CMS Wants Connecticut To Make Sure Medicaid Beneficiaries Know They Do Not Have To Switch Insurers

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance
Article Date: 14 Nov 2008 - 9:00 PST

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CMS has asked Connecticut health officials to clarify to HUSKY Health beneficiaries that they are not required to switch to new insurers by the end of December, the New Haven Register reports. HUSKY is the state's Medicaid program (O'Leary, New Haven Register, 11/11). Last month, Gov. Jodi Rell (R) announced that she has postponed until February 2009 the mandatory switch for 345,000 low-income HUSKY beneficiaries to new insurers. Rell's administration proposed the switch as a way to encourage insurers to participate in the new Charter Oak Health Plan for adults. However, Aetna Better Health and AmeriChoice -- two of the new insurers that would cover the HUSKY beneficiaries -- have had difficulties in setting up adequate provider networks (Kaiser Daily Health Policy Report, 10/27).

Mary Kahn, a spokesperson for CMS, said, "Our concern is that people not be given the impression that they have to switch to networks we don't think are ready." Kahn said that while the insurers' provider networks are improving, they are not yet sufficient. She added that a key concern is the loss of Anthem BlueCare, which will stop providing services in the state on Dec. 31. "With Anthem [BlueCare] bailing out, there are no out-of-network options for [HUSKY clients]," she said. Kahn said that CMS will continue to observe the situation, adding that if HUSKY beneficiaries do not have sufficient network options to choose from by the end of the year, "we will deal with it then. We just have to take it a day at a time."

As of Friday, 14,476 beneficiaries had moved to Aetna Better Health; 3,027 had moved to AmeriChoice; and 25,437 had moved to the Community Health Network of Connecticut, according to David Dearborn, a spokesperson for the state Department of Social Services.

Meanwhile, Sheldon Toubman, an attorney with New Haven Legal Aid Assistance, in a letter to CMS called on the agency to stop the voluntary switching of beneficiaries until the new networks are in place. He wrote that federal rules require insurers to document adequate provider networks at the time of enrollment with no distinction made between voluntary and mandatory enrollment.

The state's health care advocate Kevin Lembo also has asked the state to allow beneficiaries to switch from their new insurers to their previous coverage and said the popularity of CHNCT is unfair to the other insurers and fails to provide real choices for beneficiaries. He added that Charter Oak is unable to provide "timely and geographical access to care" because fewer physicians and hospitals participate in that program than in HUSKY (New Haven Register, 11/11).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

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