WEEKLY UPDATE: 11/12/26
Medical Frailty Guidance and Diagnosis Code List
The Department of Social Services (DSS) has posted a new knowledge base article, “HR1 Medical Frailty and the HUSKY D Work Rules,” which includes a link to the list of diagnosis, prescription drug, and medical procedure codes DSS will use to identify HUSKY D (Medicaid) members who are “medically frail.” People who are medically frail are excluded from the new work rules that take effect January 1, 2027, which will require HUSKY D clients to show proof of work or other qualifying activity to maintain Medicaid coverage.
Federal law (H.R.1) defines medical frailty as people with blindness or a disability; a substance use disorder; a disabling mental health condition; a physical, intellectual, or developmental disability that significantly limits their ability to manage daily activities; or a serious or complex medical condition. DSS will use healthcare claims to identify members who meet this standard, so many qualifying members will be excluded automatically, without needing to take any action themselves.
The Medical Frailty Code List offers a clearer picture of which conditions will lead to an automatic exclusion. It also helps identify people who may still need support. A person may qualify as medically frail but not be identified automatically, for example, if their condition is not on the list or they have not recently received care for it. In 2027, new applicants can self-attest that they have a qualifying condition when they apply; there will also be an opportunity to do so on renewal.
How healthcare providers and community partners can help:
- Providers: Share the list with revenue cycle, coding, clinical documentation, case management, and financial counseling staff, and reinforce complete and accurate documentation of qualifying conditions, since claims drive the automatic process.
- Community partners: When talking with HUSKY D members, help them understand that a serious health condition or disability may exclude them from the work rules, and encourage those who believe they qualify to self-attest at renewal. New applicants should also be encouraged to consider self-attestation when they apply.
- Everyone: Continue encouraging members to keep their contact information up to date with DSS so they receive notices and do not miss important deadlines.
The Connecticut Hospital Association (CHA) will continue to work with DSS on questions about how the list will be applied and will share updates as they become available.
New DataHaven Report: Declining Coverage and Rising Premiums
DataHaven has released a new report titled Declining Coverage and Rising Premiums: Reviewing the Effects of H.R.1 and the Expiration of Premium Credits on Medicaid and Marketplace Health Insurance. The report estimates where Connecticut residents are at risk of losing HUSKY D coverage under the new work rules and where Access Health CT enrollees face higher premiums now that federal enhanced premium tax credits (EPTCs) have expired. It also separately reports adults losing eligibility under the new immigrant eligibility rules that took effect in October.
The report draws on the state’s estimate that 108,000 HUSKY D members are at risk of losing coverage when the work rules begin. Rates are highest in Hartford, Waterbury, New Haven, and Bridgeport, but residents in every town and legislative district are at risk. Meanwhile, Access Health CT enrollees in many western and southwestern towns face steep premium increases.
Interactive maps and downloadable data on the report page provide estimates by town, State Senate district, State House district, and hospital service area. Providers and partners can use this information to:
- Understand the scale of potential coverage loss in their own communities.
- Focus outreach and enrollment assistance where the need is greatest.
- Support grant applications, community health planning, and conversations with local and state policymakers.
CHA encourages hospitals, healthcare providers, and community organizations to share this information with staff, stakeholders, and members of local Keep Your Health Coverage coalitions.
Current and future CHA-developed HUSKY D messaging materials and coalition resources are available for download at cthosp.org/huskyd.
Related News:
Federal Judge Vacates Narrowed ‘Medical Frailty’ Definition, Medicaid Work Requirements Persist
HUSKY D Educational Videos: Community Partner Virtual Classroom
HUSKY D Work Rules: Connecticut Implementation Updates
New Resources To Help Connecticut Caregivers Keep HUSKY D Coverage
Federal Medicaid Work Requirements: Governor Touts Statewide Efforts To Protect HUSKY D Coverage
New HUSKY D Outreach and Education Guide and Updated Messaging Starter Kit Materials
