Connecticut gives priority to special-needs services as part of major expansion of insurance for children
Connecticut Kids Insurance
December 31, 1997
Connecticut is going way beyond the basics with its new health insurance program for children. The state is using a portion of the federal child health insurance funds available over the next five years, not only to provide subsidized health insurance coverage to some 22,000 non-Medicaid-eligible children, but also to meet the needs of a small percentage of children who "require extraordinary services."
Coupled with a Medicaid expansion and better outreach, the state hopes to insure 90,000 additional children.
Connecticut has created the HUSKY (Healthcare for Uninsured Kids and Youth), Part B program, which will offer children who are not eligible for Medicaid the same rich package of benefits offered to state employees.
In addition, special needs children will be able to qualify for HUSKY Plus, a package of wraparound services that will supplement and enrich the services available through the core health plan.
This Husky Plus supplemental insurance will have two components: The HUSKY Plus Behavioral Health Plan will provide case management, intensive in-home child and adolescent psychiatric services and mobile crisis services. The HUSKY Plus Plan for Children with Special Physical Needs will cover durable medical equipment, hearing aids and many services such as speech therapy, respiratory therapy, diagnostic services above and beyond the basic health plan.
Early estimates are that 5-10% of children will use one or two of the wraparound programs.
Eligible population
Under the new HUSKY program, the state will pay the full premium cost for children between 185% and 235% of the federal poverty level (FPL). Families with incomes between 235% and 300% will pay a $30 premium (the maximum allowed by the legislation is $50).
Children in families with incomes over 300% of FPL may sign up for the basic HUSKY program if they pay the full premium, but not for the HUSKY Plus programs. About 14,000 children whose family incomes exceed 300% of FPL could join the program. Connecticut has opted to include coverage of pre-existing conditions in its new health insurance program.
The state also is making a major effort to enroll some 51,000 children in Medicaid who are eligible, but not enrolled. The state recently expanded eligibility to all children under 18 with family incomes below 185% of FPL and will now market the Medicaid program as HUSKY, Part A.
Michael Starkowski, deputy commissioner, Department of Social Services, said this approach will allow the state to combine its marketing and outreach efforts, and may lessen the stigma often associated with applying for Medicaid. One enrollment broker will do the initial screening of both Medicaid and non-medicaid-eligible children,although the benefits packages remain separate.
Special needs children
The state has already chosen the administrators for both HUSKY Plus programs. The Yale Child Study Center will provide assessment services and case management services for behavioral health, and will organize a statewide network of providers. It also will be responsible for reimbursement .
Connecticut Children’s Medical Center will jointly administer the supplemental program for children with special physical health needs, with the Yale New Haven Children’s Hospital and the Yale University School of Medicine .
A request for proposals for the basic HUSKY, Part B program will be released in early January.
The state has allocated about $18.3 million to cover the costs for HUSKY, Part B, HUSKY Plus and the expanded Medicaid program. About 65% of the total costs will be paid for with federal funds through the new State Children’s Insurance Program. Mr. Starkowski estimates costs for the two HUSKY Plus programs at about $5 million.
Eligibility for HUSKY Plus programs will be determined by the child’s severity of illness, level of functional impairment and the intensity of need. There will be no added premium costs for families whose children qualify for HUSKY Plus.
According to Mr. Starkowski, one of the keys to making the two-tiered coverage work is a high level of collaboration between the managed care organizations responsible for the basic benefit package and the administrators of the HUSKY Plus plans.
Goals for this collaboration are to provide services in the least restrictive setting and to help families get the best possible use out of the benefits in their primary insurance plan.
"We’ve worked out a protocol to do some real healthy up-front collaboration. This is a golden opportunity to finally do things the right way for these kids."—Cole
"We wanted supplemental benefits to be like a wraparound to prevent children from using up basic benefits," said Joseph Woolston, MD, a member of the team at the Yale Child Study Center which will administer the behavioral health program. "That would be better for everyone."
One of the pitfalls of this two-tiered coverage is the risk of cost-shifting.
Case management
Case managers from both HUSKY and HUSKY Plus will jointly coordinate services for the children, who simultaneously will receive benefits under both programs. However, utilization managers for each plan will have the final decision-making authority for those services for which they are at risk.
"We had a lot of trepidation that the MCOs would build a wall," arguing that they should be solely responsible for case management, but, at least in the initial stages, there seems to be cooperation, said Mr. Starkowski.
He stressed that the state is depending on "good faith" collaboration between the case managers to provide care to the patients in the least restrictive setting, limit the potential for cost-shifting, and make the most efficient use of the child’s benefits.
To increase flexibility in the children’s treatment programs, up to 35 of 60 inpatient days covered by MCOs under the basic HUSKY program may be converted into outpatient days. The formula would allow each inpatient day to be converted into 1-3 outpatient days, depending on the intensity of the service.
Physical Services
Molly Cole, director of the family center at the Connecticut Children’s Medical Center, said that an individual care plan will be developed for each child in HUSKY Plus for physical services. With the participation of the family, it will be decided up-front which services will be covered by the HUSKY plan and the HUSKY Plus plan and what other agencies might be involved.
"We’ve worked out a protocol to do some real healthy up-front collaboration," she said."This is a golden opportunity to finally do things the right way for these kids." In the past, she said, "a lot were falling between the cracks."
Keith Stover, lobbyist for the Association of Connecticut HMOs, said members are excited about the "groundbreaking" approach of the Connecticut program, although they are concerned that the state maintain adequate funding in the future. "It’s an extraordinary rich benefit package," he said, noting that the benefits are similar to the high-end package for state employees.
"A good start"
Ann Steele, director of public policy for the Mental Health Association of Connecticut, said she believes the state has made "a good start," but said she has many questions. For instance, she said there is no definition of medical necessity in the HUSKY Plus plan for behavioral health. The current proposal also is unclear about how long children will receive services and how they will be terminated as well as which medications will be covered, she said. She also expressed concern about how care will be coordinated for children eligible for both HUSKY Plus programs.
Contact Ms. Cole at 860-545-9023, Ms. Steele at 860-529-1970, Mr. Starkowski at 860-424-5053 and Mr. Stover at 860-275-8385. Dr. Woolston can be reached at [email protected].
Connecticut gives priority to special-needs services as part of major expansion of insurance for children
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