
As a result of the inquiry, a much more cooperative and receptive supervisor from HUSKY called my constituent. Peggy explained that she wasn’t receiving the court-ordered child support and the supervisor then determined that she would stay in Husky B, however now she only needed to pay a $5 co-pay and no premium. After two months of no coverage, Peggy’s young daughter once again has health insurance.
The Bigger Fix
I relayed Peggy’s story at the January 18 public hearing. I told the Commissioner of Social Services that enrollment and income reporting are a problem.
She replied that people can appeal if they get moved from one plan to another. My response to her was that although that may be true, the caseworkers who are handling our clients may not understand the process and need better training. We risk losing clients if they are not made to understand the appeals process.
DSS must take a closer look at using child support as a factor in income eligibility. Child support goes up, child support goes down. Whether or not someone receives child support can have a serious impact.
I hope to follow up and get something in writing about how child support will be viewed. As the Commissioner pointed out to me, DSS handles collecting child support for the state. Therefore, they have all the raw data and their own systems should be able to be integrated to solve this problem.
HMOs’ Role In HUSKY
Currently, managed care organizations have the contract to deliver health care to our HUSKY clients. There are proposals now being discussed to implement a Primary Care Case Management (PCCM) pilot program. The PCCM program is much like a fee-for-service plan. The decision of which plan to contract with going forward will be determined by which model and organizations can best deliver quality healthcare and improve patient outcomes, thus controlling costs. For example, which model will insure that our kids are immunized, thus preventing childhood illnesses?
The Managed Care Organizations (MCOs) are currently being sued by child health care advocates under the state’s Freedom of Information Act to determine how our state money is being spent regarding costs so we can determine such issues as access to quality care.
I made a suggestion about that at the hearing as well: Ask the State Comptroller to say to the MCOs, “If you would like to continue to bid for the lucrative state insurance contracts that cover the 50,000 state employees, you must start divulging the information requested by the FOIA.”
After having worked for an HMO that used to brag about the low capitation rates they paid doctors, I know the consequences of those types of provider contracts. No doctors participated. That is why it is so important to see how the MCOs are spending the state tax dollars. But it is important to know that no matter if we pay through managed care companies or fee for service companies, all Medicaid payments to providers are less than they would receive under traditional commercial plans.
My hope is that the Governor, Attorney General Blumenthal, Comptroller Wyman, and DSS Commissioner Starkowski will have a meeting, set some deadlines and goals, and force a settlement with the managed care companies so the state is able to ascertain how our money is being spent. This way, the legislature will have a clearer roadmap as to what to do next so that we may expand our coverage to the uninsured, cover our children, and do it ensuring quality, affordable and accessible care.
