Why are CT Medicaid costs rising? GOP wants auditors to find out

Minority Republicans in the state Senate are calling for a new audit and other reviews of Connecticut’s Medicaid program to stem cost overruns that have plagued the program in recent years.

The GOP caucus, which controls 11 out of 36 Senate seats, sent a letter to the state auditors of public accounts, John Geragosian and Craig Miner, asking for a review “to reveal potential efficiency measures which could produce significant savings for taxpayers.”

Senate Minority Leader Stephen Harding, R-Brookfield, also called for the General Assembly’s Human Services Committee and other legislative panels with jurisdiction over Medicaid matters need to investigate the factors driving Medicaid spending when the regular 2026 session begins in early February.

“There’s something going on, and we need to find out what that something is,” Harding said, referring to a new projection from Gov. Ned Lamont’s budget office that the Department of Social Services expects to exceed its $3.7 billion Medicaid line item by $100 million this fiscal year, which began July 1.

Social Services Commissioner Andrea Barton Reeves told The Connecticut Mirror last month that the surging costs tied to pharmaceuticals and inpatient hospital services both are straining the Medicaid budget.

Increased demand for behavioral health services, staffing shortages and medical inflation also are pushing inpatient service costs upward.

Lamont’s budget spokesman, Chris Collibee, added that the administration is following the matter closely, but changes in the economy and other factors also could affect Medicaid.

But Harding noted Connecticut’s struggles with Medicaid pre-date this fiscal year.

The legislature authorized $284 million extra to cover Medicaid cost overruns in 2024-25. And the health care program topped its budget by $166.3 million in 2023-24, according to records from the comptroller’s office.

Harding conceded some of the Medicaid growth likely stems from increasing numbers of Connecticut families unable to cover the state’s high cost of living.

The United Way of Connecticut reported last month that a record-high 581,000 Connecticut households, about 40%, couldn’t afford a basic “survival” budget in 2023. And while more than 60% of families in Bridgeport, New Haven, Hartford and other poor cities fall below this threshold, poverty now is growing the fastest outside of urban centers.

But minority Republicans in the state House and Senate said majority Democrats also are expanding Medicaid, which is funded annually with a combination of state and federal funding, without regard for what taxpayers can afford.

In January 2023, the state began covering children 12 and younger from families without qualifying immigration status. Initial expectations were that 4,250 kids would be enrolled, but that number reached 15,000 by July 2024. “It is driving and inviting illegal immigration into the state,” Harding said.

Lawmakers in 2023 ordered Medicaid coverage for services provided by health coaches and other community health workers, and they eased eligibility criteria for HUSKY C, which provides Medicaid to people who aren’t working and are 65 and older, blind or disabled.

And this year legislators took a first step, albeit much smaller than planned, to boost long-neglected Medicaid payments for providers who treat low-income patients. Connecticut hadn’t raised these reimbursement rates broadly since 2007, leaving many insured patients unable to find physicians who will treat them. 

But Rep. Jillian Gilchrest, D-West Hartford, predicted majority Democrats in the General Assembly won’t cut state investments in Medicaid, particularly given steep new federal cuts ordered for health care and nutrition assistance programs.

Gilchrest, who is running for Congress, added she is open to the Human Services Committee taking a closer look at Medicaid to make the program more efficient.

“I think we need to look at reform of the health care system” to find savings, she said, but added that effort shouldn’t involve cutting help for the most vulnerable.

Geragosian and Miner’s office hadn’t responded to the Senate Republicans’ request as of late Friday.

But Medicaid already is subjected to multiple audits annually, though not necessarily ones focused strictly on cost efficiency.

The auditors must complete a yearly Federal Single Audit that examines the tens of billions in dollars Connecticut spends annually on Medicaid, welfare, housing, transportation construction projects and other programs backed with federal funds. Geragosian and Miner’s staff also conduct an audit of all state Department of Social Services operations every two years.

And within social services, the department’s Office of Quality Assurance also conducts regular audits of the state’s Medicaid program.

Source – Indonesia News