Connecticut and the ACA’s Medicaid expansion

Connecticut first to expand Medicaid through ACA; 2nd round of cuts to eligibility for parents was averted in 2018

connecticut Medicaid guide

Medicaid expansion in Connecticut

Through a well-functioning state-run health insurance marketplace and a generous Medicaid program, Connecticut has shown commitment to helping its residents obtain health insurance. In 2010, Connecticut was the first state to adopt Medicaid expansion, and it again expanded eligibility criteria for the program at the beginning of 2014.

As of August 2018, 845,892 people were covered by HUSKY (Medicaid/CHIP) in Connecticut. This was about a 12 percent increase since the summer of 2016. And in 2013, before the ACA’s Medicaid expansion was implemented, there were 634,518 people enrolled in HUSKY coverage. So enrollment has grown by about 33 percent in the five years from 2013 to 2018, with Medicaid expansion being the primary driver of the growth.

How Medicaid is structured in Connecticut

Connecticut’s Medicaid program is called HUSKY Health, and it is broken into several categories (enrollment and cost data based on a report published in 2018).

HUSKY A covers low-income children, parents and other caregivers, and pregnant women (60 percent of enrollees; 29 percent of total costs).

HUSKY B covers children with incomes too high for HUSKY A. HUSKY B is also called the Children’s Health Insurance Program, or CHIP.

HUSKY C covers individuals who are aged, blind or disabled and who qualify based on income and asset levels, and MED-Connect is Medicaid for employees with disabilities (11 percent of enrollees; 46 percent of total costs).

HUSKY D covers low-income adults who don’t have children (29 percent of enrollees; 25 percent of total costs).

In 2015, Arielle Levin Becker of the Connecticut Mirror published an excellent description of how the four parts of HUSKY work, who’s enrolled, and how much the programs cost. The data are updated for 2018 in this report, published by the Connecticut Department of Social Services.

Who qualifies for Medicaid in Connecticut?

As of 2018, Connecticut’s eligibility standards are:

HUSKY A
196 percent of FPL for children, ages 0-18
258 percent of FPL for pregnant women
155 percent of FPL for parents of dependent children (see more details below; this used to be higher prior to 2015, was reduced even further in 2017, and restored to this level in 2018)

HUSKY B
318 percent of FPL for children

HUSKY C/MED-Connect
See income and asset criteria for aged, blind and disabled beneficiaries.

HUSKY D
138 percent of FPL for childless adults

How to apply

To apply for HUSKY A, B or D:

  • Online at www.accesshealthct.com, under Get Health Coverage
  • By mail: call 1-877-284-8759 to have an application mailed to you
  • By phone at 1-855-805- 4325 (Access Health CT call center)

To apply for HUSKY C and Medicaid for Employees with Disabilities:

  • Online at www.connect.ct.gov, under Apply for Benefits
  • By mail: print an application in English or Spanish and mail it to DSS ConneCT Scanning Center, P.O. Box 1320, Manchester, Connecticut 06045-1320. For help completing the form, call 1-855-626-6632.
  • For long-term care benefits, complete an application in English or Spanish and submit it to the Long-Term Care Application Center for your county.

New eligibility guidelines for parents: Income cap reduced in 2015, but the subsequent reduction in 2017 has been reversed

In 2014, childless adults became eligible for Medicaid coverage (HUSKY D) as a result of the ACA’s expansion of Medicaid. The federal government initially paid 100 percent of the costs for this newly-eligible population, although the states began paying a portion of the cost in 2017, and will pay 10 percent of the cost by 2020 (the 90/10 federal/state funding split will remain in place after 2020). This program — Medicaid expansion under the ACA — is not changing.

But HUSKY A eligibility guidelines have changed for parents with dependent children. In an effort to trim costs, the state reduced the upper income limit for HUSKY A (only for parents) from 201 percent of the poverty level to 155 percent of the poverty level. For new enrollees, the change was effective August 1, 2015. For existing enrollees, the change became effective August 31, 2015 if they did not have earned income from a job. For those who did have earned income from a job, the new eligibility guidelines became effective August 1, 2016.

The state noted that parents who were dropped from the HUSKY A rolls had access to subsidized coverage through Access Health CT, but advocates point out that there are considerably higher out-of-pocket costs for private plans in the exchange than there are with Medicaid. The Connecticut Mirror reported that as of September 11, 2015, only 140 out of 800 people who had lost coverage at the end of August had enrolled in new coverage through Access Health CT.

In May 2016, Access Health CT, the state-run exchange, announced that they were partnering with other state agencies to reach out to people who were going to lose access to HUSKY A on August 1, in an effort to get them signed up for new coverage (including, in some cases, other “Medicaid-funded assistance”). About 14,000 people were slated to lose coverage as of August 1, and by mid-July, only about 26 percent of them had enrolled in plans through Access Health CT. The enrollment period triggered by loss of coverage continued through August and September, although there would be a gap in coverage for people who enrolled after the end of July. As of 2018, the estimate was that roughly 80 percent of the people who lost HUSKY A coverage as a result of the lower income cap had ended up uninsured.

In 2017, legislation was enacted to again reduce the income cap for HUSKY A eligibility, to 138 percent of the poverty level (the same as the income cap for Medicaid eligibility for childless, non-elderly adults under the ACA’s Medicaid expansion). This change took effect in January 2018, but people with income from employment (ie, most enrollees) had one extra year of coverage, so the new rules weren’t going to take effect for most enrollees until January 2019.

But in May 2018, the state enacted a budget that reversed the HUSKY A eligibility cuts. As of July 2018, the HUSKY A income cap for parents was restored to 155 percent of the poverty level. Parents who had lost coverage as of January were eligible to re-enroll, although most parents hadn’t yet lost coverage (because they had income from employment).

For perspective, 138 percent of the poverty level for a household of three is $28,676 in 2018. And 155 percent of the poverty level is $32,209. So parents earning a few extra thousand dollars no longer need to worry that they’re going to lose their health insurance.

A frontrunner in Medicaid expansion

Connecticut is one of 36 states and DC that have expanded Medicaid coverage to childless adults through an optional component of the Affordable Care Act (DC and 31 of those states had already implemented Medicaid expansion as of 2018; Virginia’s Medicaid expansion takes effect January 2019, and the other four states — Utah, Idaho, Nebraska, and Maine — are expected to implement Medicaid expansion in 2019 as a result of ballot initiatives passed by voters).

Connecticut took a two-step approach to expansion. In 2010, the state launched its HUSKY D program by transitioning very low-income adults from the State Administered General Assistance (SAGA) medical program into Medicaid. In 2014, it further expanded coverage for childless adults by raising the income limit to 138 percent of FPL, utilizing federal funding from the ACA to increase the eligibility threshold.

In January 2014, the Kaiser Family Foundation estimated that about 286,000 people in Connecticut were uninsured. Kaiser also estimated that, with Medicaid expansion, about 38 percent of the 286,000 would qualify for either Medicaid or CHIP. In an October 2014 press release, Access Health CT (the state-run marketplace) estimated that 147,000 Connecticut residents were still uninsured. Medicaid enrollment through Access Health CT was 138,908 during the first open enrollment period, but grew substantially to 277,336 during the second open enrollment period. After that, HHS stopped reporting how many people had enrolled in Medicaid through the exchanges.

As of August 2018, 845,892 people were covered by HUSKY in Connecticut, up from 634,518 total enrollees in 2013.

History of Medicaid in Connecticut

Connecticut implemented Medicaid in July 1966, one year after the program was enacted at the federal level through Title XIX of the Social Security Act.

Unlike many states that are increasingly using Medicaid managed care to provide health coverage to low-income beneficiaries, Connecticut dropped its managed care contracts in 2012. Ellen Andrews, executive director of the Connecticut Health Policy Project, credits the change with increasing access for beneficiaries, improving quality, and reducing costs.

As of 2016, Connecticut was one of only two states with zero percent of the Medicaid population enrolled in managed care plans. The state notes that administrative costs for HUSKY Health are just 3.2 percent. Although the program is self-insured, the state contracts with four administrative services organizations to administer HUSKY Health. Compared with national averages, HUSKY Health has had considerable success in controlling costs and reducing per-enrollee spending in Medicaid.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

How to apply in CT

For HUSKY A, B or D: online at accesshealthct.com, under Get Health Coverage; by mail (call 1-877-284-8759 to have application mailed to you); by phone at 1-855-805- 4325 For HUSKY C and Medicaid for Employees with Disabilities: online at connect.ct.gov, under Apply for Benefits; submit application in English or Spanish by mail to address listed below. For long-term care benefits, submit application in English or Spanish to the Long-Term Care Application Center for your county.

Eligibility: HUSKY A: Children ages 0-18 with incomes up to 196% FPL; pregnant women with incomes up to 258% FPL; parents of dependent children with incomes up to 155% of FPL (for parents who were already enrolled in HUSKY prior to August 2015, and who have earned income from a job, the household income limit will continue to be 201% of FPL until August 1, 2016 - see more details below). HUSKY B: Children up to 318% of FPL HUSKY C/MED-Connect: Aged, blind and disabled beneficiaries who meet income and asset criteria HUSKY D: Childless adults with incomes up to 138% of FPL

Connecticut section

General overview

Exchange/Marketplace

Medicare

Medicaid Expansion

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