Analysis | DSS Study Suggests MCOs Don't Make Sense For HUSKY

Last Friday, the state released a consultants' report exploring the Governor's controversial plan to bring private insurers back to run Medicaid in Connecticut.

The report's authors agree with advocates that there is no evidence that MCOs control costs or improve quality or access to care. They also agree that HUSKY, our state Medicaid program, is doing very well compared to other states. Some advocates have valid concerns with the report, especially for people with disabilities and seniors, but the authors acknowledge that more study is needed to craft solutions to these problems. There are caveats and lots of questions, but Connecticut is good at finding effective solutions that work, through public, inclusive policymaking.

In 1996, Connecticut like most states brought in private Managed Care Organizations (MCOs) to run HUSKY. Very soon it became clear that the arrangement wasn't working. Complaints flooded legislators' offices, costs of the program shot up, providers fled the program, and DSS staff were overwhelmed. Since they left in 2012, access to quality care is up and Connecticut is a national leader in Medicaid cost control.

Despite this, in April, Gov. Ned Lamont was developing a plan to return MCOs to the program. Resistance to the idea was immediate and strong across interest groups and legislators. In response, DSS engaged consultants to survey the program's landscape, identify strengths and weaknesses, and evaluate whether MCOs are an answer to any identified problems.

The well-researched report released last week found that "CT Medicaid performs well on most health care outcomes and has lower per-enrollee costs than its peer states." Our per member costs are 14% lower than Northeastern states and are growing more slowly. HUSKY's administrative burden is less than half what states with MCOs spend. Our program also performs better than most states on about 70% of Medicaid quality measures. Ninety seven percent of HUSKY providers are satisfied with the program and provider participation grew 5.4% from 2021 to 2022.

To be clear, no one would suggest that the program is perfect, including HUSKY's strongest supporters. The consultants found some areas that need improvement. While HUSKY per member costs across the program are lower than nearby states, per member costs for seniors and for people with disabilities are 65% and 93% higher, respectively. More study is needed to identify the reasons and design solutions. That study needs to happen in a public process that engages all stakeholders. Numbers are important but they don't capture the critical context that is essential to successful solutions.

In addition, while we are doing well, some behavioral health measures are slipping. The researchers suggest increasing payment rates for behavioral health providers to improve care. HUSKY's prescription drug costs are rising faster than inflation, but this is not just a Medicaid problem, and we are well below other states. Fortunately, a legislative task force was just formed to look at this problem across the state.

More troubling, in surveys HUSKY patients rate health care in the program, their personal doctor, and specialists somewhat below national averages. This is despite rating access to care very good. There are many potential reasons such as administrative barriers, poor communications, little care coordination between providers, and how people are treated. In oversight council meetings, among other problems, we've heard a lot about long wait times on the phone and transportation to appointments that doesn't show up. While we are just below national rates, performance is dropping so we need to fix this.

Even where we are doing well, we can always do better. Both patients and taxpayers deserve our best efforts. Despite my deep concerns, I have to admit this study is useful. But we have a lot of work ahead of us.

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