A regulatory body set up to oversee the state’s Medicaid programs, voted 11-0 Wednesday to immediately freeze enrollment in Gov. M. Jodi Rell’s new state-subsidized Charter Oak Health Plan and delay implementation of the HUSKY program, which serves more than 320,000 low-income children and families.
At the conclusion of the two-hour long meeting Wednesday, State Health Care Advocate Kevin Lembo, said the Medicaid Managed Care Council, rarely makes motions and uses its oversight capacity. He said the motion may come as a welcome relief to the Department of Social Services, which scurried to get the insurance plans off-the-ground.
However, relief isn’t what Gov. M. Jodi Rell and her administration had in mind. In a strongly-worded statement released Wednesday afternoon, Rell said, “Let me be crystal clear: Charter Oak and HUSKY are going ahead – on time and on schedule – period.”
Rell said the lawmakers on the Medicaid Managed Care Council “oppose Charter Oak because they know it is working.”
“They oppose Charter Oak because what they really want is ‘universal health care’ at any cost – and they know that cost is $17 billion a year, which Connecticut taxpayers neither want nor can afford,” Rell said.
But lawmakers like Sen. Jonathan Harris, D-West Hartford, said the state-subsidized Charter Oak Health Plan could end up costing the taxpayers more than the $11 million appropriated for the program. Harris said the problem is that there’s a disconnect between what the state is offering to pay the insurance companies to administer the programs and what the insurance companies are agreeing to reimburse the doctors.
Harris held up an Aug. 12 letter from Doug Arnold, the executive director of Middlesex Professional Services Inc., to Rell, as an example of why he thinks the state should delay implementation of the plans.
“If you want Connecticut physicians to provide care to Charter Oak Health Plan enrollees, your administration should work with the legislature and Connecticut physician organizations to offer a plan which reimburses physicians at rates which are market competitive and do not put physicians in economic jeopardy,” Arnold wrote.
Sylvia Kelly of Community Health Networks said there was a misconception on the part of some doctors that the Charter Oak Health Plan was similar to a commercial insurance product.
“The program is not a commercial product,” she said. “The amount of funding doesn’t allow it to pay commercial rates.”
Sen. Mary Ann Handley, D-Manchester, said she wants to know if the insurance companies are reimbursing these doctors and hospitals at different rates.
Aetna Better Health representative Rita Paradis said, “There’s much more to a contract than reimbursements,” but “Yes, there are different payments for different providers.”
State Rep. Vickie Nardello, D-Prospect, stated “that’s created problems for us in the past.” However, as part of their agreement with the state, the insurance companies have agreed to share that information with the state.
State Rep. David McCluskey, D-West Hartford, said he’s heard a lot about the phone calls being made to the Charter Oak hotline, but wanted to know if all those calls translated into enrollment.
Aetna Better Health has enrolled 79 individuals, Americhoice has enrolled 4 individuals, and Community Health Networks has enrolled 54 individuals, representatives from each of the respective companies told the Medicaid Managed Care Council Wednesday.
Based on a handout from the Department of Social Services, as of Aug. 18th, 36 individuals in Hartford, 13 in Litchfield, 37 in New Haven, 21 in Fairfield, 14 in New London, 10 in Windham, 4 in Tolland, and 7 individuals in Middlesex county have enrolled in the Charter Oak Health Plan.
In her statement Wednesday afternoon, Rell said, “More than 6,000 people have already applied for Charter Oak and I am going to make sure they get coverage.”
“I will not allow a tiny minority of legislators to deny people the health care coverage they desperately need,” Rell said.
But the Medicaid Managed Care Council felt Wednesday that there were just too many unanswered questions about the insurance plans and provider networks of doctors and hospitals.
Harris said he thinks the coupling of Charter Oak and HUSKY is holding the more than 320,000 HUSKY children and families “hostage” because doctors are reluctant to join Charter Oak and aren’t being given a choice by the insurance companies. Representatives from the insurance companies said Wednesday that they were aggressively trying to sign up doctors for both programs.
The transition of the current HUSKY population will being Sept. 1 in Middlesex County where enrollees have been mailed letters asking whether they want to switch insurance companies to one of the two new companies, or Community Health Network, which they may already belong to.
Sheldon Toubman, of New Haven Legal Aid, said he wants to warn the HUSKY population in Middlesex County that their options, if they switch to one of the two new insurance companies, may be limited because Americhoice has nine primary care physicians and specialists in the county and Aetna Better Health has 51 primary care physicians and specialists in the county. Community Health Networks has 72 primary care physicians and 199 specialists in that county based on information distributed during Wednesday’s council meeting.
“Enrollees do not have to make a decision to change insurers (or stay where they are) until late November,” David Dearborn, spokesman for the Department of Social Services said Wednesday. “Our customer service staff will provide whatever assistance is needed.”
In terms of the council’s overall discussion Wednesday, Dearborn said, “Unfortunately, not everyone seems to appreciate the fact that Charter Oak is the most important health care initiative in Connecticut since HUSKY was created a decade ago. To go backward now would be harmful to the Connecticut taxpayers who have applied for coverage in a program that was, after all, approved by the General Assembly.”
On Wednesday the council attempted to identify some of the problems with both Charter Oak and HUSKY, which was difficult because the Department of Social Services, which is in charge of administering both programs, was not represented at the meeting. According to Sen. Toni Harp, D-New Haven, Department of Social Services Commissioner Michael Starkowski, was unable attend due to a family emergency and no representative from the state agency was present.
The next Medicaid Managed Care Council meeting will be held 9:30 a.m. Sept. 19.