Nearly 84,000 people across Connecticut are enrolled in Medicaid LIA, thousands more than anticipated. Ben Barnes, the state's budget director, recently told members of the legislature's Appropriations Committee that LIA caseloads for the month of October were 5.4 percent higher than originally budgeted. In addition, demand for other Medicaid services, such as hospital and nursing home care, also has climbed. The Department of Social Services' overall Medicaid budget this fiscal year is nearly $224 million in the red.
The bump in demand has prompted lawmakers to question why it is happening and when it could max out.
"It's the biggest single piece of the state's budget that has the largest impact on the most lives," said state Rep. Craig Miner, R-Litchfield, ranking House Republican on the Appropriations Committee. "One way or another, we need to get control of it, or at least better understand why it's trending the way it's trending."
In 2010, Connecticut became the first state in the country to gain federal approval to extend Medicaid coverage to about 47,000 low-income residents, ages 19 to 64. Most were previously enrolled in a limited state-funded program known as State Administered General Assistance or SAGA. Since then, about 37,000 people have signed up for Medicaid LIA, which offers more services than SAGA. The expansion qualified the state to receive 50 percent federal reimbursement.
To be eligible, a single adult can earn up to $508.48 a month and a couple up to $617.44 a month. The limits are slightly higher for Fairfield County applicants.
Before the expansion, there were an average of 107 recipients in Greenwich signed up for SAGA between July 2009 and June 2010, according DSS's report. The next fiscal year, when Medicaid was expanded to include the SAGA recipients, the figure jumped to 216. During last fiscal year, from July 2011 to June 2012, the average monthly caseload was 301.
Barry is not surprised by the numbers. He said the cost of living is high in the region, and about 43 percent of the town's applicants for local emergency assistance are Latino, a younger and less affluent population.
"I think Greenwich is much more diverse than what people view," he said, adding how the recipients are not necessarily newcomers to the border town. Greenwich has a six-month residency requirement for assistance.
Eileen Bronko, a social worker and a former co-chairman of the Naugatuck Social Service Network, is not surprised by the spike in applications either. Average monthly caseloads for needy adults in the blue-collar community of Naugatuck increased from 330 in fiscal year 2010 when SAGA was in place to 592 in fiscal year 2012.
"I think that anybody that thought that this wasn't going to happen was not really looking at the reality of how much people are hurting," she said. "Many, many, many people are without health care. So I think part of what you're seeing is that people can get health care through Medicaid. For the first time, many people are getting health care."
Hartford has experienced the greatest growth, with a monthly average of 6,838 SAGA clients in fiscal year 2010 and a monthly average of 9,866 Medicaid LIA clients is fiscal year 2012.
The numbers are expected to grow more once Connecticut extends coverage further beginning in 2014 as part of the federal health care overhaul law. Those earning up to 133 percent of the federal poverty level, or $29,700 a year for a family of four, will be eligible.
But the state's budgetary issue may be abated because the federal government is supposed to cover 100 percent of the cost for all low-income adults on Medicaid living up to the 133 percent federal poverty level. That reimbursement level will last until 2016. After that, it will gradually be reduced to 90 percent by 2020.
Sen. Toni Harp, D-New Haven, co-chairman of the Appropriations Committee, said even though the state will receive 100 percent federal reimbursement, it still will have to budget for the Medicaid program, and therefore needs a way to plan for the additional growth.
"I think that what concerns me is, that we were led to believe that the LIA population had stabilized and had slowed down somewhat, only to find out we had 4,000 new people in the first three months," she said. "It's shocking."