Managed Healthcare Executive - November 2008 - (Page 16)

{EX EC U T I V E PROFIL E} Charter Oak’s lack of mental-health parity and its limited network of physicians. “I hope that Connecticut will x these problems as the program moves forward,” she says. In the design of Charter Oak, Gov. Rell was determined to make the product a ordable, according to Starkowski. He defends both criticisms. “When the Charter Oak bene ts package was crafted, bene ts were examined in both individual and employer-sponsored plan products,” he says. “We feel we have a comprehensive bene t package and did not try to tailor the package to attract any one segment of the market. Criticizing the level of Charter Oak’s mental-health bene ts is a little ironic for this reason: People who can’t a ord to purchase a private health insurance policy with full parity are completely out in the cold. Charter Oak is an a ordable, credible alternative.” Some lawmakers and consumer advocates have criticized Charter Oak because it’s a public program without parity. However, to say Charter Oak does not serve enrollees with mental-health needs is incorrect, Starkowski says. The program places no day or visit limits in psychiatric inpatient or outpatient care, but does have limits on inpatient and outpatient services for members with substanceabuse conditions. Mental health and substance abuse service coverage is actually carved out and provided through the CT Behavioral Health Partnership, such as in the HUSKY program. He acknowledges that reaching actual parity level, from the current slight variation, is a possibility for the future, as resources permit. As a public coverage program, Charter Oak is not subject to state insurance department regulation of private health insurance products. Hushagen believes that a state program with less-comprehensive bene ts, such as Healthy New York, for example, designed to assist small business owners in providing their employees and their employees’ families with health insurance, would see problems with adverse selection, “and the adverse selection death spiral has left indi- HEADQUARTERS: Optima Health CONNECTICUT DEPARTMENT OF SOCIAL SERVICES 4417 Corporation Lane HEADQUARTERS: Virginia Beach, VA 23462 25 Sigourney St. YEAR FOUNDED: in 1984 by Sentara Healthcare as an integrated health plan Hartford, CTOFFERED: HMO, PPO, POS, Medicare, Medicaid, FAMIS, HSA PRODUCTS 06106-5033 BUDGET: $4.5 billion MEMBERS: 345,000, including 125,000 Medicaid FINANCIALS: STAFF: 2,102Not-for-pro t SERVICE: Children, families, adults, people with disabilities and the elderly, including healthcare, child care, child support enforcement, rehabilitation and independentliving services, energy assistance, food stamps and program grants grams should displace those who would otherwise participate in the private health insurance marketplace,” Kelly says. “The Charter Oak plan was carefully designed to avoid this. Rather, it was designed to provide coverage for people who currently have no insurance, including those who today receive uncompensated care on an expensive, emergency basis.” Guaranteed issue Although most states’ oversight of the fully commercial individual-healthinsurance market provides little protection for consumers, according to a Families USA survey, Connecticut has enacted some important private market regulations overall. It is one of a few states that received several full- and partial-credit scores for various categories on the survey’s scorecard, including coverage revocation, a ordable coverage alternatives for uninsurables, advance review of proposed premium rates, and objective standards to de ne pre-existing conditions. “We applaud Connecticut’s e orts to cover more uninsured residents,” says Ella Hushagen, health policy analyst and state policy coordinator at Families USA. “There are a few good protections in Connecticut’s individual insurance market.” Among them, according to Hushagen are the high-risk pools, objective standards for pre-existing conditions, and oversight of rescissions. There are, however, some improvements that Connecticut could make in 16 NOVEMBER 2008 the individual commercial market, such as guaranteed issue, she says. “Data from one state show that a relatively small percentage of people—about 15%—who are rejected by the health plan they applied for actually enroll in the highrisk pool,” Hushagen says. “Guaranteed issue allows individuals to enroll in the health plan they choose based on their needs, and there is less chance that they will get lost in the application process.” In Connecticut, there are only 2,500 individuals enrolled in the high-risk pool, compared with an estimated 195,000 adults under 65 who are uninsured. On the public coverage side, Charter Oak already handles the guaranteed issue, according to Starkowski. “Charter Oak has absolutely no exclusions for pre-existing conditions,” he says. “Nor are there loopholes that would allow the managed care companies to avoid paying for services related to any pre-existing conditions. In addition, enrollees with pre-existing conditions are not individually rated.” Hushagen agrees that these are all helpful provisions, but there is a potential barrier to coverage in the Charter Oak plan. Eligibles must be uninsured for six months to qualify, with some exceptions for loss of eligibility for public coverage and nancial hardship. According to Starkowski, the waiting period is meant to safeguard against public coverage supplanting private coverage. Hushagen says two things present coverage shortcomings and limits on choice:

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Managed Healthcare Executive - November 2008

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