(Updated) After a month delay, Gov. M. Jodi Rell said she will tell the federal government Connecticut is ready to sign an agreement to administer a federally funded high-risk insurance pool for individuals with pre-existing medical conditions.
The move comes a month later than expected, but during that time the Rell administration worked with the federal government to lower the insurance rates by 35 percent.
Earlier this month U.S. Sen. Chris Dodd criticized Rell’s decision to seek a further review of the program and warned that any delay means uninsured residents with pre-existing conditions will go without the coverage intended under the new federal health care law.
As Dodd predicted, the delay did push coverage in the new program for Connecticut residents back from Aug. 1 to Sept. 1. If things had gone as planned enrollment would have begun July 1 and coverage would have started Aug. 1. However, Dodd wasn’t critical at all Tuesday morning when he learned of the states plans.
“This is welcome news for uninsured Connecticut residents with pre-existing conditions,” said Dodd. “One of the top priorities of health-care reform was to end discrimination against people with pre-existing conditions and these pools are one step towards that goal. I’ll continue to work with Governor Rell and federal officials to get this program up and running as quickly as possible.”
Rell delayed enrolling the state in the plan because she felt the premiums of $436 per month for adults younger than 30 to $1,365 for those 65 and older, were too high and unaffordable. She said three state agencies were able to work with the federal government on a new methodology to get the rates down to $285 per month for adults under 30 to $893 for those 65 and older.
“I believe the contrast in rates represents the difference between a program that was out of reach for those who needed it most and one that will truly meet a need,” Rell said. “Along with the Charter Oak Health Plan I developed, Connecticut is leading the nation in providing coverage to those who do not have it or cannot find it.”
Rell’s Charter Oak Health Plan already covers uninsured adults with pre-existing conditions. The program used to be subsidized by income level and still is for enrollees that were grandfathered in, but for new enrollees there’s a flat $307 monthly premium.
Whether it’s $285 per month or $307 per month, Ellen Andrews, executive director of the Connecticut Health Policy Project, wonders if that’s affordable for some of her clients.
But even more concerning for Andrews is that the state will be administering the $50 million in federal funding for the program. She said the state had the opportunity to let the federal government operate the program like 21 other states have done, but it decided to take on this program in addition to the dozens of others it runs.
The state has done a poor job enrolling patients and doctors in Primary Care Case Management, a non-HMO model of health care delivery for those on the state’s Medicaid plan, Andrews said.
The state agencies, “don’t have time for this,” Andrews added. “They haven’t been able to implement PCCM, among other things, mandated by the legislature because they claim that they don’t have the manpower to do everything.“
“If the feds are willing to do this (and will doubtless do a better job), why wouldn’t DSS [Department of Social Services] let them and get on with their own job,” Andrews said.
Currently there are 12,300 individuals covered by Charter Oak, but the Department of Social Services was unable to provide statistics on how many doctors and hospitals are participating in the plan. One of the biggest complaints of participants is that they have to drive further or can’t find a doctor or hospital that accepts the program.
It’s unclear how many residents may qualify for the new Pre-existing Condition Insurance Plan or exactly what kind of coverage and benefits it may provide.
According to a June presentation made to the Medicaid Managed Care Council, the Pre-existing Condition Insurance Plan will have annual deductibles ranging from $1,250 to $3,000 for individuals and $2,500 to $6,000 for families. It’s unclear what the co-pays will be, but state officials estimated that on average the maximum out of pocket cost is $7,000 plus co-pays.
The plan would be administered by United Health Care, which the Department of Social Services noted has contracts with all Connecticut hospitals and 90 percent of Connecticut physicians and practices. It also noted the network is broader than that of the Charter Oak Health Plan.
In order for individuals to qualify for the federal program they must have a pre-existing condition and be uninsured for up to six months. Since the Charter Oak Health Plan counts as insurance, those on the state plan won’t be able to enroll in the federal program unless they drop their coverage.
The federal government’s Pre-existing Condition Insurance Plan is intended as a stop gap measure to cover the highest risk adults for more than three years until the Patient Protection and Affordable Care Act is fully implemented in 2014.