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Connecticut and the ACA’s Medicaid expansion

Connecticut first to expand Medicaid through ACA; Enrollment is up 48% since 2018

Medicaid expansion in Connecticut

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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 January 2021, 940,768 people were covered by Medicaid in Connecticut. In 2013, before the ACA’s Medicaid expansion was implemented, there were 634,518 people enrolled in Medicaid coverage. So enrollment had grown by about 48% in seven years, with Medicaid expansion and the COVID pandemic being the primary driver of the growth.

According to an analysis by Charles Gaba, Medicaid expansion enrollment in Connecticut has grown by 22% during the COVID pandemic, and overall Medicaid enrollment in the state is up 15% during the same time period.

Nationwide, enrollment in Medicaid increased sharply during the pandemic, due to job/income losses as well as the Family First Coronavirus Response Act. That legislation provides additional federal Medicaid funding to states, but only as long as they don’t terminate any Medicaid enrollees’ coverage during the COVID public health emergency. The PHE is expected to last through the end of 2021, but up to 10 million Americans could lose their Medicaid coverage once the COVID public health emergency ends and eligibility redeterminations are restarted.

Connecticut Medicaid structure

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 2021).

  • HUSKY A covers low-income children, parents and other caregivers, and pregnant women (57% of enrollees; 29% 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 (10% of enrollees; 38% of total costs).
  • HUSKY D covers low-income adults who don’t have children; ie, the Medicaid expansion population (33% enrollees; 33% 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 Connecticut Department of Social Services updated the data for 2020 in this report, which includes details about the impact of the COVID pandemic.

Who is eligible for Medicaid in Connecticut?

Depending on the reason for eligibility, Connecticut residents can qualify for Medicaid based on income alone, or a combination of income and assets. For children, pregnant women, parents of minor children, and childless adults up to age 64, eligibility is based on income, with income limits that vary for each group. For the aged, blind, and disabled, eligibility rules are stricter, with both income limits and asset limits.

What is the maximum income for Medicaid in Connecticut?

The income limits for Medicaid (HUSKY) coverage vary depending on whether the person is qualifying as a child, pregnant woman, parent of a minor child, childless non-elderly adult, or aged/blind/disabled. For the groups that qualify based on income alone, eligibility is determined as a percentage of the federal poverty level (FPL). You can see the 2021 FPL numbers here. As of 2021, Connecticut Medicaid eligibility standards are:

HUSKY A

  • 196% of FPL for children, ages 0-18
  • 258% of FPL for pregnant women
  • 155% 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 (CHIP)

  • 318% of FPL for children

HUSKY C/MED-Connect

HUSKY D

  • 138% of FPL for childless adults

How does Medicaid provide financial assistance to Medicare beneficiaries in Connecticut?

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.

Our guide to financial assistance for Medicare enrollees in Connecticut includes overviews of these programs, including Medicaid long-term care benefits, Extra Help, and eligibility guidelines for assistance.

How to enroll in Medicaid in Connecticut?

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.

Changes to Connecticut Medicaid eligibility guidelines for parents

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 the full cost for this newly-eligible population, although the states began paying a portion of the cost in 2017, and now pay 10% of the cost (the 90/10 federal/state funding split will remain in place going forward). 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% of the poverty level to 155% 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% of them had enrolled in plans through Access Health CT. As of 2018, the estimate was that roughly 80% 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% 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% 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% of the poverty level for a household of three is $30,305 in 2021. And 155% of the poverty level is $34,038 for a household of three. So parents earning a few extra thousand dollars no longer need to worry that they’re going to lose their health insurance.

Connecticut a frontrunner in Medicaid expansion

Connecticut is one of 37 states and DC that have expanded Medicaid coverage to childless adults through an optional component of the Affordable Care Act.

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% 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. KFF also estimated that, with Medicaid expansion, about 38% of those 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.

But as of January 2021, 940,768 people were covered by HUSKY Health, up from 634,518 total enrollees in 2013. As noted above, this growth was driven primarily by Medicaid expansion coupled with the COVID pandemic.

Connecticut Medicaid history

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 2019, Connecticut was one of only four states with zero percent of the Medicaid population enrolled in managed care plans, and the state continues to use a fee-for-service approach as of 2021. The state notes that administrative costs for HUSKY Health are just 4.5%, and estimates that they would be 10% if the state were to use a managed care approach to Medicaid. 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.

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Apply for Medicaid in Connecticut

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. 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

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