Connecticut Department of Social Services Releases Medicaid Landscape Analysis

On Monday, December 9, the Connecticut Department of Social Services (DSS) released the final report containing an independent evaluation of the state’s Medicaid program, also known as HUSKY Health.  The objective of the Medicaid Landscape Analysis, leveraging state and federal Medicaid data, industry research, and enrollee/provider feedback, is to gauge the program’s performance on cost efficiency, access, and quality and identify opportunities for improvement.

Key takeaways of the analysis include Connecticut’s system — which, unique to most states, operates through an administrative services organization (ACO) model — has a 14% lower per-enrollee spend than the Northeastern average, spends substantially less on administrative costs (3.8% of total Medicaid expenditures) than estimates in managed care states (9.4%), and performs above the median for about 70% of national adult and child quality measures.  Based on these data validating the benefits of the current model, the researchers recommend DSS explore “targeted areas to reduce costs and improve outcomes instead of pursuing a transition to comprehensive managed care at this time.”

Additionally, it was found that Connecticut “performs lower than median on 53% of core set quality measures related to acute and chronic conditions.”  The report recommends that DSS explore “new care management strategies within the current fee-for-service delivery system to improve acute/chronic disease outcomes and reduce avoidable hospital utilization.”  The findings “suggest CT Medicaid could more effectively coordinate patient care to improve acute/chronic disease management and beneficiary care experience,” the report reads.

The study also encourages DSS to identify cost drivers in pharmacy expenditures and stem surging prescription drug costs, aligning with the goals of the newly formed bipartisan, bicameral Prescription Drug Task Force, of which the Connecticut Hospital Association (CHA) is a participant.

“This analysis confirms that we are on the right track, but it also highlights areas where we can do better, particularly for individuals with chronic conditions and those with complex needs,” Governor Ned Lamont commented on the report.

To inform the report’s recommendations, DSS facilitated three stakeholder engagement sessions, including a Medicaid member meeting on October 30, a provider stakeholder meeting on November 7, and a general stakeholder meeting on November 8 as part of the Medical Assistance Program Oversight Council (MAPOC) meeting.  Stakeholders across the board expressed the need to “raise reimbursement rates to improve access and quality of care” and “continue to enhance care coordination/care management for recipients moving between settings and/or recipients that could benefit from more preventive community-based services.”

In conjunction with sharing verbal comments during the stakeholder meetings, CHA submitted a comment letter to DSS regarding ways to improve the Medicaid program and outlined CHA’s Medicaid redesign framework.  Importantly, the landscape analysis’s findings affirm CHA’s proposed approach, which prioritizes investment in preventive, community-based care and focuses on upstream, root-cause drivers of health.  CHA continues to promote the benefits of implementing an innovative financing model that returns 100% of the savings generated by cross-sector collaboratives and care delivery improvements back to hospitals, community partners, and primary care providers.

DSS is required to develop a strategy to reform the state’s Medicaid program (HUSKY Health Report) by January 1, 2025, pursuant to Section 17 of Public Act 23-171, An Act Protecting Patients And Prohibiting Unnecessary Health Care Cost.  CHA also submitted a comment letter to DSS on the HUSKY Health Report.

Learn more about Medicaid and Medicare Reimbursement on CHA’s website.