As I discussed in my October 31, 2011 entry, Connecticut is moving toward a new model of health care delivery for people on Medicare who also qualify for Medicaid because of their low incomes: the so-called  “dual eligibles.”  That plan is moving forward, but will be more consumer friendly thanks to coordinated advocacy spearheaded by New Haven Legal Assistance Association (NHLAA).

As state and federal care reform move forward, we are optimistic that the number of uninsured will go down and care can be provided more efficiently. We are also vigilant in monitoring the reforms, so that meaningful access to care for low-income individuals can be maintained and improved.  NHLAA has had some recent success in moving reform forward and also away from a more problematic proposal.

The Malloy Administration took a major step forward in February, when, adopting a position advocates had pursued for several years (see http://uwgnh.org/blog/new-day-healthcare-husky-alternative-hmos),  it announced that it would end its contracts with three “capitated” insurers under the HUSKY program (coverage for low-income families and children) and instead contract with an entity on an administrative fee basis only.  What this means is that there will no longer be an insurance company paid a fixed amount of money per member per month for providing all health care for a set of Medicaid enrollees. Under such arrangements, the insurers often denied access to needed care because the cost of that care came out of their bottom lines.  For example, one of these state contractors did not provide needed hours of home health care to a child born with cerebral palsy and significant cognitive and physical limitations. The insurance company unlawfully claimed that the care was “custodial” as a basis for limiting the hours.

For the last several years, I have advocated for the State of Connecticut's adoption of the Primary Care Case Management model, “PCCM”, for HUSKY, Connecticut’s Medicaid program that provides health coverage for low-income children and families. PCCM does not involve insurance companies or HMOs. Under it, primary care providers are paid extra to coordinate care and keep their patients out of more expensive settings. This Medicaid model could deliver better quality care at a lower cost.