Some with insurance seek to join state plan

by Lesley Politi on December 9, 2008

Lynn Sawyer of Greenwich has Anthem Blue Cross-Blue Shield insurance, which is supposed to exclude her from qualifying for the state’s new Charter Oak Health Plan for adults.

But after the plan launched in July, Sawyer – who earns about $30,000 as a part-time legal assistant in Stamford – discovered it would be cheaper than the $300 monthly payments and $5,000 deductible under Anthem.

So she applied for the Charter Oak plan, hoping the state Department of Social Services would grant her an exemption.

She is not alone. Although Charter Oak was crafted to serve uninsured adults ages 19 to 64 of all incomes, DSS has received numerous requests from insured residents hoping to cut their monthly payments and deductibles.

“There are many Charter Oak applicants who feel that they cannot afford their current health insurance and are looking for a more affordable health coverage option,” David Parella, DSS director of medical care administration, wrote Sawyer last month. “DSS is in the process of developing a fair way to assess those individuals who state they are experiencing a financial hardship.”

Charter Oak applicants are supposed to be without health insurance for at least six months.

That waiting period was based on how the state handles its HUSKY health plan for children, DSS spokesman David Dearborn said. The federal government, which partially reimburses the state for some of the costs of HUSKY, imposed the waiting period in 1997, Dearborn said

was not intended to encourage people to leave their current coverage or, by the same token, to tempt employers to drop their fringe benefits,” he said.

When state lawmakers passed the law creating Charter Oak, the six-month waiting period was built in, with exceptions, he said. The exceptions include sudden loss of employment, loss of coverage because of divorce or death of a spouse, or if an employer terminates health coverage for reasons unrelated to the availability of Charter Oak.

DSS determined that applicants paying 40 percent or more of their income for other insurance or out-of-pocket medical expenses qualify for Charter Oak, Dearborn said.

Applicants whose insurance costs are 25 percent to 39 percent of their income are placed on a hardship list temporarily, pending review of other costs such as housing.

The broader list of exemptions is “fairly straightforward to determine with fairly simple documentation,” Dearborn said. “The financial hardship requests can get more complex in terms of documentation.”

DSS so far approved about 200 waiting-period exceptions. Dearborn did not know how many were for financial hardship, or how many applicants tried to claim financial hardship.

Sawyer was not one of them. She received a letter last week from DSS denying her application. She is considering filing an appeal within the allotted 10 days but is skeptical it will succeed.

“I gave them all my financials,” Sawyer said. “I’m disappointed. To me this is not what this program was all about. It was supposed to be for people exactly like me.”

Enrollment in Charter Oak reached 3,000 this week, with another 1,500 deemed eligible and ready to enroll, Dearborn said.

- Staff Writer Brian Lockhart can be reached at brian.lockhart@scni.com or 750-5352.

Source: www.stamfordadvocate.com

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