CT’s budget deal hurts access to HUSKY health insurance

Gov. Ned Lamont and legislative leaders are claiming that they reached a budget deal that stays within “fiscal guardrails” and fairly balances competing needs. They have expressed pride in breaking tradition by not reopening the two-year budget passed last year.

However, apart from staying within the fiscal guardrails, none of this is true. The deal did not expand access to health care for residents with the lowest incomes in our state, and methodically takes health care access away from them by reopening the two-year budget to make cruel cuts. Given the substantial revenue surplus reported for this year before the finalization of their deal, the governor and legislative leaders should reconsider the equity impact of the deal they passed.

Many groups advocated this year for modest expansions in access to health care for residents with lower incomes. This included an increase in the age limit for income-eligible undocumented children to receive HUSKY services (from 15 to 18 years old) and the removal of the discriminatory low asset limits in the HUSKY C program for disabled and elderly individuals (HUSKY has no asset limits for non-elderly, non-disabled individuals). It also included an administrative change to expedite access to coverage for emergency medical conditions (EMCs), the only Medicaid coverage available for undocumented people.

We advocates were repeatedly told there was no money to fund these modest expansions. This alone was bad enough, but legislative leaders and the governor did far more damage than this: they agreed to make deep cuts in the existing Medicaid program, despite rejection by the Human Services Committee, harming access to basic health services for people with lower incomes.

In the “ARPA” bill, they agreed to repeal the anti-discrimination law they passed just last year. That law would have ended discrimination against individuals with disabilities and older adults in terms of income eligibility for the Medicaid program by increasing the income limit in HUSKY C, effective Oct. 1, so it was no longer less than the income limit for HUSKY D (Medicaid for non-disabled, non-elderly adults). They repealed the law despite being told repeatedly that this proposed repeal, as had been proposed by the governor in February, would run afoul of the state constitution’s prohibition on discrimination based on “physical or mental disability.”

The “ARPA” bill also dramatically cuts the income limit for adults in HUSKY A, the Medicaid program for children and families, from 160% to 138% of the federal poverty level. This cut was justified on the premise that individuals can get the same level of care on the exchange, supplemented by the Covered CT program. This is untrue for several reasons.

• Anyone over 65 or on Medicare losing HUSKY A is ineligible for subsidies on the exchange, rendering it completely unaffordable for them.

• Even those eligible for subsidies on the exchange will find less access to many services covered under HUSKY A either because they aren’t covered there or because of the shift to private, for-profit insurance companies.

• Even where the coverage is the same on paper, having prior authorization conducted by an insurance company with a direct financial incentive to deny care means routine denials of needed care relative to the current efficient use of non-risk administrative services organizations for prior authorization under the state-run Medicaid program.

Leaders also negotiated with the governor — with no public notice or input — to reduce access to urgently needed medications under Medicaid, changing the time allowed for prior authorization from two to 24 hours. This means that individuals with lower incomes, who often have great difficulty getting to a pharmacy because of a lack of transportation or a disability, will have to go home and somehow return the next day (assuming the drug is approved) if they can, to get the prescription filled.

Not one of these cuts was analyzed by the governor in his budget proposal as to their impact on addressing health disparities, per CGS § 4-74a, passed by the legislature in 2022. If the governor had complied with this law and analyzed his HUSKY A and C cuts, he would have to conclude they exacerbate health disparities.

HUSKY programs are vital in mitigating racial health disparities and promoting health equity in our state. Black, Indigenous, Latino/a, and other people of color in Connecticut are already at greater risk of avoiding care, accruing medical debt, and going uninsured. Additionally, HUSKY C is only for individuals with disabilities and the elderly. Prior to the large reduction just passed, older adults and people with disabilities were slated to qualify on Oct. 1 for HUSKY C with incomes around the income limit under HUSKY D. This cut unceremoniously reinstated discrimination.

Our projected revenue surplus this year will be about $1.1 billion, and the following years’ projected surplus will be about the same. This is many times what it would cost to avoid all of these cuts and adopt all of the proposed expansions.

We can’t know for sure the real reason behind these harmful refusals and cuts.

But the governor often said that he was unwilling to adjust the arbitrary “fiscal guardrails” that would allow us to spend any of this excess revenue. The legislative leaders responded to that roadblock by saying that they would not make any budget adjustments this year and stick with the two-year budget passed last year — except that they proceeded to cut access to services under Medicaid to save money relative to what was passed in the budget last year, while agreeing to repeal the critical provision eliminating income eligibility discrimination against people with disabilities passed just last year.

If legislative leaders and the governor think it is more important to prioritize piling up billions of dollars in savings and are less concerned about whether residents with lower incomes have access to health care or with ensuring equity for individuals with disabilities, they should acknowledge it directly, and not tout fictitious claims about “fiscal constraints” prohibiting us from spending that money.

It is our hope that next year, if not sooner, our General Assembly and governor will reflect on their decisions made in silo this year, their detrimental impact on our state’s continuously marginalized communities, and the legacy they want to leave behind. Right now, it appears the only concern is financial stockpiling at the expense of advancing equity, especially for people with lower incomes who need greater, not less, access to health care.

Kally Moquete, of Health Equity Solutions, and Liz Dupont-Diehl, of the Connecticut Citizen Action Group, write on behalf of the following: AgingCT, Black and Brown United in Action, Center for Disability Rights, Citizens Coalition For Equal Access, CT Citizen Action Group, CT Coalition on Aging, CT Cross Disability Lifespan Alliance, CT Jobs & Human Rights Task Force, CT Legal Rights Project, CT State Independent Living Council, Disabilities Network of Eastern Connecticut, Disability Rights CT, Health Equity Solutions, HUSKY 4 Immigrants, Independence Northwest, Keep the Promise Coalition, Leukemia and Lymphoma Society, Medicare for All CT, Ministerial Health Fellowship Advocacy Coalition, More Than Walking, NAMI-CT, National Association of Social Workers, CT Chapter, Physicians for a National Health Program- CT Chapter, Rev. Josh Pawelek, UUSE Manchester, The Arc Connecticut and Universal Health Care Foundation of CT