Advocates who had hoped to see another expansion of Medicaid coverage this year for children regardless of their immigration status are now calling for the proposal to be included in the state budget implementer, following a surprising defeat of the bill in committee.
Last year, lawmakers approved an expansion of Medicaid, known as HUSKY in Connecticut, that allowed children 8 and younger, regardless of their immigration status, to qualify for the program beginning Jan. 1, 2023. Children must come from households earning up to 323% of the federal poverty level to be eligible for coverage.
With the start date imminent, some legislators wanted to widen that age group this year. A bill permitting children 18 and younger, regardless of immigration status, to qualify for HUSKY coverage was raised in the Human Services Committee but failed to advance after members cast a tie vote (10-10) earlier this month.
Supporters now want lawmakers to wrap the initiative into the budget implementer, a measure that puts into effect the provisions of an adopted state budget.
“Every child should have a right to health care coverage. It’s a fundamental right,” said Jay Sicklick, deputy director of the Center for Children’s Advocacy. “From an access issue, why are we drawing the line that this cohort of individuals should not be covered?”
Sicklick noted that the state is already paying for treatment for undocumented children in the form of uncompensated hospital care. Expanding the HUSKY eligibility would allow them better access to preventive and primary care.
“If we’re going to exclude a group, they’re going to have to get treatment somewhere and somehow, and somebody is going to pay for it, either through an inpatient stay or a shifting around of uncompensated care monies,” he said. “So why not embolden the primary and preventative care system to handle these, to reduce the costs on the back end? That’s good public health policy, but it’s also supported by data and even more significant in a pandemic.”
Dr. Julia Rosenberg, an instructor of pediatrics at the Yale School of Medicine, has seen first-hand the difficulties of children accessing care when children aren’t covered by health insurance. She described a series of obstacles she faced recently in helping to secure a crucial test for a patient.
“I was trying to make sure that I could get a child a tuberculosis screening they needed, which is important for the person’s health as well as for public health,” she said. “I was having a lot of challenges, because this was a child who did not have insurance. It’s the kind of thing where there are a lot of extra steps involved to make sure that we can get kids the health care they need and deserve.”
Rosenberg has advocated for the Medicaid expansion.
“The challenges we have faced in making sure that undocumented children can get the care they need has been incredibly disheartening,” she said in an interview. “I’ve been so hopeful that Connecticut could support this legislation. … I really cannot think of anything else that could be more important for children’s health. It can’t come soon enough.”
Legislators supporting the bill did not expect it to fail in committee. In an interview before the vote, Sen. Marilyn Moore, a Democrat from Bridgeport and a co-chair of the Human Services Committee, predicted it would likely pass.
“I don’t think it’s a good look for anyone to deny this type of health care to people, especially children,” she said.
But, in a 10-10 tie vote, the bill failed, with every Republican and three of the committee’s 13 Democrats voting against it, including co-chair Rep. Cathy Abercrombie, D-Meriden. The Medicaid expansion is the only proposal that the Human Services Committee did not pass this session.
Some legislators voiced concerns that the expansion was premature because of a lack of information regarding the number of residents who would qualify for the program and what the cost would be to the state. Last year’s bill mandated the Office of Health Strategy to conduct a feasibility study on expanding coverage to all children 18 and younger that would address those points, but the findings are not due until July. During the committee vote, many legislators said they felt the bill should not pass before the findings are available.
Though the feasibility study is not yet complete, the Connecticut Health Foundation and Georgetown University published a brief in September 2020 that addressed many of the questions raised during the committee meeting.
The Migration Policy Institute estimated that, at the time, there were around 13,000 undocumented children 18 and younger in Connecticut. The brief estimated that about 4,550 children would enroll during the first year of eligibility and that the total number of children enrolled would reach 5,590 by the second year, costing about $11.3 million in the first year and $13.9 million in the second. Most of those findings were not presented during committee debate.
House Speaker Matthew Ritter, D-Hartford, said the issue would be part of the upcoming budget negotiations, but he did not predict an outcome. The cost of the expansion and the fact that the state commissioner of social services testified against the bill are things lawmakers will also have to consider, he said.
Deidre Gifford, the commissioner, said in her testimony that the state would be unable to claim federal funding for those who would qualify for coverage under the measure, meaning Connecticut would incur “significant additional program costs” to extend the benefit.
Asked whether he supported the measure, a spokesman for Gov. Ned Lamont said the governor is reviewing the proposal.
“We did have this conversation last year. We reached a compromise to [the 8 years old and younger] age group, and that was not easy to do,” Ritter said. “So there are a lot of people who are going to have to be involved in this conversation in the next couple of weeks. And a lot of it may come down to what the Appropriations Committee has with the spending cap and what people have as priorities.”
Senate President Pro Tem Martin Looney, a supporter of the Medicaid expansion, said the bill has “a very good chance” of being included in the budget process. Looney said he is concerned for children who would face an “arbitrary” cutoff after age 8.
Some lawmakers said if the expansion to age 18 was unsuccessful, they would weigh an amendment that would at least allow children who are turning 9 in 2023 to keep the benefit through the end of the calendar year. Legislators have not yet openly discussed that idea.
Looney said he hopes the HUSKY expansion will be included in the budget.
“These are children who are now residents of Connecticut, they are in need of health coverage and they are likely to be long-term residents of Connecticut,” he said. “There is a basic need to treat children humanely when they have illnesses that need care. It really is just a matter of simple humanity to incorporate the care of these children in our health care system.”