Connecticut Medicaid sees many fiscal opportunities with reform

Michael P. Starkowski, commissioner of Connecticut's Department of Social Services, says that he sees "opportunities galore" in the health care reform legislation. "We are looking at a number of initiatives that are coming down the pike; some of those have pros and cons," says Mr. Starkowski.

Adding smoking cessation to the Medicaid package, for example, will have a cost benefit in the long run. However, in the short term this represents an additional cost to the state, he notes.

Two years ago, Connecticut carved out all pharmaceuticals from its programs. "We handle those collectively as an agency," says Mr. Starkowski. "Every one of our programs has a pharmaceutical benefit, even though based on the program, you may have a copay or an annual cap."

All drugs are pooled through the department using a Preferred Drug List, and they are reviewed and decided on by a pharmaceutical and therapeutics committee. "We already receive a supplemental rebate from the manufacturers. In this department alone, we spend somewhere in the range of $400 million on pharmaceuticals," says Mr. Starkowski.

Altogether, 48 possible opportunities for the state were identified in health care reform. "Some are requirements and some voluntary; some we may apply for and some we may not, but we are trying to look at this in aggregate," Mr. Starkowski says. "We are looking at medical homes. We are looking at multistate initiatives. We are trying to take every single one of the initiatives seriously, and figure out whether it is advantageous to the state."

The state has found that the federal government and the Centers for Medicare & Medicaid Services are eager to move quickly with initiatives, he says. For example, with the high-risk pool initiative, there was a very short time frame for states to get their information together and make decisions.

"In some respects, this actually benefits the states. You have a short window of time to focus your resources, make a decision, and move on to the next issue," says Mr. Starkowski. "If you are allowed six or eight months to go through a process, the decision-making gets harder. It keeps popping up, but then it goes down to the bottom of the pile again and comes up another day."

More incentives

The state is interested in taking greater advantage of financial incentives for the transition of people from institutional care to community settings, he says. This is something that Connecticut has been working on for some time.

"We have a new — but robust — Money Follows the Person program. We have moved out 300 people from skilled nursing facilities back into the community," says Mr. Starkowski.

Previously, an individual had to be in a facility for six months to be transitioned, but this was decreased to 90 days. This is an advantage not only for the state, but also for residents, says Mr. Starkowski, as it's easier to move someone into the community who still has connections in place.

At the end of the day, will health care reform actually be self-sustaining for Connecticut? Mr. Starkowski says, "I think the jury is out. It has the potential to cost states significant amounts of money by increasing the rolls they are responsible for. In general, our first experiences have been positive. Whether those will continue for the next three and a half years, time will tell."

Contact Mr. Starkowski at (860) 424-5054 or