What Lamont’s budget proposal would mean for health care in CT

Gov. Ned Lamont has put oversight of hospitals, nursing homes and drug companies at the top of his list of health care priorities in his spending plan for the fiscal year that begins July 1.

But the governor also proposed moving some residents from Medicaid plans to free insurance through the Connecticut Health Insurance Exchange and adding funding to the Office of the Long-Term Care Ombudsman.

Lamont's proposed budget would spend $627,000 to create four new positions in the state Office of Health Strategy. The administration's plan would support “expanding” hospital financial oversight, “deploying advance warning of financial distress” and strengthening Connecticut's certificate of need review process, officials said. are writing.

Jeffrey Beckham, director of the state's Office of Policy and Management, said Wednesday that “there has been a lot of news recently about hospitals facing financial difficulties, and ultimately the state has to be involved in some way.” “We want to give you a little bit more early warning of when that's going to happen.”

The Connecticut Mirror reports that three Connecticut hospitals — Manchester Memorial Hospital, Rockville General Hospital and Waterbury Hospital — have been hit by devastating cyberattacks and owe tens of millions of dollars in taxes to vendors, doctors and the state. ) reported on the plight of The sale of these facilities, owned by Prospect Medical Holdings, to Yale New Haven Health is also in jeopardy due to data breaches and financial difficulties. YNHH asked the state to contribute $80 million to the agreement.

Two other positions recommended for the Office of Health Strategies would create a prescription drug committee to explore best practices for prescription drug affordability, monitor policies in other states, and collaborate with similar committees across the country. It turns out. The new workers will also be responsible for launching a review of how health insurers prioritize affordability.

The final additional OHS position will oversee provider performance improvement plans that exceed state cost growth benchmarks. The standard, which was issued by executive order in 2020 and signed into law in 2022, requires OHS to develop annual targets for health care cost increases and requires providers, insurance companies, and others to report annual increases to states. It is mandatory to report.

The program aims to expose hospitals, medical practices and insurance companies whose costs soar beyond state-imposed targets. Lamont said annual reporting requirements would put public pressure on these agencies and companies to keep costs down.

“Health care only makes a difference if it is accessible and affordable,” the governor said in his State of the State address Wednesday. “Deirdre Gifford [OHS’ director] We are building healthcare benchmarks to hold hospitals, insurance, and drug companies accountable for significant price hikes. ”

“The new positions proposed 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 OHS spokesperson Tina Kumar Hyde.

Medicaid reimbursement rate

The issue of Medicaid reimbursement rates received increased attention last year after leaders directed the Department of Human Services to review, in two tiers, the reimbursement rates paid to health care providers who treat indigent patients. Collected.

Lamont's proposal would maintain the $7 million he and lawmakers agreed to last year to raise fees for specialists, dentists and behavioral health providers. The administration is expected to provide data on fees paid to these groups early in this Congress.

The second phase of the report, expected to be completed by early 2025, will cover all other aspects of the Medicaid program.

Because of this timeline, Lamont on Wednesday suspended already approved rate increases for ambulance and methadone maintenance providers, allowing them to be resolved when the second phase of the study is taken up in the 2025 session. He recommended that. The administration says this will save the state $5.4 million in the next budget.

Medicaid reimbursement rates determine the amount of money that health care providers receive for treating eligible patients. In 2007, Connecticut set Medicaid reimbursement rates for most physician services at 57.5% of Medicare rates at the time.

Since then, fees have not been adjusted significantly, although certain health care providers, such as family physicians and obstetricians and gynecologists, have experienced fee increases.

Doctors say they can't accept as many Medicaid patients as they would like because of the low fees. Hospitals and community health centers, which must admit patients regardless of their ability to pay, claim they are losing money.

“We have consistently argued that the chronic underfunding of Medicaid reimbursement payments to health care providers is not only detrimental to Medicaid patient access, but also puts tremendous pressure on commercial insurance payments. We believe now is the time to address this role of underpayment in health care's affordability,'' said Paul Kidwell, senior vice president of policy at the Connecticut Hospital Association.

The hospital is paid According to a report released by the Office of Health Strategies, the cost of treating Medicaid patients in fiscal year 2022 will be 62 cents on the dollar. Jennifer Granger, president and CEO of United Community and Family Services in Norwich, said the state's community health centers will receive $65 million for medical services provided to Medicaid-eligible patients. He also said that he had not been paid.

“When a state agrees to participate in the Medicaid program, it is responsible for providing its enrolled Medicaid members with appropriate access to the highest quality of care and services possible. By not paying networks appropriately, we are shifting that cost onto nonprofit community health centers, which is not sustainable. We cannot continue to function in this environment.” said Granger.

Mr Beckham said last June: “We are fully aware that we need to update the rates and we have plans to do so next year.”

Prime Minister David Beckham said Wednesday morning that officials were waiting for the results of the rate redemption review before deciding where to prioritize rate hikes.

“We probably want to address some serious areas where rates are low, but we want to see what the whole system looks like before we propose them,” Beckham said. Ta. “We fully anticipate having to do something in the remaining two years. I'm not saying we're going to solve all the gaps, but we're going to try to address as many gaps as we can.”

Medicaid is one of the largest and fastest-growing components of the nation's budget, and the administration used its proposal to remind lawmakers on Wednesday.

Medicaid accounts for nearly $3.4 billion of this year's total state budget of $25.1 billion. But that's less than the total amount Connecticut will spend on Medicaid this year.

Because Medicaid is a federal program administered in partnership with states, Connecticut will receive an additional $4.9 billion in matching grants from Washington, which will also cover Connecticut's Medicaid-related programs, although outside the state budget. will be spent.

The governor's staff projects that the state's share of Medicaid costs will increase by an additional $21 million next year, at which point it would be $780 million, or 30% more than in 2019, when Lamont first took office. .

But Rep. Gillian Gilchrest (D-West Hartford), co-chair of the Human Services Committee, expected Mr. Lamont to propose greater investment in health care.

“I'm disappointed,” she said. “Even without research, we know there is a need for rate increases. At this point, rates are so low that providers cannot provide care to Medicaid recipients.”

But Gilchrest said he still believes the Legislature will get a rate increase, even if the governor's proposal doesn't include one.

“Now it’s our turn,” she said. She added, “I hear a lot about Medicaid rates from her colleagues, so I think we're likely to see increased investment in Medicaid rates. This will have a real impact on providers across the state.”

The governor's proposal also maintains two nursing home-related Medicaid items in the interim state budget for fiscal year 2024-25 that the governor and lawmakers approved last June.

The state intends to continue adjusting rates to reflect the greater medical needs typically seen among nursing home residents. This will cost Connecticut an additional $33 million in the next fiscal year.

But the state would also eliminate inflation adjustments required by law for nursing homes, residential care facilities and intermediate care facilities for clients with developmental disabilities. This will save Connecticut approximately $67 million from 2024 to 2025.

husky qualifications

The governor's budget proposal also lowers the eligibility criteria for the state's Medicaid Husky A program from 160% of the Federal Poverty Level (FPL) to 138%. This affects most adults, but not pregnant women or children. The measure would save the state $2.1 million in 2024-25 and $33 million annually thereafter.

Connecticut is the only state that offers Medicaid insurance to parent and kin caregivers with incomes above 138% of the FPL. Beckham said people who no longer qualify for Medicaid are still eligible for a zero-premium, no-cost coverage plan under Covered CT through the state health insurance exchange.

“This is a combination of federal grants that will save the state a significant amount of money that it would otherwise have to pay in Husky A, which is the state's share under Medicaid,” Beckham said. “We recommend moving these parents and relative caregivers to covered CT. They won't lose coverage. They'll simply be in the exchange.”

Prospect Medical Holdings Tax

The governor's proposal also assumes that recent problems with state health care provider tax collection will not occur again in the next budget.

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

The company has not paid taxes retroactive to March 2022, according to a lien filed by the Internal Revenue Service.

Asked why the administration didn't adjust its revenue forecast given Prospect's recent history, Beckham deflected.

“That issue – what's the word – is being dealt with right now,” Beckham said. “I can't say much about that.”

ombudsman office

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

In 2022, lawmakers signed the state budget. The funding was provided by This is one position to begin expanding that office into the home care sector. Until recently, the Ombudsman's services were only available to residents of nursing homes and assisted living centers. The state approved a manager that year to help design and oversee programs in the home care sector. However, no funds were set aside to hire workers to handle complaints.

Last year, one additional post was approved to support home care residents. Mairead Painter, long-term care ombudsman, will serve people participating in the state's waiver programs, including those participating in the Money Follows the Person initiative and the Connecticut Senior Home Care Program. He said he would start a home care program by expanding the But she wanted to expand. Tens of thousands of people in Connecticut rely on home care services.

Painter said among the council's agenda this year: a supervisor to oversee regional nursing home ombudsmen, seven regional ombudsmen for nursing homes, 11 regional community ombudsmen serving the home care population and two intake coordinators. , sought funding for several additional positions. .

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

Rep. Jane Garibay (D-Windsor), co-chair of the Committee on Aging, said the priorities of this session are “to keep older adults safe, and to do that, we need the Ombudsman Office to provide the necessary support.” “This includes supporting the public,” he told CT Mirror. “We have enacted a lot of laws, but we also need to provide the tools to enforce them.”

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