HARTFORD, CT – An advocate for the disability community is raising alarms over the budget implementer bill the legislature is debating today based on changes he says it will make in how – and in many cases, whether – disabled people will access healthcare.
The advocate, Sheldon V. Toubman, a litigation attorney for Disability Rights Connecticut, says the Lamont administration and Democratic leaders at the legislature have put forward language in the implementer bill – House Bill 5523 – that circumvents the public process and makes “cruel” changes to Medicaid that will make thousands of poor, disabled people ineligible for their current healthcare. He said the changes in the bill violate the state constitution.
Sen. Matt Lesser, a Middletown Democrat who also co-chairs the Human Services Committee, shared many of Toubman’s concerns in an interview Monday night, particularly in light of the state’s current surplus of funds that are sequestered behind its fiscal guardrails.
Toubman said the bill changes the language in existing law to decrease the income limits for people utilizing both HUSKY A and HUSKY C, in effect making thousands of the state’s poor, including disabled residents, ineligible for the two Medicaid programs.
“Thousands of low-income disabled people and older adults, disproportionately Black and Brown people, will be denied access to Medicaid, and incur more medical debt or just go without needed health services (including services needed to prevent institutionalization), as a direct result,” Toubman said via email.
He decried both the Lamont administration as well as the leadership of the majority Democrats in the General Assembly for the bill’s language and its impact.
The Lamont administration did not immediately respond to a request Monday for comment on this story.
“It is quite outrageous that the Governor and legislative leadership would, behind the scenes, negotiate to overrule the decision made by the Human Services Committee to reject this proposed cut by the Governor (HB 5053) and agree to affirmatively reinstate discrimination against people with disabilities, a marginalized group expressly protected by the state constitution, in Article I, Section 20, thus exacerbating health disparities, at a time of huge budget surpluses,” Toubman wrote.
He continued: “It is a sad state of affairs that the niceties of applying the arbitrary spending caps would drive such an unfortunate decision, pushing CT backwards in the effort to address discrimination and address health disparities for people with disabilities and Black and Brown people, when there is plenty of excess revenue (and even more are recently reported) to prevent this harm.”
Additionally, Toubman said that the bill changes the state Department of Social Services’ time limit for providing prior authorization for prescription drug purchases from two hours to 24 hours – a change that both Toubman and Lesser said was made without a public hearing or the Human Services Committee’s consideration. Toubman said that change will mean that a lot of disabled residents will have to make multiple trips to the pharmacy, which is often difficult for disabled people, and he said Medicaid does not pay for transportation to the pharmacy.
“None of this was discussed at a public hearing because the Lamont administration chose to subvert the democratic process by not proposing a bill for review and a hearing by the Human Services Committee, where this could all be discussed and thrashed out, including any possible 3rd-way solutions,” Toubman said.
Monday, the Senate Democrats’ office responded via email to Toubman’s concerns, reiterating that the HUSKY changes were in the governor’s budget. In addition, they said:
- The HUSKY A change will move 20,000 people off of HUSKY A. But they retain their HUSKY A coverage for a year, and so technically won’t be off HUSKY A until July 1, 2025 (2026 fiscal year). Also, moving them off of HUSKY A allows them to get coverage through Covered CT, which is a new program insurance program for the poor.
- HUSKY C had a drafting language error in last year’s budget bill that was quickly discovered after it was signed. It was decided that the erroneous language would be corrected in the second year of the budget to actually comport with the amount of money that was put in the budget.
- Regarding the change from two hours to 24 for the DSS to act on prescription drug authorizations, Medicaid patients still get a 14-day supply of those meds at the point of purchase regardless of the timing of the authorization. “And the goal of this longer 24-hour time frame is for DSS to find a cheaper and sometimes more effective generic drug in order to save money, because Connecticut spends much more on Medicaid prescription drugs than our neighboring New England states.”
Toubman said elderly and disabled people on Medicare are “ineligible for any federal subsidies on the exchange,” and as such that makes Covered CT an unaffordable option for them. He said Covered CT can only be used for people who have federal subsidies.
“These individuals will be completely shut out of the exchange/Covered CT, period,” Toubman said.
He also said Covered CT is not the same level of healthcare that is offered through the HUSKY programs.
“There are many Medicaid-covered services that are not covered at all under the exchange/Covered CT,” Toubman said. “It is a long list but includes long-term care, a much broader array of behavioral health services, broad coverage for durable medical coverage, etc. – these services will now have to be paid for out of pocket or, much more likely given their low income status, go unprovided.”
He said coverage under Medicaid through HUSKY A is far superior to whatever one can get on the exchange, including with Covered CT.
“There is no plan to compensate harmed individuals for what they will lose from this forced transfer following the termination of all Medicaid coverage,” Toubman said. “If there were, those costs would probably exceed the projected savings from this severe cut.”
Lesser on Monday confirmed most of what Toubman said.
“At a time when the state is flush with cash, it is incongruous that we are making it hard to access healthcare in some cases,” Lesser said. “There’s certainly a lot to be proud of in the budget with respect to improving access to care, including for people with disabilities, but these cuts are real and certainly they weren’t the direction that many of us on the Human Services Committee wanted to go in.”
Asked about the difference between the HUSKY programs and Covered CT, he said it’s hard to make an apples to apples comparison.
“Because in some ways Covered CT is better, and in other ways it may not offer some things that Medicaid offers. The intent was to create a parallel or equivalent system,” Lesser said. “It’s hard to make a general statement. In general though, Covered CT has a bigger provider network. That is something.”
Lesser said the access issues Toubman has raised are important.
“I take seriously his concerns about access for people with disabilities,” Lesser said. “Covered CT is still new but I think most people are better off if they switch, but not all people. And there are certainly concerns about Covered CT’s longterm viability because it depends on federal subsidies.”
Lesser described the Covered CT program as a hybrid of Medicaid and the Affordable Care Act.
“One of the things President Biden did is expand federal subsidies, so we’re really dependent on those federal subsidies to make the math work,” Lesser said, adding that those had been extended once, but they are not permanent.
If the election goes the wrong way, he said, those subsidies could disappear.
Lesser said he thinks the 2 to 24 hour change in DSS’s prior authorization time limit for prescriptions is the biggest.
“That never received a public hearing. We don’t really know the impact of that on folks. It hasn’t been fully vetted. But it’s happening anyway. The governor and his budget team pushed very hard,” Lesser said. “It’s just striking that we’re making these cuts when the state’s fiscal position is actually quite rosy, and we’re not making any investments in improving reimbursement rates, except for children’s mental health providers, but that’s not the only issue out there.”
