Proposal to cut health care for low-income people flawed
There is a myth going around that the governor’s proposed budget just treads water, doesn’t expand anything but does not cut either. In fact, due to arbitrary “fiscal guardrails” which supposedly prevent the state from spending the $650 Million or so in surplus it has this fiscal year, he makes the budget work by proposing to slash basic health care for thousands of low income disabled people and older adults.
The main way the governor proposes to take health care away is to dramatically lower the income limit for HUSKY C, the full-benefit Medicaid program only for disabled and older adults. It currently has an income limit of $1,234/month, far below any of the other Medicaid programs, like HUSKY A and D, which are, respectively, for families and non-disabled, non-elderly adults. And only disabled and older adults are subject to asset limits ($1,600 singles/$2,400 couples).
Because of the current low HUSKY C income limit (below the federal poverty level (“FPL”)), thousands of elderly/disabled adults right now have no access to the health care services and equipment covered only under Medicaid (even if they have Medicare), like dental care, vision care, hearing aids, medical transportation, long-term care, most home care services, and more. If they are lucky enough to find a provider willing to provide services without insurance coverage, they have to incur substantial medical debt for these non-covered services.
One of us, Ms. Moore, has a severe circulatory condition and also recently was diagnosed with heart disease. She has income of $1,572/month, too high for the current HUSKY C limits. Without that coverage, she will lose her 51 hours per week of personal care assistance services, which she needs because of her limitations in performing basic activities of daily living, like dressing and showering. She is only getting these services now, despite being over the current HUSKY C income limits, due to the protective rules during the pandemic, which are coming to an end. Then, she will face institutionalization, which on average costs the taxpayers about $8,000 per month.
Last year, aware of the express discrimination against disabled and older adults in our Medicaid program, which advocates believe violates the state Constitution’s prohibition on discrimination on the basis of “physical or mental disability,” the legislature ended the discrimination against them in terms of income eligibility: effective October 2024, the income limit for HUSKY C, under the law signed by the governor, will be raised to $1,829/month.
The change in the law could not have come soon enough. Essential health services only under Medicaid will now be available to individuals like Ms. Moore, allowing them to avoid medical complications and even placement in a nursing home, as well as medical debt.
But before the benefit of this essential change is implemented, the governor proposes to take it away, saying the amount he budgeted for the change is not enough to cover the cost of the increase he signed into law. Rather than fix his budget office’s error, he proposes to change the law to match the bad math, by allowing for only a tiny increase in the income limit in October, to $1,318/ month — only about $85/month, versus the almost $600/month increase provided under the law.
The governor doesn’t stop there: He also proposes to cut the HUSKY A program for children and their caretaker relative adults, by terminating from Medicaid coverage all adults with income over 138% of FPL (the limit is currently 160% of FPL). This cut also particularly singles out older and disabled adults for loss of health care coverage.
The governor’s budget director misleadingly justifies the cut to HUSKY A adults on the basis that “[t]hey would not lose coverage. They would simply be on the [state healthcare] exchange,” with extra subsidies under the “Covered CT” program.
First, the coverage is not the same. There are many services not covered under the exchange plans relative to Medicaid, like PCA services, and there are broad federal rules protecting access to services only under Medicaid. And health plans on the exchange are run by insurance companies which apply harsher prior authorization rules than DSS applies under Medicaid, so as to maximize profits. As a practical matter, the coverage is substantially harder to access if you need any kind of expensive care.
Critically important, adults on HUSKY A who also are over 65 or disabled/on Medicare are by law ineligible for any federal subsidies on the exchange, and therefore cannot qualify for Covered CT either. They will lose access to all Medicaid-covered services not covered under Medicare.
These cuts to HUSKY A and C for people with disabilities and older adults will exacerbate health disparities because they will (1) cut off many people from coverage at income levels disproportionately represented by Black and Brown people, and (2) increase medical debt, which the governor seeks to reduce because of the impact on Black and Brown people. Many more people will incur medical debt because of the governor’s proposed cuts to coverage for essential services that used to be covered under Medicaid.
Instead, the legislature should protect access to health care for low-income people throughout the state by fully eliminating the discrimination against disabled and older adults in our Medicaid/husky program, including by removing the asset limits in HUSKY C (like California just did for its similar program). We should also increase access for low-income kids, many of whom have significant disabilities, regardless of immigrant status.
If the only reason we are proposing these cuts, and not supporting these expansions which we can readily afford, is those arbitrary guardrails, maybe it is time for the governor to look in the mirror and ask himself if this is really the kind of governor he wants to be.