Medicaid Costs and Coverage in Connecticut

“How much is Medicaid in Connecticut?” is a common question with no straightforward answer. Medicaid cost estimatescan vary significantly depending on an applicant’s household size, income and other qualifying factors. To explore how much does Medicaid cost beneficiaries, applicants need to familiarize themselves with the different levels and types of Medicaid insurance available to them. In Connecticut, HUSKY Health is divided into several distinct plans under which applicants may qualify for coverage. For each plan, what services are covered by Medicaid and how much cost-sharing is required on the part of recipients is determined by multiple factors including household income and eligibility for other services and supports.

Services Covered By Medicaid in Connecticut

Medicaid coverage in Connecticut is available under four different HUSKY Health plans. These different types of Medicaid insurance are subject to different eligibility requirements and will cover health care services differently. HUSKY A is generally equivalent to standard Medicaid and is open to children and their parents or caregivers as well as pregnant women in income-eligible households. HUSKY B is comparable to the Children’s Health Insurance Program (CHIP) and offers Medicaid insurance to children and youth 18 years of age and younger in households that do not meet the income-eligibility requirements for HUSKY A. HUSKY C provides Medicaid coverage to individuals 65 years of age and residents between the 18 and 64 years of age who are blind or who have other disabilities. HUSKY C is equivalent to Medicaid’s Long-Term Services and Supports (LTSS) and Medicaid for Employees with Disabilities programs. HUSKY D is comparable to Medicaid for the Lowest-Income Populations and makes Medicaid insurance available to residents between19 and 64 years of age and who do not have dependent children, are not receiving Medicare, are not pregnant or do not qualify for HUSKY A.

Services covered by Medicaid in Connecticut are delivered by health and behavioral care providers that have contracted with DSS. These providers offer medical care, dental care, pharmacy services and a wide range of behavioral health supports. In keeping with federal legislation regulating all types of Medicaid insurance, HUSKY Health plans include preventive care, primary care and, where appropriate, specialist care services. All HUSKY Health recipients can expect to have access to Medicaid coverage and benefits that partially or fully pay for regularly scheduled check-ups and preventative care appointments with their primary care physicians.

The standards for services covered by Medicaid as part of routine well-patient visits were designed to align with recommendations from the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention (CDC). These recommendations hold that Medicaid coverage-approved well-patient visits can encompass a patient’s medical history, a physical exam, blood work, urine tests, vaccines and screenings for behavioral health concerns. Children’s visits covered by Medicaid may also comprise of growth and oral screenings and education about approved health and safety topics. Adult visits may include screenings for blood pressure and cholesterol concerns, hearing exams, consultation on alcohol, tobacco and substance use, and education related to heart health, nutrition and physical activity.

Women covered under a HUSKY Health program can also rely on Medicaid coverage for some or all of their health care expenses related to women’s health issues, family planning services, pregnancy and maternity care. Based on the provided information on Medicaid applications, enrollees may qualify for additional services. HUSKY Health recipients with qualifying health conditions or disabilities can expect the following services to be covered by Medicaid:

  • Physical, occupational or speech therapy

  • Orthotic and prosthetic devices

  • Durable medical equipment

  • Hearing aids

  • Physical rehabilitation services

In qualifying situations, HUSKY Health Medicaid coveragewill pay for laboratory tests, radiology services (such as X-rays), ambulatory surgery and outpatient hospital care. HUSKY Medicaid coverage plans also make provisions for hospital and emergency room visits, vision care and prescription medications. Other services covered by Medicaid (in part or in whole) for eligible recipients include audiology services, dialysis, home health aides and hospice services where they are determined to be appropriate. Behavioral health services covered by Medicaid include, but are not limited to:

  • Full or partial psychiatric hospitalization and observation periods.

  • Group home placement for children or adults.

  • Case management services.

  • Outpatient and intensive outpatient services.

  • Autism Spectrum Disorder Services.

Medicaid coverage may also pay for psychological testing, detoxification services and home health services related to behavioral health concerns. On top of these universally available services, some types of Medicaid insurance such as HUSKY plans A, C and D may fund additional supports. Examples include transportation services associated with routine health care appointments, extended screening, diagnosis and treatment services and counseling and medication designed to help recipients stop smoking. Download our comprehensive Medicaid guide for more details about mandatory coverage for certain medical treatments.

How much does Medicaid cost in Connecticut?

Medicaid cost estimates in Connecticut vary widely. How much Medicaid costs is influenced by numerous factors. These include household income, for which HUSKY plan an applicant or household qualifies and how the household qualifies for benefits (e.g. income-eligibility vs. eligible due to age or disability). Medicaid coverage costs can also be influenced by what kinds of care a household needs and uses. For example, depending on their plans and income levels, households that require only routine preventative and primary care services covered by Medicaid may expect to see lower costs than households that use Medicaid to help pay for hospital visits, surgeries and other, more intensive forms of care.

Generally, how much Medicaid costs increases in line with a household’s income level when members initiate the Medicaid application process in CT. This is because income affects what types of Medicaid insurance a household qualifies for and the higher a household’s income the more cost-sharing the household can expect to be responsible for. The impact of income levels on Medicaid coverage is not uniform. Applicants living in Region A, or Southwestern Connecticut, are assessed under different income-eligibility standards than residents in the rest of the state (Regions B and C). Region A residents become eligible at a higher income level than other applicants. Connecticut residents living in institutionalized settings are subject to distinct income limits unique to their situations.

Not all expenses associated with how much Medicaid costs can be accounted for by looking at copays, out-of-pocket expenses and other payouts. In some cases, Medicaid coverage may come with indirect costs for applicants. For example, applicants seeking coverage under HUSKY C who have substantial non-monetary assets may not qualify for benefits until they liquidate and “spend down” those assets. Learn more about Medicaid costs and coverage by downloading our detailed Medicaid guide.

Services Not Covered by Medicaid in Connecticut

“What does Medicaid not cover in Connecticut?” is a key Medicaid information for many HUSKY Health enrollees. The most important fact to be aware of on this subject is that all types of Medicaid insurance cover health care services delivered by providers enrolled in the HUSKY network. They do not necessarily cover services delivered by non-enrolled providers. Although HUSKY Health recipients can be permitted to fill prescriptions and receive tests or referrals from non-enrolled providers, Medicaid may not cover any of the associated costs and patients may be required to pay the full cost of those services out-of-pocket. Some screenings are paid for by Medicaid coverage only if the patient is considered to be at high risk for the disease or condition. Examples include screenings for Hepatitis B, Hepatitis C, HIV, Colorectal Cancer and Tuberculosis. Residential treatment for behavioral health problems in children is among the services covered by Medicaid unless or until all other service options have been attempted and proven inadequate. HUSKY B plans require more cost-sharing across the board for all enrollees and impose monthly premiums on plan members.