Implementer §§ 253 & 254 — Covered Connecticut

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The bill transfers administration of the Covered Connecticut program from OHS to DSS and expands program eligibility to include disabled adult children and certain other dependents. By law, the Covered Connecticut is a two-phase program that provides eligible people health insurance at no out-of-pocket cost to them.

Expanded Eligibility and New Eligibility Requirements

Under current law (i.e., Phase 1), the program must provide enough premium and cost-sharing subsidies to ensure fully subsidized coverage to parents and needy caretaker relatives, and their tax dependents that are 26 or younger, if the parents or needy caretaker relatives:

  1. are eligible for premium and cost-sharing subsidies for a qualified health plan (QHP), but over-income for Medicaid;
  2. have household income up to 175% of the federal poverty level (FPL); and
  3. are covered by a silver-level health plan offered on the exchange.

The bill limits eligibility to people who, in addition to meeting the criteria described above, use the full amount of their premium subsidies on their QHP.

By law, Covered Connecticut eligibility expands beginning July 1, 2022 (i.e., Phase 2). Under the bill, it expands to all low-income adults between ages 19 and 64, instead of only nonpregnant low-income adults between ages 18 and 64 as under current law. These people must meet all eligibility requirements in existing law, as described above, including the bill’s additional requirement that they must use the full amount of their premium subsidies on their QHP. Under current law and the bill, parents and needy caretaker relatives who meet the above requirements remain eligible.

The bill also expands program eligibility to include certain family members of otherwise eligible parents and caretaker relatives. Beginning July 1, 2021, for people eligible for Phase 1 coverage, and July 1, 2022, for people eligible for Phase 2 coverage, Covered Connecticut must also provide subsidized coverage for:

  1. permanently and totally disabled children over age 26;
  2. children older than age 26 who are incapable of self-sustaining employment due to a mental or physical handicap and who are dependent upon the parent or caretaker relative for support and maintenance; or
  3. a child or stepchild covered by the QHP (beginning July 1, 2022, coverage extends to children or stepchildren, without specifying they must be covered by the QHP).

Under current law, OHS must provide, beginning no earlier than July 1, 2022, dental benefits and nonemergency medical transportation services, as those services are provided under Medicaid, to people eligible for Covered Connecticut. In addition to requiring that DSS, not OHS, provide these services, the bill extends these dental benefits and nonemergency transportation to the newly eligible people as well.

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