Expand HUSKY for older and disabled adults to end unfairness
Imagine having to live on just $1,182 a month. Or imagine being told you are not allowed to have more than $1600 in savings for emergencies. Imagine that you have to live under both of these limitations if you want to have access to needed health care.
In fact, these are the rules if you want to have access to needed health care under Connecticut’s Medicaid program, also known as HUSKY. But it’s not everyone who is subject to these extreme limitations. These restrictive rules only apply to people who are 65 or older or adults who meet the severe disability standard to qualify for Social Security Disability benefits.
For non-disabled, non-elderly adults and for children, the income limits are substantial higher — with the main Medicaid programs having income limits ranging from $1,677 per month (HUSKY D for adults not living with minor children) to $1,944 per month for caretaker relatives of minor children on HUSKY A, and $2,443 per month for children on HUSKY A. No other Medicaid program comes close to having such low income limits. And it is only older and disabled adults who are subject to any asset limitations at all; those limits are extremely low: $1,600 for one and $2,400 for a couple.
This harshly discriminatory treatment of low income older and disabled Connecticut residents was not intentional, but mostly is a result of the way that different Medicaid eligibility groups came into being over the several decades of the Medicaid program’s existence.
For example, the newest Medicaid eligibility category under federal law is the Medicaid expansion under the Affordable Care Act (ACA), covering adults without minor children, called HUSKY D in our state. Congress said in the ACA that the income limit for this group had to be set at 138% of the federal poverty level, which gets adjusted every year. Congress also prohibited the imposition of any asset limits for this new program, concluding that very few people at these income levels would likely have significant assets and that the administrative costs of checking the amount of assets were just not worth it.
By contrast, the Medicaid program for older and disabled adults, called HUSKY C, dates back many decades. The income limits have always been low. Now based (indirectly) on the federal poverty level, the income limit for individuals with unearned income like Social Security Disability payments currently is only about 97% of the federal poverty level. And the asset limits for HUSKY C were set literally in the 1970s, back when $1,600 was not a pittance of savings that might cover one month’s living costs (if extremely frugal). The extremely low asset limits for HUSKY C of $1,600/$2,400 mean it is impossible for elderly/disabled individuals to save up for emergencies like car repairs, or put money aside for a down payment on a new apartment.
Elderly/disabled individuals blocked from access to the HUSKY C program due to these very low eligibility tests often do qualify for Medicare. But there are many services covered by Medicaid which are not covered by Medicare, such as dental care, vision coverage, hearing aids, medical transportation, personal care attendants, home care services not associated with skilled services, etc. Many of these individuals are threatened with institutionalization, at much greater cost to the state, simply because their total income is modestly above the HUSKY C limits, such as $1,300 per month, so they cannot access these critical health services which allow them to remain in the community.
These income amounts are below the HUSKY D income limit but federal rules block adults 65 or over and younger disabled adults on Medicare from being eligible for HUSKY D.
There is no obstacle to Connecticut raising the income limit for HUSKY C to match the lowest income limits of any other state Medicaid program (HUSKY D, at 138% of FPL). This can be accomplished in compliance with federal rules simply by establishing the appropriate income disregards.
Connecticut is not the only state that historically has subjected older and disabled adults to much stricter eligibility rules than state residents under its other Medicaid groups. But other states have also more recently addressed this injustice. For example, California in 2020, and New York last year, raised the income limit for their respective Medicaid programs for older and disabled adults to 138% of the poverty level. New York also raised the asset limit for one to over $30,000, while California has gone further: it has removed the asset limits under its program for these individuals entirely, effective in January of 2024.
There are other aspects of discrimination in the HUSKY program, including toward individuals based on immigration status. Now that we know that it exists for older and disabled adults in the program to a high degree, it is incumbent upon policy makers to finally address the inequity and make it possible for these individuals with low incomes, and who by definition are older or have severe disabilities, to be treated at least close to the way we treat other adults without disabilities. It is a basic question of fairness.