New State Updates

Connecticut: In an effort to expand access to public health insurance, the Connecticut legislature passed a health care reform bill in June 2007.  In addition to increasing Medicaid reimbursements for physicians and hospitals at an estimated cost of $151 million in 2008, Senate Bill 1484 makes a number of changes to the HUSKY (Connecticut’s Medicaid and State Children’s Health Insurance Program [SCHIP]) program:

• Raises the income limit for HUSKY A (Medicaid) coverage for caretaker relatives from 150 percent  to 185 percent of the federal poverty level (FPL) at a cost of $17 million in 2008;
• Expands HUSKY A coverage for pregnant women from 185 percent to 250 percent FPL, at an estimated cost of $3.5 million in 2008;
• Expands HUSKY B (SCHIP) coverage for children from 300 percent to 400 percent FPL at a cost of $6 million in 2008; and
• Requires automatic enrollment of uninsured newborns in HUSKY, and mandates that the state pay premiums for the first two months, at an estimated cost of $2.7 million in 2008.

Additionally, the bill establishes two new planning entities. The HealthFirst Connecticut Authority will recommend alternatives for affordable quality health care coverage for un- and underinsured people, cost containment measures, and insurance financing mechanisms. The Statewide Primary Care Authority will develop a universal system for providing primary care services, including prescription drugs, to all Connecticut residents.

Other features of the bill:

• Establish a board to oversee a network that integrates state and social services data within and across various departments. It gives authority to the Public Health Department to develop standards to facilitate the development of a statewide, integrated electronic health information system that will be used by health care providers and institutions funded by the state.
• Require the Department of Social Services (DSS) commissioner to develop and implement a preventive health services system for children covered by HUSKY A and B. Also the DSS commissioner is charged with establishing a child health quality improvement program to promote implementation of evidence-based strategies by HUSKY providers.
• Extend (from age 23 to 26) the age to which group comprehensive and individual health insurance policies that cover children must do so.

Democrats estimate the bill will cost $62 million over two years after federal reimbursements, excluding the proposed provider rate increases. Republicans believe that the bill will actually cost $390 million over the next two years, including the proposed rate increases.

Governor Jodi Rell (R) is not expected to sign SB 1484 without a negotiated budget agreement. However, Democrats in the legislature believe they have “close to a veto-proof majority” and could override Rell’s potential veto.[1]

Missouri: In May 2007, the Missouri General Assembly passed a reconfigured state Medicaid system, called MO HealthNet. Senate Bill 577 restores coverage and benefits to some of the people whose services were eliminated two years ago.

The legislation:

• Restores Medicaid coverage for about 4,000 workers with disabilities;
• Restores Medicaid coverage for 6,000 children who lost coverage because their parents had access to employer-sponsored health insurance;
• Restores some optional benefits in Medicaid, including dental and vision care, for adults;
• Restores SCHIP coverage to 20,000 children through revised income eligibility requirements;
• Offers cancer screenings and family planning services for about 90,000 women whose incomes make them ineligible for Medicaid ;
• Requires Medicaid officials to devise a plan to increase provider reimbursements to the maximum federal level within four years;
• Allows physicians to collect copayments from Medicaid beneficiaries;
• Requires state Medicaid officials to assign beneficiaries to a primary care location and enroll them in a health improvement plan;
• Establishes a pilot program in one rural area and one urban area of the state that allows workers to purchase employer-sponsored insurance subsidized by Medicaid; and
• Forms an 18-member committee responsible for the supervision of changes to the state Medicaid program.

Despite the expansions in coverage, critics said that the bill will not restore Medicaid coverage for the 100,000 adults who lost coverage in 2005 when income eligibility for Medicaid was reduced from 75 percent FPL to 22 percent FPL.

Hawaii: Hawaii’s legislature passed several bills focused on expanding health insurance to children, raising the reimbursement rate for Medicaid providers, and reestablishing insurance rate regulation provisions.

House Bill 1008 expands health care coverage to infants and children in Hawaii through two pilot programs:

• Hawaii Infant Health Program, which provides coverage to uninsured newborn infants, 1 to 30 days of age, up to $10,000 of health care assistance per child; and
• Hawaii Children’s Health Care Program, in which eligible children will receive health care coverage through a public-private partnership with the Department of Human Services and one or more managed care plans.

Additionally, HB 1008 increases eligibility for state-only-funded medical assistance to 300 percent FPL from 200 percent.

Senate Bill 1672 provides funding to increase provider reimbursements for physician services caring for Medicaid-eligible persons (including those enrolled in both fee-for-service and managed care forms of Medicaid) up to 100 percent of the Medicare fee schedule.

Senate Bill 12 re-establishes health insurance rate regulation. A law, which had previously established health insurance rate regulation, had been repealed in June 2006 due to a sunset provision. SB 12 re-instates health insurance rate regulation for managed care plans by prohibiting insurance rates that are excessive, inadequate, or unfairly discriminatory. Additionally, the bill allows the insurance commissioner to impose monetary penalties on managed care plans that violate the provisions of the bill; up to $500 for each violation, and if the violation is found to be deliberate, the commissioner can impose a penalty of up to $5,000 for each violation. Additionally, the legislation permits the insurance commissioner to suspend the license or operating authority of a managed care plan that fails to comply with the law.

Oklahoma: Governor Brad Henry (D) signed into law two bills designed to expand access to health insurance in June. The first bill, Senate Bill 424, expands the income eligibility from 185 percent FPL to 300 percent of FPL for children in Medicaid.

Under the All Kids Act, families with incomes between 185 percent FPL and 300 percent FPL are eligible to receive subsidies toward the cost of privately sponsored health insurance. Parents will pay a portion of the costs for the private health plan while the state and federal government will pay the remainder. If privately sponsored health insurance is not available, parents could buy into Medicaid, paying a portion of the premium and copayment costs. The income eligibility expansion could provide health insurance coverage to as many as 42,000 additional children and is expected to cost about $8.5 million over three years, to be funded through a tobacco tax.

Additionally, Governor Henry signed into law House Bill 1225, which would expand eligibility for the Insure Oklahoma program. Insure Oklahoma provides subsidies for businesses to purchase health insurance for their employees. Funded through the tobacco tax, the expansion will extend eligibility to businesses with 250 or fewer employees and workers who earn up to 250 percent FPL (from 50 or fewer employees and workers who earned no more than 185 percent FPL).