A piece of Gov. M. Jodi Rell's legacy is in jeopardy: Beginning in September, the
state will substantially increase the premiums for new and recent enrollees in
the Charter Oak Health Plan, which Rell started three
years as an attempt to offer affordable insurance to the uninsured. It may make
the program unaffordable to the target audience.
Mark Schaefer, director of
medical care administration for the state Department of Social Services, said
the change will likely make Charter Oak unaffordable to new enrollees who don't
have health problems, and will be contrary to the original goals of the
program.
But he said the increase, which
has not yet been determined, is unavoidable.
The premium increase stems from
changes made to the current biennial budget that prohibit the
state from subsidizing Charter Oak for anyone but those enrolled in the program
before June 1, 2010. The program costs will now have to be based on claims
experience, and Charter Oak has attracted many people with health conditions, a
high-cost population.
The change coincides with an
effort to get more people to enroll in a federally subsidized insurance plan
for people with pre-existing conditions, which has so
far attracted only about 70 people. DSS is seeking to lower the monthly premium
costs for most people in the Connecticut Pre-Existing Condition Insurance Plan, or PCIP. But those in Charter Oak won't likely be able to
move to PCIP, and for some, staying in their current plan will be unaffordable,
Schaefer said.
"We really are eliminating
our affordable health care coverage," Sen. Edith G. Prague, D-Columbia, said after hearing about the
changes at a meeting of the Medicaid Care Management Oversight Council Friday.
Charter Oak has 9,446 enrollees
and costs $307 per month. Low-income enrollees who were part of the plan before
June 2010 receive monthly subsidies of between $50 and $175, but those will be
reduced to between $35 and $115. Premiums for PCIP range
from $242.66 to $893, based on a person's age. For anyone 30 and older, Charter
Oak is the less costly plan.
But DSS is seeking permission
from the federal government to change the PCIP premium to a flat rate,
regardless of age, and make it more affordable to most enrollees. Kristin Dowty, a DSS health program associate, said the department
has proposed a rate of $381 per month, although it could change depending on
what federal health officials allow.
Schaefer said he is most
concerned about people who are now in Charter Oak and will face premium
increases, because they will be unable to move into PCIP. Federal rules prohibit anyone from
joining PCIP if he or she had health insurance in the past six months, so a
person in Charter Oak would need to go without coverage for six months to join
PCIP. For some in Charter Oak, the cost of staying in the program will be more
than they can afford, Schaefer said.
As part of the changes in the
budget, people who qualify for PCIP will not be allowed to join Charter Oak.
Currently, people who are eligible for both can join either plan. After Sept.
1, those who meet the PCIP requirements except for having had insurance in the
past six months will still be allowed to join Charter Oak.
PCIP was created as part of the
federal health reform law as a way to cover people whose medical conditions
have left them unable to get insurance. It is meant as a temporary measure
until 2014, when insurance carriers will be prohibited from excluding people
with pre-existing conditions.
Considered a signature program
of Rell's administration, Charter Oak faced criticism from the start from some state
officials and patient advocates, who took issue with the limited benefits it
offered.
As of September, the plan will
no longer have annual benefit limits, Schaefer said.
Dr. M. Alex Geertsma,
a Waterbury pediatrician on the Medicaid council, said the Charter Oak
experience illustrated the problem of requiring plans to cover pre-existing
conditions while not requiring people to have insurance. As costs rise, people
without medical needs drop off, leaving the plan to largely cover people with
high medical costs
Read more http://www.ctmirror.org/story/13220/charter-oak-costs-rise-while-state-seeks-move-people-federally-subsidized-health-plan