O F F I C E O F L E G I S L A T I V E R E S E A R C H
P U B L I C A C T S U M M A R Y
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PA 21-176—HB 6687
Emergency Certification
AN ACT CONCERNING ME DICAL ASSISTANCE FOR CHILDREN
AND ADULTS WITHOUT H EALTH CARE COVERAGE
SUMMARY: This act requires the Department of Social Services (DSS) to
extend eligibility for medical assistance, subject to income limits and within
available appropriations, to certain groups of people, regardless of immigration
status, who do not otherwise qualify for health care coverage. The act extends this
coverage to (1) children under age 9 and (2) women for 12 months after giving
birth.
The act also requires the DSS commissioner to amend the Children’s Health
Insurance Program (CHIP) state plan to provide medical assistance for prenatal
care through the “unborn child option.” This is a state option that allows states to
consider an unborn child a low-income child eligible for prenatal care coverage if
other CHIP eligibility requirements are met.
Additionally, the act requires the Office of Health Strategy (OHS) executive
director to study the feasibility of offering health care coverage for certain (1)
income-eligible children ages 9 to 18, regardless of immigration status, and (2)
adults with household income up to 200% of the federal poverty level (FPL) (see
BACKGROUND). The executive director must report her findings to the
Appropriations, Human Services, and Insurance and Real Estate committees by
July 1, 2022.
Lastly, the act allows the DSS commissioner to (1) seek a state innovation
waiver under section 1332 of the Affordable Care Act (ACA) or (2) enter into
contractual agreements, including with other states, in accordance with
established procedures, as needed to perform duties under the act. Section 1332 of
the ACA allows states to waive certain ACA requirements in order to customize
their health insurance systems to better meet state needs while retaining the
ACA’s basic protections.
EFFECTIVE DATE: October 1, 2021, except the report requirement is effective
upon passage.
§§ 1 & 3 — CHILDREN UNDER AGE 9
The act requires the DSS commissioner, generally beginning January 1, 2023,
to provide state-funded medical assistance, within available appropriations, to
children under age 9, regardless of immigration status, with household incomes
(1) up to 201% of FPL with no asset limit and (2) over 201% of FPL and up to
323% of FPL. Under the act, eligible children are those who do not otherwise
qualify for (1) Medicaid, (2) CHIP, or (3) an offer of affordable, employer-
sponsored insurance as defined in the ACA as an employee’s dependent. O L R P U B L I C A C T S U M M A R Y
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§ 2 — POSTPARTUM CARE FOR WOMEN
The act requires the DSS commissioner, on or after April 1, 2023, to provide
state-funded medical assistance, within available appropriations, for postpartum
care to women for 12 months after birth who (1) do not qualify for Medicaid due
to immigration status and (2) have household incomes up to 263% of FPL.
§ 4 — UNBORN CHILD OPTION FOR PRENATAL CARE
The act requires the DSS commissioner to amend the CHIP state plan to
provide medical assistance for prenatal care through the “unborn child option.”
This is a state option that allows states to consider an unborn child a low-income
child eligible for coverage of prenatal care if other CHIP eligibility requirements
are met. According to the federal Centers for Medicare and Medicaid Services,
the requirement to meet other CHIP eligibility criteria applies to the child and not
the mother.
The commissioner must provide medical assistance for prenatal care through
this option by April 1, 2022. CHIP is jointly funded by the state and federal
government and is administered by DSS according to federal requirements. The
state provides CHIP coverage under HUSKY B, which covers children in families
with household incomes between 196% and 318% of FPL. (PA 21-2, June Special
Session (§ 344) limits eligibility under the unborn child option to families with
household incomes at or below 258% of FPL, aligning it with eligibility for
pregnant women under the state’s Medicaid program.)
§ 5 — STUDY ON FEASIBILITY OF EXPANDING HEALTH CARE
COVERAGE
The act requires the OHS executive director to study the feasibility of offering
health care coverage for the following groups:
1. income-eligible children ages 9 to 18, regardless of immigration status,
who are not otherwise eligible for other coverage (i.e., under Medicaid,
CHIP, or an offer of affordable employer-sponsored insurance as defined
in the ACA as an employee or employee’s dependent) and
2. adults with household income up to 200% of FPL who do not otherwise
qualify for other coverage (i.e., under medical assistance programs (e.g.,
Medicaid); affordable employer-sponsored insurance as defined in the
ACA as an employee or employee’s dependent; or health care coverage
through the Connecticut Health Insurance Exchange due to household
income).
The act requires the OHS director to conduct the studies in consultation with
the Office of Policy and Management, DSS, the Connecticut Insurance
Department, and the Connecticut Health Insurance Exchange.
The act requires the study on health care coverage for income-eligible
children to include: O L R P U B L I C A C T S U M M A R Y
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1. the age groups that would be provided medical assistance in each year,
and the appropriations needed to do so;
2. income eligibility criteria and health care coverage consistent with
assistance the state provides under Medicaid and CHIP; and
3. recommendations for identifying and enrolling eligible children.
The act requires the study on health care coverage for adults to include:
1. household income caps for adults who would be provided health care
coverage in each year, and the appropriations needed to do so;
2. health care coverage consistent with medical assistance the state provides
under Medicaid, generally, and HUSKY D, specifically; and
3. recommendations for identifying and enrolling eligible adults.
The act requires the OHS executive director to report on the studies to the
Appropriations, Human Services, and Insurance and Real Estate committees by
July 1, 2022.
BACKGROUND
Federal Poverty Level
The U.S. Department of Health and Human Services establishes the FPL
annually. Table 1 shows the number of people in a household and the annual FPL
amounts for 2021 at various percentages, rounded to the nearest dollar.
Table 1: FPL Amounts at Various Percentages (2021)
Number of
People in
Household
100% 200% 201% 258% 263% 323%
1 $12,880 $25,760 $25,889 $33,230 $33,874 $41,602
2 $17,420 $34,840 $35,014 $44,944 $45,815 $56,267
3 $21,960 $43,920 $44,140 $56,657 $57,755 $70,931