Connecticut Health Insurance Laws
Help is available to certain low-income residents of Connecticut who cannot afford to buy health insurance. Medicaid, which includes the Healthcare for Uninsured Kids and Youth (HUSKY), and other programs offer free health insurance coverage, direct medical services or other help. In addition, the federal government, under the Trade Adjustment Assistance (TAA) program, provides tax credits to some workers who lose their jobs or whose work hours and wages are reduced as a result of increased imports. This chapter provides summary information about these programs and contact information for further assistance.
Medicaid is a program that provides health coverage to some low-income Connecticut residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Legal residents who are not U.S. citizens may be eligible for Medicaid. Non-citizens who do not have immigration documents cannot enroll in Medicaid.
• For certain categories of people, eligibility for Medicaid is based on the amount of your household income. In Connecticut you may be eligible for Medicaid if you are an infant, a child, pregnant, the parent of a dependent child, elderly, or disabled and your family income meets the Medicaid income standards.
Income eligibility levels for these categories are described below. For most eligibility categories your assets and some expenses also may be taken into account. However, there is no asset test for children, parents and pregnant women. For more information, contact the Medical Assistance Program of the Connecticut Department of Social Services
Low income persons eligible for Medicaid in Connecticut*
Category Income eligibility (as percent of federal poverty level)
Child to age 19 185% (monthly income of about $2,823 for family of 3)
Pregnant woman 250%
* Eligibility information was compiled from State Health Facts, the Henry J. Kaiser Family Foundation, and may have changed since this guide was published. Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.
To get an idea of how your income compares to the federal poverty level, use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2009:
Size of Family Unit Poverty Guideline (annual income)
For larger families add $3,740 for each additional person
So, for example, using this guideline, 185% of the federal poverty level for a family of 3 would be an annual income of $33,874, or a monthly income of $2,823.
* Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.
• Parents who receive benefits under TANF (also called Jobs First in Connecticut) should also know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period. In addition, your children may qualify for Medicaid of your family’s income meets certain income standards.
• Poor elderly or disabled people who get Supplemental Security Income (SSI) benefits may be eligible for Medicaid, although it is not automatic. Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage at least for a limited time.
• People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you have high medical expenses that, when subtracted from your income, would make you eligible for Medicaid coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they don’t have health insurance that covers these services.
• Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you. If your household income is below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance. This is called the Qualified Medicare Beneficiary (QMB) program.
If your household income is between 100% and 120% of the poverty level, Medicaid will pay for your monthly Medicare premiums only. This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.
Contact your Medical Assistance Program of the Connecticut Department of Social Services for more information about other eligibility requirements.
• There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact Medical Assistance Programs of the Connecticut Department of Social Services.
HEALTHCARE FOR UNINSURED KIDS AND YOUTH (HUSKY)
HUSKY (Healthcare for Uninsured Kids and Youth) is Connecticut’s public health insurance program for children and teenagers under 19.
• Eligibility for the HUSKY program is based only on age, residency and health insurance status, not income. If you have children under the age of 19 living in Connecticut, they might be eligible for the HUSKY program. Generally, the HUSKY program is intended for children who don’t have health insurance but there are many exceptions. Even if your child has health insurance, you should call the HUSKY program to find out if they are eligible for the HUSKY program.
• Coverage through the HUSKY program is considered comprehensive. If eligible, your child will be covered for most medical services through a managed care plan
• There may be some costs associated with HUSKY coverage. Coverage through the HUSKY program is either free or low cost depending on your family income and family size To find out if more information regarding the HUSKY program, please call (877) CT-HUSKY (877-284-8759) or visit the program online at http://www.huskyhealth.com/hh/site/default.asp.
BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM
• The Breast and Cervical Cancer Program provides free screening and diagnostic services for qualified women. If you are diagnosed with breast and/or cervical cancer through the screening program, you may be eligible for free health coverage through the Medicaid program. If eligible, Medicaid will extend through out the duration of your treatment.
• In order to be eligible for free services through the program, you must be a Connecticut resident and meet, among other requirements, age, income and insurance requirements. Generally, to be eligible, you must be between the ages of 19 and 64, have income at or below 200% of poverty, and either be uninsured or underinsured. You are considered underinsured if your health insurance doesn’t cover pap tests and/or mammograms or has a deductible $1000 or more. For more information, please contact the Connecticut State Department of Public Health – Breast and Cervical Cancer Early Detection program, at (860) 509-7804. For a list of screening locations, please visit http://www.dph.state.ct.us/BCH/HEI/bccedp_program_locations.htm.
HRA LOW-INCOME PREMIUM SUBSIDY
• HRA, the Connecticut high-risk pool, offers subsidies for people with modest incomes. If your income is below 300% of the Federal Poverty Level you may be eligible for reduced premiums and cost sharing. Low-income subsidies are only available for the Special Health Care Plan option. (see Chapter 3) For more information about the HRA Low-Income Premium Subsidy, please call the Connecticut Health Reinsurance Association at (800) 842-0004 or visit their web site at http://www.hract.org/hra/.
CHARTER OAK HEALTH PLAN
Charter Oak Health Plan is a program that offers qualified Connecticut residents access to a standard health benefit plan on a guaranteed basis with no pre-existing condition exclusion periods. Premiums assistance is available for low-income enrollees. This program is administered and subsidized by the State of Connecticut in cooperation with private health insurers.
• You must meet certain eligibility criteria. You must be between the ages of 19-64 and uninsured for at least six months. However, the six-month rule can be waived if you lost your job, or if you lost coverage under the HUSKY plan.
• Charter Oak Health Plan covers standard benefits. These include physician services, inpatient hospital services, emergency room care, behavioral health services, prescription drugs, and others. There is an annual benefit maximum of $100,000, and a $7,500 annual benefit limit on coverage for prescription drugs. Cost sharing is required, including an annual deductible that varies depending on your income.
• The Charter Oak Health does not impose any pre-existing condition exclusion periods.
• Premiums for Charter Oak Health Plan will vary based on your income and the insurer you select. Depending on your income, premiums vary from $75 to $259 per month. For more information about premiums, see http://www.charteroakhealthplan.com/coh/cwp/view.asp?a=3542&q=418274&cohNav=|.
• To apply for Charter Oak Health Plan, all you need to do is complete the application and send it in. You can download an application form at http://www.charteroakhealthplan.com/coh/cwp/view.asp?a=3542&q=418270&cohNav=|. For more information about the Charter Oak Health Plan call (877) 77-CTOAK or visit the program online at http://www.charteroakhealthplan.com/coh/site/default.asp
• There may be other financial assistance programs available. For more information about medical assistance programs, please call Connecticut Department of Social Services at (800) 842-1508.
THE FEDERAL HEALTH COVERAGE TAX CREDIT (HCTC)
A federal income tax credit is available to help certain trade dislocated workers and early retirees, and their dependents, buy qualified health insurance coverage. The Health Coverage Tax Credit (HCTC) covers 80% of the insurance premium for qualified coverage. Under this program, you can either claim the tax credit at the end of the year on your tax return or you can elect to have the money paid directly to your qualified health plan each month by the Internal Revenue Service.
WHEN AM I ELIGIBLE FOR THE HCTC?
• To be eligible for the tax credit, you must be receiving Trade Adjustment Assistance (TAA) benefits or retirement benefits from the PBGC. If you are receiving PBGC benefits, you also must be at least 55 years old. In addition, you must not be enrolled in Medicare, Medicaid, or in other employer-sponsored coverage for which the employer contributes at least half of the premium.
• HCTC may apply to your family, too. If you are eligible, you can use the credit to help purchase qualified health coverage for your qualified family members. Qualified family members are your spouse and dependents that you can claim on your federal tax return. Family members are not eligible if they are enrolled in another group health plan where the employer pays at least 50% of the cost of coverage, or in Medicaid, SCHIP, FEHBP, Tricare/CHAMPUS.
• Eligibility for HCTC is not based on income. In addition, the HCTC is refundable. This means you can claim the credit even if you do not earn enough income to owe federal income tax.
HOW MUCH OF MY PREMIUM WILL THE TAX CREDIT COVER?
• The HCTC is equal to 80% of health insurance premiums for qualified health insurance coverage.
WHAT HEALTH COVERAGE IS ELIGIBLE FOR THE TAX CREDIT?
• The HCTC can only be used to help pay for “qualified” health coverage. COBRA continuation coverage is considered qualified health coverage (see Chapter 3 for more information about COBRA). In addition, Connecticut has designated a policy offered through Health Reinsurance Association of Connecticut (HRA) as qualified health coverage. For more information, contact HRA at (800) 842-0004.
HOW DO I CLAIM THE HCTC?
• You can claim the HCTC on your tax return and be reimbursed for 85% of the premium you paid for qualified coverage while you were eligible for the HCTC. Currently, this is the only way to claim the HCTC if your qualified health plan is provided through a spouse’s employer.
• Alternatively, you can choose to have your credit sent directly to your qualified health plan each month. To do this, you must register with the HCTC customer service center by calling (866) 628-HCTC (866-628-4282), Monday through Friday between the hours of 7 am and 7 pm, Central time. TDD/TYY callers, please call (866) 626-HCTC (866-626-4282).
WHERE CAN I GET MORE INFORMATION?
• For more information about the HCTC, contact the HCTC customer service center at (866) 628-HCTC, or see the IRS website at http://www.irs.gov/individuals/article/0,,id=187948,00.html.
• For more information about TAA benefits, visit http://www.doleta.gov/tradeact.
• For more information about PBGC, call (202) 326-4000 or visit online at http://www.pbgc.gov.
FOR MORE INFORMATION…
As a summary, this guide will not answer every question for every person in every circumstance. In addition, it is not a substitute for legal advice. If you have more questions, contact the agencies listed below or consult an attorney.
For questions about:
Individual health insurance
Fully insured group health plan
Connecticut Insurance Department
(800) 203-3447 (CT only)
(800) 842-0004 (HRA)
Self-insured group health plans
COBRA continuation coverage
Family and Medical Leave Act
U.S. Department of Labor
Employee Benefits Administrator
Employee & Employer Assistance Hotlines and Publications
(800) 444-EBSA (3272)
High Risk Pool
Health Reinsurance Association (HRA)
Connecticut Department of Social Services
Healthcare for Uninsured Kids and Youth (HUSKY)
State of Connecticut Department of Social Services
The Connecticut Breast and Cervical Cancer Early Detection Program
Connecticut State Department of Public Health
Charter Oak Health Plan
Connecticut Department OF Social Services
The Federal Health Coverage Tax Credit (HCTC)
Internal Revenue Service (IRS)