You asked us to compare eligibility criteria, benefits, and cost sharing requirements for “public health insurance” in Connecticut and Massachusetts before and after Massachusetts passed universal health insurance legislation earlier this year. To the extent possible, you asked us to divide this into three categories: children, adults with children, and childless adults.

This report does not include community health centers. In both states, these publicly supported centers are available to anyone.

SUMMARY

Both Connecticut and Massachusetts have fairly generous eligibility criteria for children in their public health insurance programs. Medicaid and the State Children's Health Insurance Program (SCHIP) provide the lion's share of child coverage, but Massachusetts' Medicaid (MassHealth) program appears to cover many more non-disabled adults than Connecticut. Massachusetts will soon be covering more uninsured residents as a result of a new universal coverage law that includes state-procured insurance for all residents.

Massachusetts seems to require more in cost sharing, even from its lowest-income Medicaid recipients. Benefits for lower income families in both states are provided through managed care organizations and are fairly comprehensive. The new Massachusetts law restores Medicaid coverage for certain “optional services” provided to adults, as well as provides new coverage for smoking cessation treatment. Connecticut does not cover several of these optional services, including smoking cessation treatment.

We should note that unlike Connecticut, Massachusetts has exhausted its federal SCHIP block grant, which could affect the state's ability to offer more coverage to certain higher-income families in its MassHealth Family Assistance program. Historically, Connecticut has had significant surpluses in its SCHIP grant. This grant pays 65% of the state's HUSKY B costs.

PUBLIC HEALTH INSURANCE IN MASSACHUSETTS AND CONNECTICUT

Until earlier this year, Massachusetts' public health insurance system consisted of MassHealth, the major Medicaid and State Children's Health Insurance Program(SCHIP)-funded programs and other assistance geared to specific subgroups of the uninsured population. By far, MassHealth is the largest. Table 1 presents the main MassHealth coverage groups.

Table 1: MassHealth Coverage Types

[1] For a listing of MassHealth services by coverage type, please see Attachment 1.

The state has also offered coverage for inpatient and outpatient hospital care through its Uncompensated Care Pool (UCP), as well as premium assistance for individuals who are receiving unemployment compensation and can maintain employer-sponsored coverage or private coverage. Both programs are available to individuals with family income up to 400% of the federal poverty level (FPL).

In April 2006, the legislature passed the nation's most far-reaching universal health insurance law. The law includes expansions in MassHealth eligibility and restores program benefits that were previously cut. These benefits include vision care (including eyeglasses), administrative days in inpatient hospitals, substance abuse treatment, dental services, and chiropractors. (Connecticut eliminated coverage of several optional services in 2002.) It also increases the enrollment caps in some of its MassHealth programs.

Starting April 1, 2007, the new law offers an insurance product, Commonwealth Care Health Inusrance Program (C-CHIP), to uninsured adults who do not qualify for MassHealth or Medicare. To qualify for a state subsidy for this plan, family income cannot exceed 300% of the FPL. And very low-income childless adults may be able to get this insurance, without cost sharing, if their income is at or below 100% of the FPL. Many people receiving care from the UCP will now be served by the C-CHIP. Until 2009, the existing Medicaid managed care plans have the exclusive right to serve people in the C-CHIP program. For a summary of the new law, please see OLR Report 2006-R-0285.

Connecticut's public health insurance consists of Medicaid, including HUSKY A and HUSKY B, and State-Administered General Assistance (SAGA) Medical Assistance. The state's Uncompensated Care Pool/Disproportionate Share Hospitals program provides financial assistance to hospitals for providing uncompensated care to residents.

Table 2 presents Massachusetts public health insurance coverage before the 2006 law passed and after and compares it to Connecticut's coverage.

Table 2: Public Health Insurance—Pre- and Post-Universal Health Insurance Reform in Massachusetts and Connecticut

[1] For a complete listing of HUSKY benefits and co-payments, go to www.huskyhealth.com.

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Attachment 1: Services Included in MassHealth by Coverage Type

This chart shows the services that the five main MassHealth coverage types offer and the citations to regulations that describe those services in detail. For a listing of behavioral health services through the Partnership, see www.masspartnership.org

Source: Massachusetts Law Reform Institute, 2006