Connecticut’s program to provide state-sponsored health coverage for children regardless of immigration status has generated explosive demand, shattering projected enrollment estimates.
When the program, often referred to as ‘HUSKY for immigrants,’ launched in January 2023, officials predicted 4,250 kids would sign up. But, by April 2024, 11,000 children had enrolled.
In July 2024, the program expanded to include children up to age 16, by which time 15,000 children had enrolled, more than double the projections of 7,000 sign-ups for fiscal year 2025. The program’s supporters have celebrated the high enrollment numbers, but critics are now raising concerns about cost overruns.
The current budget earmarked $11.5 million in state fiscal year 2024, which ended in June, and $18.9 million in 2025, which goes through the start of next summer, to cover the program’s costs, but those figures assumed lower enrollment projections.
The Department of Social Services, which administers the program, still does not have a clear understanding of how much ‘HUSKY for immigrants’ cost the state last fiscal year or what it’s on track to cost this year.
DSS officials believe that some enrollees actually have citizenship status that would qualify them for traditional Medicaid, which would reduce the number of people enrolled in ‘HUSKY for immigrants.’ The department expects to have a more concrete idea of the price tag prior to the release of the governor’s new biennial budget in February 2025, according to DSS spokesperson Christine Stuart.
“The Department of Social Services is conducting a thorough review to ensure that only undocumented individuals and all kids who have immigration statuses that don’t qualify for Medicaid or CHIP are being funded through this program,” stated Stuart in emailed comments.
‘HUSKY for immigrants’ provides Medicaid-like state-sponsored coverage regardless of immigration status to children 15 and under, as well as people who are pregnant or postpartum, who have qualifying incomes.
The federal government covers roughly half the cost of coverage for traditional Medicaid enrollees, but for those who don’t qualify for Medicaid because of their immigration status, the state bears 100% of the costs. However, the feds provide 65% of the funding for prenatal coverage, even for those who wouldn’t qualify because of immigration status.
‘HUSKY for immigrants’ cost estimates
While DSS officials believe that the review will reveal that there are fewer enrollees in ‘HUSKY for immigrants,’ several estimates floated over the last year suggest the program is over budget.
In April 2024, DSS estimated that covering kids 12 and under was on track to cost the state roughly $25 million in fiscal year 2024, more than $13 million over the original $11.5 million budget.
The governor’s February 2024 proposed budget adjustments estimated that the total cost of covering undocumented children was going to run the state roughly $30 million in fiscal year 2025, compared to the $18.9 million earmarked for the program. However, Office of Policy and Management spokesperson Chris Collibee said the administration expects that figure will come down after DSS’s review.
According to draft estimates from the Office of Fiscal Analysis, the cost of coverage for children was nearly $10 million over budget in fiscal year 2024. In fiscal year 2025, it is on track to run between roughly $12 million and $20 million over budget, assuming that between 13,500 and 15,500 children are enrolled.
The program for people who are postpartum was originally budgeted at $5 million in FY 2025, but OFA estimates that the actual expenditure is somewhere between $5 million and $7 million over budget. The prenatal program expenditure, which receives federal dollars, is estimated to come in slightly below or on par with its budget of $6.5 million.
OFA’s draft analysis acknowledges that it’s “awaiting revised caseload and expenditure data to more accurately reflect the eligible population and associated state costs.”
“We’ve been trying to get this data out of DSS, and they just don’t have it. And that’s also alarming that you have a brand new program that’s not capped, and we don’t have any easy way of ascertaining the cost,” said House Minority Leader Vincent Candelora.
Amidst a Medicaid shortfall of over $200 million, Republican leadership is now calling on the state to halt ‘HUSKY for immigrants’ entirely. Stuart, the DSS spokesperson, said suspension of the program would require legislative approval.
Rep. Jillian Gilchrest, D-West Hartford, co-chair of the Human Services Committee and a supporter of ‘HUSKY for immigrants,’ called Republican demands to suspend the program “short-sighted,” given the long term benefits she said it provides by easing the burden of uncompensated care on hospitals and allowing people to get preventative care.
“I’m not surprised that the Republicans don’t see health care as a human right, but I am surprised that they don’t recognize the long-term savings from covering undocumented immigrants with Medicaid,” she said.
Candelora said he is in favor of some level of coverage for undocumented immigrants to ensure hospitals don’t have to foot the bill through uncompensated care. But, he considers the current program, which covers everything that traditional Medicaid does, too broad.
“I understand that they would never be denied health care coverage,” said Candelora. “But, I think Connecticut overstepped when they gave out this ‘Cadillac’ program.”
Gilchrest said she’s not surprised DSS is still reviewing the final cost of the program, but conceded that any conversation around increasing the eligibility age, which advocates have fought for in years past, would require knowing what the cost of the program has been.
“We’re definitely going to need to know those numbers to make any decisions about expansion,” she said.
Medicaid shortfall
The state’s $3.3 billion Medicaid program has a projected net shortfall of nearly $230 million, according to the latest monthly fiscal update from Gov. Ned Lamont’s budget office to the state comptroller’s office.
Candelora said it’s important to review all current Medicaid spending in order to find areas to trim costs, especially given potential cuts by the incoming federal administration.
“We’re seeing other programs potentially fall by the wayside because of the oversubscription of Medicaid, in particular this program,” said Candelora.
Sen. Matt Lesser, D-Middletown, co-chair of the Human Services Committee and a supporter of HUSKY coverage for undocumented children, said he doubts the program is significantly contributing to the Medicaid overruns.
“Having a better sense of what is driving that will help inform policy decisions moving forward. I just don’t think the answer is immigrant kids,” said Lesser, adding that he expects the program’s cost to fall below estimates once DSS completes its review.
However, Lesser said that the legislature needs more detailed insight into Medicaid’s budgetary issues. In September, Collibee, the OPM spokesperson, said that higher enrollment and utilization, as well as Medicaid expansions were driving the overruns.
“It’s important that the legislature has a good idea of what’s happening. And at this point, I don’t think the information that we have really gives us a deep dive,” said Lesser.
This story was originally published by the Connecticut Mirror Dec. 2, 2024.
