Participation in Connecticut Charter Oak Health Plan off to slow start

Aug 3 2008

Fewer than 3,000 primary care physicians and one hospital are currently participating in Connecticut's Charter Oak Health Plan for uninsured adults, which began accepting applications in July, the Hartford Courant reports.

The program is expected to ultimately serve 19,000 people. So far, 16,000 people have called the state's hotline and 5,351 have applied for coverage. Twenty-four residents began coverage on Thursday (AP/Hartford Courant, 7/31).

Under the plan, state residents ages 19 to 65 who do not qualify for existing state health insurance programs and are not insured through an employer are eligible for coverage, as well as those paying high premiums through private insurance, such as COBRA. Residents also must be uninsured for at least six months to qualify for the plan.

Monthly premiums will be between $75 and $259, with subsidies available for residents who have incomes below 300% of the federal poverty level. Copayments will be $25 for primary care office visits and $35 for specialist visits. Preventive care visits will be fully covered by the state, and deductibles for inpatient hospital treatment, outpatient surgical and inpatient rehabilitation and skilled nursing will range from $150 to $900 for an individual. Beneficiaries also will be required to contribute 10% of hospital bills, and annual coverage will be capped at $100,000. No dental or vision coverage is included (Kaiser Daily Health Policy Report, 7/2).

Participation

The Hospital of St. Raphael in New Haven is the only medical center to sign a contract with one of the insurers operating the program for the state. Stephen Frayne, senior vice president of the Connecticut Hospital Association, said reimbursement rates are the reason most hospitals are not participating. He said, "The question is: How do you make it work for everybody?" Cheryl Lescarbeau of ProHealth Physicians Group said, "Our physicians aren't sure they can take on a deluge of new patients under the rates being offered."

Lawmakers and advocates also are concerned that the 320,000 children and adults enrolled in HUSKY, Connecticut's version of SCHIP, will have less access to physicians when beneficiaries of that program are switched to one of three plans offered under Charter Oak on Sept. 1. State Sen. Jonathan Harris (D) said, "This program was supposed to be a safety net for people; it's shaping up to be more like a sieve" (Somma, Hartford Courant, 7/31).