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12/04/2017 11:00 PMA statewide outcry is prompting state legislators to reconsider one big cut they made to reach a balanced budget this year: slicing the income eligibility threshold in half for Medicare recipients whose Medicare plan premiums, patient cost-shares, and deductibles are covered by Medicaid.
Medicare and Medicaid are both government-run programs that help people meet their health care needs. Medicare is a federal program that provides coverage for people 65 and older. Medicaid is state and federal program that provides help with medical costs for people with limited incomes.
The statewide program that got cut in the most recent state budget, called the Medicare Savings Program (MSP), previously paid these very-low-income individual’s medical costs if their annual income was under $25,447; the new budget lowers that threshold to $12,060. Now, tens of thousands of low-income elderly throughout the state suddenly are without medical coverage as of Jan. 1, 2018—unless they act by Thursday, Dec. 7, 2017, to sign up for Medicare, Medicare Supplement (MediGap), or Medicare Advantage plans they did not previously need.
Town social services directors are scrambling to explain to their low-income elderly clients that the new state budget cut their health benefits, and that if they do not sign up for a new plan by Dec. 7, they risk having no health care or prescription drug plan coverage as of Jan. 1, 2018.
Old Saybrook Social Services Director Sue Consoli spread the message through letters and a Social Services Help Day she organized at Grace Church in Old Saybrook on Nov. 30. The meeting, also attended by State Senator Paul Formica (R-20) and State Representative Devin Carney (R-23), was a chance to discuss the changes with the elderly and disabled clients affected, and to let them know what they need to do now. Consoli had invited representatives of ConnectiCare and an insurance broker to help guide her clients through their choices.
“Some of you have received your [Department of Social Services] letters telling you your eligibility for the MSP is terminated. Those of you who carry the gray Connect Card, you may be losing that. Most of you need that for medical conditions. The reality is if you have a medical condition, it’s very important that you talk with someone about signing up for extra coverage now,” Consoli told the filled room of more than 50 clients.
Consoli explained that anyone who received their gray MSP Connect Card before July 1, 2017, will remain eligible for prescription drug coverage through 2018. Those who got their card after that date will lose coverage on Jan. 1, 2018.
“I also want you to know about the pre-existing condition clause that is in some [Medicare and Medicare Supplement] plans. You want to ask for plans that do not have a pre-existing condition clause. Otherwise, for the first six months, you will pay 100 percent of your costs. Medicare Advantage plans may be a good choice,” said Consoli.
The Affordable Care Act (ACA, commonly called Obamacare) did not apply to those on Medicare, which is why pre-existing condition clauses can be included in Medicare supplement plans, but not in ACA plans.
Formica said that all but five states set income eligibility at 100 percent of the federal poverty level to receive MSP benefits. Connecticut, until the budget passed, had been one of the five states to set a higher income threshold of 125 percent of poverty.
In the new bipartisan budget, the threshold moved back to 100 percent of the federal poverty level or $12,060.
Formica said that the four legislative caucus leaders met on Nov. 29 and agreed to work on a fix for this MSP eligibility budget provision. The finance teams for the four caucuses—State Senate Republicans and Democrats and State Assembly Republicans and Democrats—have been charged to meet and discuss fiscal options. At press time, legislative leaders planned to meet together this week to discuss these options.
Finding Ways to Fill the Gap
According to Formica, an important element of a fix may be to subject MSP recipients to an asset test, which exist in other programs like energy assistance. Other Medicaid programs require that recipients not hold more than $1,600 in assets (not including the applicant’s home and car) to be eligible. Fixing this budget problem now would require calling a new special session of the Legislature in mid-December. Alternatively, the governor could act by executive order, or the Legislature could act in its next regular session that begins in February 2018. No solution will be soon enough for those low-income clients that filled the Grace Church space last week, however, so Formica urged those at the meeting to act to secure health care coverage now and not assume the fix would be made in time to restore MSP coverage by Jan. 1.
“For today, we understand your concerns and we will work on a fix,” said Formica. “This is to me the number-one priority to fix in this year’s budget.”
After hearing the presentation, clients with the gray Connect cards that indicated their prior full MSP benefits eligibility offered their comments and questions.
“How does our government justify spending millions on a building in Hartford as opposed to helping the elderly?” asked Rhonda Harbor, referring to the action of the Bonding Commission to approve $40 million for the XL Center renovations and upgrades.
Another woman said she already has two cataract surgeries scheduled in January 2018 and doesn’t know what she will do. Consoli explained that without a new plan, the woman would face paying 20 percent of the charges out of pocket—Medicare Part A and B pays 80 percent—plus the $1,340 Medicare deductible, if she doesn’t buy a Medicare Supplement or Medicare Advantage Plan.
Urging everyone to sign-up for a health plan to guarantee they are covered as of Jan. 1, Consoll said, “On Jan. 1, you are losing your coverage. [Without that coverage] all you need is one major health condition to have a catastrophic financial situation.” Consoli said she is working with Formica and Carney to assure a smooth transition should the Legislature or the governor enact a fix. The goal would be to allow those restored to MSP eligibility to recoup some or of all of the costs for Medicare and Medicare Supplement plans they may have bought in Dec. 2017.