Reduction of health care benefits, asset tests, and a potential cap on enrollment are all things health care advocates expected from Republican administrations, so they were more than concerned and a little surprised when the Malloy administration submitted a “concept paper”  that proposed all of those things.

The “concept paper” submitted to the Centers for Medicaid and Medicare Services says the Medicaid program for low-income adults has become a “strain” on the state’s budget. It goes onto say that in the first year alone the caseload has grown nearly 60 percent resulting in a deficit of $139 million.

“For this reason, we have explored various mechanisms to control growth such as imposition of an asset test, counting family income for 19 and 20 year olds, limiting skilled nursing facility admissions to 90 days, and establishing an alternative benefit package,” Department of Social Services Commissioner Roderick Bremby wrote in his Oct. 27 letter.

That got the attention of the State Health Care Advocate Victoria Veltri and advocates from 13 different organizations, who decided to offer their own response to Bremby‘s proposal.

Veltri called   the concept paper “extreme in design” and said it would “shred the safety net for the over seventy thousand people currently enrolled in the program.”

“Whether it is through harmful benefit reductions, caps on enrollment, new utilization management requirements or asset tests that force people from the program, the concept paper takes us in the opposite direction from where the state should be heading,” Veltri said.

She said there’s a reason Medicaid is not a commercial product with limited benefits and that’s because lower income populations tend to be less healthy.

Most offensive to advocates was the proposal to allow the state to cap enrollment in the program.

In a letter to Bremby and Gov. Dannel P. Malloy they said that “represents not only a violation of established Medicaid policy but a reversal of a long commitment by Connecticut to meeting basic health care needs.”

“Similarly, the proposal to count family income in establishing eligibility for health care programs for adult children is a break with established state practice,“ the letter says. “Requiring the counting of family income against adults for whom their families have no financial responsibility is inconsistent with established Medicaid eligibility rules.”

But Bremby said Thursday that the expenditures of the program “were beyond anyone’s expectations.”

“At the last deficiency hearing we reported the LIA population leveled off at about 70,000 and we want to keep our eye on it to make sure it doesn’t escalate on us,” he said. “We also were asked by the legislature to develop a report, a white paper, to determine how we were to contain LIA costs and so we did that.”

He said they’re asking the federal government to take a look at it and help them determine what they can and can’t do with the program.

“It’s not a white paper that suggests we’re going to implement any of those, but we did put a timeline in that white paper with CMS to try and get a quicker review,” Bremby said Thursday after the commissioner’s meeting.

“We recognize that the LIA program has expanded faster than anticipated and that DSS has not realized the anticipated savings in the state budget. But the rapid expansion is probably an indication of the great and expanding need in a difficult economy,” advocates wrote in their letter. “In any event, the reduction in the number of uninsured through the growth of this program should be seen as an important success by your administration, in an area where few other states have made headway.”

They said if the administration moves forward with any of these advocates contend it “would be a first step in dismantling, rather than protecting, the safety net and health care for very low-income people.”

Connecticut was the first state in the nation to embrace the new federal health reform law which allowed it to move 45,000 low-income adults from a state sponsored program to one which receives a 50 percent match in funds from the federal government.