Recently, I had the opportunity to take a close look at how well Connecticut’s Medicaid and CHIP programs – known as Husky Health – are serving children. My assessment and recommendations were published in a new brief released recently by the Connecticut Health Foundation.
In many ways, Husky Health is a high performing Medicaid and CHIP program. The state has a lower rate of uninsured children than the national average. Husky Health has one of the highest eligibility levels at 323% FPL or $67,119 for a family of three. It ranked in the top quartile on 17 of 25 Child Core Set of Health Care Quality Measures for children in Medicaid and CHIP in 2017.
But looking under the hood helps to identify ways Husky Health can work even better for the 330,000 children it serves in Connecticut.
Despite a low uninsured rate of 3.1%, Connecticut ranks 12th in the county and lags behind its neighboring states of New York, Massachusetts, and Rhode Island. And like most states, as many or more than half of its 24,000 uninsured children are likely eligible but not enrolled in Husky Health. And the share of children enrolled for a full year dropped by 10 percentage points to 76% between 2013 and 2015.
Husky Health’s performance on most key child health care quality measures puts Connecticut among the top performing states in terms of child health outcomes. In striking contrast, use of the emergency room for non-emergency room services ranks in the bottom quartile among states and is the highest in the Northeast. But these indicators may not be telling the complete story. If children are not continuously enrolled for at least 12 months, their health is excluded when performance measures are calculated. And if data are not disaggregated by race and ethnicity, it can mask the disparities known to exist, particularly for children of color.
So what can Connecticut do to improve? A key recommendation proposed in the report is to adopt 12-month continuous eligibility in Medicaid (which 24 states do) and CHIP (which 26 or 36 CHIP programs do). Twelve-month continuous eligibility can increase coverage, reduce churn, reduce health costs that follow gaps in coverage, and improve quality reporting.
Among the other opportunities to improve Husky Health, the state should look at streamlining program administration. Currently over 95% of children covered by Husky Health are enrolled in Medicaid. Meanwhile the state maintains a significantly smaller separate CHIP program with different eligibility, benefits, and cost-sharing rules. Providing full EPSDT benefits to CHIP enrollees and converting the state’s separate CHIP program into a CHIP-funded Medicaid expansion can streamline administration for the state and its administrative services organization.
There were other recommendations in the report but a key take-away is that there is always opportunity to make Medicaid and CHIP work even better for our nation’s vulnerable and disadvantaged children. While there is clear empirical evidence that Medicaid and CHIP improve children’s health and contribute to children’s success in school and beyond, we should never stop striving to do better even when key indicators say we’re doing a good job.