Connecticut Charter Oak Plan Adding Providers; Some Are Concerned Reimbursement Rates Are Too Low

Main Category: Health Insurance / Medical Insurance
Also Included In: Public Health;  Primary Care / General Practice
Article Date: 24 Sep 2008 - 9:00 PDT

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Seven hospitals and 4,029 primary care physicians have signed up to participate in Connecticut's Charter Oak Health Plan, state officials said at a briefing on Friday, the Hartford Courant reports. Gov. Jodi Rell (R) hopes the program eventually will enroll about 19,000 state residents who cannot afford insurance but who have annual incomes that make them ineligible for HUSKY, the state's Medicaid program. The state began marketing the plan on Aug. 1. State Social Services Commissioner Michael Starkowski said that he is "confident" the program's networks will meet the needs of all HUSKY beneficiaries before they are transferred into Charter Oak.

Only one of the three networks contracted to operate Charter Oak plans had a pre-existing network of physicians and hospitals, the Courant reports. In addition, many doctors are "balking at joining" the networks because of low reimbursement fees, according to the Courant. Most private plans pay $88 for an office visit, but Charter Oak contractors are offering family doctors $37.48 -- a $35 copayment from patients and $2.48 from the state, according to Doug Arnold, executive director of Middlesex Professional Services. He added, "With what they are proposing to pay, it is not economically feasible to take on new patients." Pediatricians and obstetrician-gynecologists are paid at a higher rate, he noted. The low reimbursements are required to meet Rell's goal of keeping premiums at $250. Charter Oak also caps benefits at $100,000 annually (Pazniokas, Hartford Courant, 9/20). Critics also warn that with deductible as high as $900, the program will not be able to attract the young, healthy members needed to stabilize costs (AP/Hartford Courant, 9/22).

The program has enrolled 843 beneficiaries, and nearly 10,000 people have applied. Some lawmakers have expressed concern that trying to transfer too many state residents to the program before adequate provider networks are available could limit access to care for beneficiaries. Starkowski said residents enrolled in HUSKY will not be forced into Charter Oak until the networks are adequate (Hartford Courant, 9/20).

Kevin Lembo, Connecticut's health care advocate, said he is concerned that some businesses could drop their employee health insurance programs, which could lead thousands of additional state residents to enroll in Charter Oak (AP/Hartford Courant, 9/22).

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