What Lamonts Budget Proposal Would Mean For Health Care In CT

Oversight of hospitals, nursing homes and pharmaceutical companies is on Gov. Ned Lamont's list of health care priorities in his spending plan for the fiscal year that begins July 1.

But the governor also proposed enrolling some residents in Medicaid plans to receive free coverage through Connecticut's health insurance exchange and increasing funding for the Office of the Long-Term Care Ombudsman.

Lamont's proposed budget includes $627,000 to create four new positions in the state Office of Health Strategy. It would provide "enhanced" financial oversight of hospitals to "develop early warnings of financial distress" and strengthen Connecticut's needs assessment process, officials wrote in the administration's plan.

“There has been a lot of news lately about hospitals facing financial difficulties and the state at some point having to intervene in one way or another,” Jeffrey Beckham, secretary of the state’s Office of Policy and Management, said Wednesday. “We want to be warned early about when this could happen.”

Three Connecticut hospitals — Manchester Memorial, Rockville General Hospital and Waterbury Hospital — were hit by a devastating cyberattack and owe tens of millions of dollars in back taxes to providers, doctors and the state. A data breach and financial problems also jeopardize the sale of that facility, owned by Prospect Medical Holdings, to Yale New Haven Health. YNHH asked the state to contribute $80 million to the settlement.

Two other positions recommended for the Office of Health Strategy would be reviewing best practices for prescription drug availability, monitoring policies in other states and establishing a prescribing council to work with similar committees across the country. New hires are also tasked with checking to see if health insurance companies are prioritizing affordability.

The final additional position at OHS will oversee health care providers' performance improvement plans that exceed state cost growth benchmarks. The guidelines, approved by regulation in 2020 and effective in 2022, require HHS to set annual targets for health care cost increases and require providers, insurers and others to report annual price increases to the state.

The goal of the program is to identify hospitals, doctor's offices and insurance companies that go beyond government-set goals. An annual reporting requirement would put public pressure on these agencies and companies to cut costs, Lamont said.

“Health care only makes a difference when it is available and affordable,” the governor said in his State of the State address on Wednesday. “Deidre Gifford [Director of Occupational Health and Safety] is using our standard of care to hold hospitals, insurers and pharmacies accountable for these massive price increases.”

“The proposed new positions for the Office of Health Strategy reflect Governor Lamont's continued commitment to increasing health care affordability and ensuring a high-quality, equitable and affordable hospital system,” added HHS spokesperson Tina Kumar Hyde.

Medicaid Reimbursement Rates

The issue of Medicaid reimbursement fees gained widespread attention last year after leaders directed the Department of Human Services to conduct a two-stage review of fees paid to providers who treat indigent patients.

Lamont's proposal maintains the $7 million in rate increases he and lawmakers approved last year for specialists, dentists and behavioral health providers. The administration is expected to provide data on fees paid for these categories early this legislative session.

The second phase of the report, which will not be completed until early 2025, will cover all other aspects of Medicaid.

Because of that timeline, Lamont recommended Wednesday that already-approved price increases for pharmacies and methadone maintenance providers be suspended so they can be adjusted when the second phase of the trial is conducted in the 2025 session. This would save the state $5.4 million. In the next budget, according to the administration.

Medicaid reimbursement rates determine how much providers pay to treat eligible patients. In 2007, Connecticut set Medicaid reimbursement rates for most physician services at 57.5% of the Medicare rate.

Prices have not been broadly adjusted since then, although some providers, including primary care physicians and obstetricians and gynecologists, have received price increases.

Doctors say the low rates prevent them from accepting as many Medicaid patients as they would like. Hospitals and community health centers that must accept patients regardless of their ability to pay say they are losing money.

“We have consistently advocated that chronic underfunding of Medicaid payments to providers hurts patient access to Medicaid but also puts enormous pressure on payments from commercial insurers, and we believe the time has come: this payment is low for health affordability.” Concern, - he said. said Paul Kidwell, senior vice president of policy at the Connecticut Hospital Association.

Hospitals paid 62 cents on the dollar to treat Medicaid patients in fiscal year 2022, according to a report from the Office of Health Strategy. Community health centers across the state bill $65 million for medical services for patients covered by Medicaid, said Jennifer Granger, president and CEO of United Community and Family Services in Norwich.

“If a state agrees to participate in the Medicaid program, it is the responsibility of Medicaid participants to ensure the best possible care and appropriate access to services. “Failure to properly pay the provider network will shift costs and prevent us from continuing our operations,” Granger said. In this environment.”

“We are fully aware that pricing needs to be updated and we have a plan to do so next year,” Beckham said last June.

On Wednesday morning, Beckham said officials would wait for the results of the rate-cutting study before deciding where to prioritize rate hikes.

“We may want to target them in some of the heavily burdened areas with low interest rates, but we want to see what the whole system looks like before we propose it,” Beckham said. "We feel strongly that we need to do something for others over the course of the biennium. "I'm not going to say we're going to fix everything that's out there, but we're going to try to fix everything we can. "."

Medicaid is one of the largest and fastest-growing components of the state budget, and the administration used its proposal Wednesday to remind lawmakers of that.

Medicaid accounts for about $3.4 billion of this year's total budget of $25.1 billion. But that's far from all Connecticut will spend on Medicaid this year.

Because Medicaid is a federal program administered in partnership with states, Connecticut receives $4.9 billion in additional grants from Washington, outside of the state budget but also for Medicaid programs be issued.

The governor's staff expects the state's share of Medicaid costs to increase by an additional $21 million next fiscal year, $780 million, or 30 percent, more than when Lamont took office in 2019.

But Rep. Jillian Gilchrist, D-West Hartford, chairwoman of the Human Services Committee, expressed hope that Lamont would propose greater investments in health care.

"I'm disappointed. "Even without screening, we know rates will have to go up. "Right now rates are so low that providers can't provide health care to Medicaid recipients."

But Gilchrist said he still believes the Legislature will pass rate improvements even if the governor's proposal does not include an increase.

“Now it’s our turn,” he said. “I think there is great potential for increased investment in Medicaid fees, as I have heard from many of my colleagues. It’s really impacting providers across the state.”

The governor's proposal also would remove Medicaid items related to nursing homes from the original state budget that he and the Legislature approved last June for the 2024-25 fiscal year.

The state will continue to adjust prices to reflect the common medical needs of nursing home residents. That would cost Connecticut another $33 million in the next fiscal year.

Husky suitability

The governor's proposed budget would also lower the eligibility threshold for the state's Medicaid HUSKY A program from 160 percent of the federal poverty level (FPL) to 138 percent. This would affect most adults, but not pregnant women or children. The measure will save the state $2.1 million in 2024-2025 and $33 million annually thereafter.

Connecticut is the only state to offer Medicaid coverage to parents and caregivers with incomes greater than 138% of the FPL. People who are no longer eligible for Medicaid are eligible for a premium-free, no-cost insurance plan under Covered CT through the state health insurance exchange, Beckham said.

“It is a combination of federal grants that will provide the state with significant savings compared to what we have to pay for HUSKY An,” Beckham said. “We recommend moving these parents and family caregivers to Covered CT. You do not lose insurance coverage. They will participate in the stock market.”

The tax potential of health insurance coverage

The governor's proposal also assumes that the problem of collecting state taxes from health care providers in recent years will not be repeated in the next budget.

Lamont's plan calls for taxing suppliers of $957 million, the same amount originally planned for this year. But Prospect Medical Holdings, the California-based parent company of Waterbury, Manchester and Vernon hospitals, failed to pay $67 million in taxes, the CT Mirror reported last month.

According to liens filed by the Treasury Department, the company has not paid taxes since March 2022.

When asked why management didn't adjust sales forecasts given Prospect's recent history, Beckham responded evasively.

“This matter is now being addressed,” Beckham said. "I can not say more about that."

Office of the People's Advocate

Lamont recommended spending $90,000 to add a community ombudsman position to the Office of the Long-Term Care Ombudsman.

In 2022, the Legislature passed a state budget that funded an office to begin expanding that office into the home care sector. Previously, only residents of nursing homes and assisted living facilities had access to ombudsman services. This year, the state appointed a director to help design and oversee a program for the home care sector. However, no funding has been provided to recruit workers to file complaints.

Last year, an additional position was approved to support nursing home residents. Mairead Painter, the long-term care ombudsman, said she would launch the home care program by expanding services to people who participate in government exemption programs, such as the Money Follows the Person initiative or the family care program. But he hoped to expand. Tens of thousands of people in Connecticut use home care services.

In his legislative agenda, Painter requested funding for several additional positions this year, including a supervisor to oversee nursing home ombudsmen in the county, seven additional ombudsmen for senior centers in the county, 11 additional community ombudsmen in the county to supervise nursing home residents, and two admission coordinators.

Lawmakers said they plan to provide funding for at least two ombudsman positions this year, beyond Lamont's proposal.

Rep. Jane Garibay, D-Windsor, chairwoman of the CT Mirror of Aging Committee, said this session's priorities are "the safety of seniors, and that includes helping the Ombudsman's Office get them the help they need." they need." "We enforce some laws, but we also need to give them the tools to enforce them."

Debt, Taxes and Salt of Governor Lamont of Connecticut