Legal aid lawyer sounds warning on Medicaid cut for working families

April 23--NEW HAVEN -- Sheldon Toubman says he is lending voice to the voiceless.

Toubman, an attorney with New Haven Legal Assistance Association and a longtime advocate for low-income families, said there is no movement in the legislature to assist some 13,300 individuals due to lose funding for Medicaid coverage.

He said it is unlikely they will be able to afford the premiums, deductibles and cost-sharing required of insurance through Access Health, the state's exchange under the Affordable Care Act.

"They are all working folks, they are all low-income. They are all struggling to try to support their families and they are all going to lose their health insurance on Jan. 1 unless the legislature, before the end of the session, which is May 9, does something to undo that," Toubman said.

This group represents the working parents and relative caregivers of children enrolled in HUSKY A, which is Connecticut's Medicaid program for children.

"There has been almost no recognition from legislative leadership about what this is (the Huskey A cuts) and the harm it will bring," Toubman said.

Lawmakers in 2015 changed the income eligibility limits for this group of residents from 201 percent of the poverty level to 155 percent of poverty. This was further dropped in October 2017 to individuals at 138 percent.

While children remain eligible for coverage, Touban and Karen Siegel, of Connecticut Voices for Children said, some parents assume that once they no longer qualify for assistance, neither do their children.

Voices, in a study of the 11,209 caregivers who lost their coverage in 2015 due to the first change in income eligibility, found two years later that 8,822 were still without health insurance.

Toubman and Siegel fear a large percentage of the additional 13,300 caregivers will drop insurance in January when faced with competing priorities such as paying rent, buying food, covering utility costs or covering child care expenses.

Paying premiums and cost-share out of pocket can consume from 17 percent to 20 percent of household income for two parents in a family of four at 150 percent of the poverty level, Siegel said.

"That is not a small amount of money and that is not inconsequential to a family living at or near poverty," Siegel said.

She said studies on Medicaid have found that people with this coverage are more able to work and work regularly because they can address chronic health care issues.

"This has real consequences for real people," she said. Siegel said there is also the emotional and physical cost of unexpected medical debt from an accident or serious illness.

"You have the constant worry that your family will have these catastrophic medical costs. There are a dual set of risks," Siegel said.

Under the current rules, a family of three making $32,209 would qualify for the Medicaid insurance for parents. As of Jan. 1, when the changes go into effect, a family of three could only make $28,676 to be covered by Medicaid.

Originally, when the legislation was passed in October, the Husky A changes were targeted to become effective in January 2018. Under federal rules however, recipients are entitled to one-year transitional coverage if any of their income is from a job.

This pushed off the effective date until January 2019.

"To give you an indication that this is truly the working poor, only 3 percent of the Husky A recipients didn't have income from earnings," Toubman said.

At the same time that lawmakers in October imposed $11.3 million in cuts on the Husky A parents, it also cut $56 million in coverage for 113,000 senior citizens and the disabled who took advantage of the Medicare Savings Program.

While this fund supports some Medicare costs, it is underwritten with Medicaid money.

The seniors and disabled, who are not only a larger demographic but better organized than the Husky A caregivers, came by the busload to the Capitol to complain. Consequently, this issue is on the radar screen for lawmakers to reconsider.

Without the supplemental help from the Medicare Savings Program, they will now be responsible for the $134 per month premium cost of Medicare Part B, as well as cost sharing expenses for visits and procedures.

But unlike the Husky parents, who lose all their insurance, the seniors and disabled individuals will continue to have health insurance through Medicare.

Lawmakers are trying to put a budget together while accounting for a projected deficit this year of $363.5 million, as well as billions more through 2022.

It has been a convoluted ride so far with lawmakers restoring the Medicare Savings Program cuts in early January, only to have them vetoed by Gov. Dannel P. Malloy, who said the lawmakers' numbers did not add up.

On Friday, Democrats and Republicans unveiled their budget proposals for fiscal 2018 and 2019.

Neither party offered to restore any funds for these "working poor parents," Toubman said. They did restore some money for the seniors and disabled, but not all would be covered.

The Democratic plan dropped coverage for some 38,000 residents out of the 113,000 seniors and disabled, while the Republican plan cut off funds for 68,000, Toubman said.

Siegel said one of the reasons that the Husky A parents have not been lobbying as successfully is that they are working and have less time, and the effective date of implementation makes it feel less imminent. The Medicare Savings Program cuts go into effect in July.

"As anyone who has experienced any sort of medical insurance knows, you get a lot of letters that you may not have read carefully, especially if it is not happening now," Siegel said. "So I think that is part of why this issue hasn't risen to the level of noise that it really needs to."

"This is an issue of the voiceless," Toubman said.

Still, the consequences for those who will lose the Medicare Savings Program are serious.

Voices has said those without discretionary income to cover premiums and cost-sharing requirements will go without essential treatment and medications, forcing some into emergency rooms and others into nursing homes.

As for the Husky A recipients, the cuts are bad for the state, Siegel said.

"This is a short-term fiscal decision and in the long run term you are going to have increased uncompensated care costs. You are going to have more uninsured adults," she said.

Toubman said he is of the opinion that health care is a right for everyone and feels the government has an obligation to provide basic health care.

He said there is also a disconnect between what state lawmakers are saying about these cuts and what they said when Medicaid was threatened on the federal level by the Trump administration.

He said Malloy was very strong opposing the federal cuts in the Affordable Care Act and in June of 2017, he issued a press release saying this was an outrage because tens of thousands of people would lose their health care.

"Our question is why does that not matter if the state does the exact same thing?" Toubman asked.

He said at the federal level it came from an ideology, while here it is a budgetary issue, but it is the same thing on the ground.

On a map provided by Voices, every community has Husky A individuals who would be hurt by the cuts.

Bridgeport would be affected the most with 988 residents losing this assistance, followed by Hartford at 801, Waterbury at 765 and New Haven at 634.

Other communities with higher representation include: Stamford with more than 450, New Britain at 506, Danbury at 392, Meriden at 326 and Torrington at 221.

In Greater New Haven, West Haven has 249 recipients, East Haven has 132 recipients, Hamden has 187, Milford has 148 and Shelton has 126.

"Every legislator has working poor parents in their districts that will be impacted," Toubman said.

[email protected]; 203-641-2577

Editor's note: This story has been updated to reflect that Karen Siegel, Health Policy Fellow, was initially misidentified.

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