'There's momentum behind it'

Bryan Chong moved to Connecticut from Hong Kong to attend school as an international student. But since graduating from Wesleyan University, he has worked as a gig employee and no longer has access to health insurance.

"Since I've lost my college health insurance two years ago ... I have needed to be very careful to not fall sick or get injured, which has put a lot of stress on my work," Chong told lawmakers Tuesday. "When I have been sick, I have needed to self-manage and self-medicate with over-the-counter medications. I have not seen a doctor in years now, and I hope my luck does not run out before I find a job that can offer me robust insurance."

Chong, a New Britain resident who said he is under a federal Deferred Enforcement of Departure status, is one of hundreds of people who wrote to legislators and turned up at a public hearing urging them to expand Medicaid to people 25 and younger, regardless of their immigration status.

The General Assembly in 2021 approved an expansion of Medicaid, known as HUSKY in Connecticut, to children 8 and younger without permanent legal status. Last year, they broadened the eligibility to kids 12 and younger, so long as their families meet the qualifying income limits for Medicaid. The program launched last month.

Children 12 and younger who enroll in HUSKY are allowed to keep the benefit through age 19. Children older than 12 without permanent legal status at the time of enrollment are not eligible.

Now, lawmakers want to expand the program again. They have proposed extending Medicaid to people 20 and younger regardless of immigration status starting in January 2024, and then to those 25 and younger beginning in June 2024.

Children and young adults from households that earn up to 201% of the federal poverty level would qualify (for a family of four, that's $55,778). Kids from households earning between 201% and 323% of the federal poverty level (for a family of four, that's $89,633) also qualify but are subject to small co-pays and, in some cases, modest premiums.

"We're talking about children in Connecticut and young people who are struggling for health care," said Sen. Matthew Lesser, a Middletown Democrat who is co-chair of the Human Services Committee. "These are kids who are growing up in Connecticut schools and are living in our communities. This is a question of benefiting the whole state."

"There's momentum behind it," he said of the proposal. "This is going to save hospitals money, because when we don't provide this coverage, the need does not disappear, it just falls on us in a less efficient way through uncompensated care. And that raises health care costs for everyone in the state of Connecticut."

Hundreds of residents signed up to speak virtually and in person at the state's legislative office building Tuesday. Dozens more wrote to lawmakers.

Rose Murphy, an English teacher at Hill Regional Career High School in New Haven, said her students who do not have permanent legal status live in "constant fear."

"I spoke with one of my students, we'll call her Sophia, and she said that one of her earliest memories is of her mother telling her not to get sick," Murphy recalled. "After a childhood accident, Sophia's brother had to be rushed to the ER. Eight years later, Sofia's mother is still paying back that medical bill.

"For Sophia's family and countless others, dental care is an unattainable luxury. ... Sophia is 17. She last went to the dentist when she was 11."

Dr. Julia Rosenberg, a pediatrician with the Yale School of Medicine, told legislators that children's health suffers when they don't have access to insurance. Compared to their uninsured peers, she wrote, children with health coverage do better in school, have better attendance, have fewer "costly and painful" chronic conditions and avoid drug and alcohol use.

"I do not want to have to tell another family that their child's recent celebration of their 13th birthday disqualifies them from receiving essential health care," she said, referring to the cutoff of the current program for those without permanent legal status. "I worry and care for the children I see, but I worry even more for those whom I do not see -- those who cannot receive care because of lack of insurance eligibility.

"The relationship built from consistent, reliable care can reduce unnecessary and expensive emergency room visits, hospitalizations and preventable illnesses. For the many undocumented children without insurance who have already faced significant trauma, serious problems may only come to medical attention when it's too late."

Not everyone was supportive of the measure.

Linda Dalessio, an advanced practice registered nurse, called the proposal a "slap in the face to every working American who is struggling to pay bills."

"Health care is in crisis," she wrote to legislators. "We cannot even take care of American citizens, yet you are proposing to allow illegal migrants who broke our laws to come to the United States to receive benefits that most non-insured and under-insured American citizens do not have."

Gui Woolsten, director of Medicaid for the state's social services department, said officials estimate the cost of expanding the program to be $15 million, an amount not included in Gov. Ned Lamont's budget proposal.

Additionally, he said, the program for children ages 12 and younger launched in January, and the department has not yet been able to analyze the long-term cost and effectiveness of the program. More than 2,000 people have signed up since last month.

"The department does not yet know whether funds appropriated for the program in its existing format will be sufficient to cover all individuals through the end of the fiscal year," Woolsten said. "Accordingly, the department believes any further expansion of program is premature until there's been an opportunity to take stock of the program in its current form."

A study by the RAND Corporation, a nonprofit think tank, found that expanding HUSKY to undocumented residents could reduce the cost of uncompensated care in Connecticut by $63 million to $72 million.

The state currently has a Medicaid program that covers emergency care for people who qualify based on income, regardless of immigration status. The cost of that program -- about $15 million in 2021 -- would "presumably be substantially reduced by the decrease in uninsurance among undocumented" residents, according to the study.

The study's authors estimated the direct care cost of a HUSKY expansion to be $83 million for 2023 if extended to all residents without permanent legal status.