Monday, May 10, 2010

Fiore's Restaurant in Old Saybrook, CT and The Charter Oak Health Plan

Before I get into a recipe and other local places to visit people in Connecticut received stunning information from Charter Oak -- the health insurance being provided by the state who want insurance and cannot afford it. According to File No. 913 of the Connecticut General Assembly which met on May 7, 2010. This is from the bill...

It cannot be anticipated what the structure of the 1115 waiver submitted by the department will be, nor what the federal government may require prior to final approval of federal financial participation. (For the purposes of this analysis, it is assumed that any such waiver is specific only to the SAGA and Charter Oak programs, and does not alter the structure of the current state Medicaid program.)
Medicaid waivers allow states great flexibility in structuring benefits. Both the SAGA and Charter Oak program have substantially different benefit plans and payment mechanisms as compared to the Medicaid program. Should the federal government simply allow these program structures to be maintained while providing federal reimbursement (which is unlikely), the state would realize a net revenue gain of $95 million.
It is more likely that the federal government would require substantial changes in these programs prior to waiver approval. These changes would likely increase the overall cost of the program, thereby reducing the net state gain. Although the changes required cannot be anticipated, the state would likely see a net gain even with substantial increases (up to 70%) in the overall programmatic costs.
DSS will also incur additional administrative costs (likely between $100,000 and $200,000) for staff and contractual obligations necessary to develop and submit such a waiver
The Out Years
The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.
Sources: DSS cost and caseload data, current services budget estimates, OLR bill summary, public hearing testimony.
OLR Bill Analysis
sSB 988
This bill requires the Department of Social Services (DSS) commissioner, by January 1, 2010, to apply for a federal Medicaid 1115 demonstration waiver to provide Medicaid coverage to individuals qualifying for either the State-Administered General Assistance (SAGA) medical assistance program or the Charter Oak Health Plan (see BACKGROUND). Currently, state funds are used to pay for the SAGA program and the subsidized portion of the Charter Oak Health Plan. Medicaid coverage would provide federal matching funds for these state expenditures.
The bill requires the commissioner to submit the application to the Human Services and Appropriations committees before sending it to the federal Medicaid agency, in accordance with state law. If he fails to do so by January 1, 2010, he must submit a written report to both committees, by January 2, 2010, explaining (1) why he has not done so and (2) an estimate of the cost savings that such a waiver would provide in a single calendar year.
Under current law, the DSS commissioner, by January 1, 2008, was to have sought a waiver to cover SAGA recipients with income up to 100% of the federal poverty level. He never sought the waiver. The bill repeals this separate provision.
EFFECTIVE DATE: Upon passage
Federal Waivers
Federal Medicaid law (Section 1115 of the Social Security Act) allows states to request “demonstration” waivers of federal rules to expand health care coverage when those rules would otherwise not allow such, or to limit whom the program covers. These waivers are generally good for five years unless renewed.
States may still request 1115 waivers, which are research and demonstration waivers that allow states to experiment with coverage. These states must be able to demonstrate that they are “budget neutral” over the life of the demonstration, meaning they cannot be expected to cost the federal government more than it would cost without the waiver.
Legislative Approval of Waivers—CGS §17b-8
State law requires the DSS commissioner, when applying for a federal waiver for other than routine operational issues, to submit the application to the Human Services and Appropriations committees before sending it to the federal government. The committees have 30 days to hold a hearing and advise the commissioner of their approval, denial, or modification of it. If they deny the application, the commissioner may not submit it to the federal government. The law also sets up a process for when the committees do not agree. If the committees do not act within the 30 day period, the application is deemed approved.
Medicaid Coverage for SAGA
In 2003, the legislature directed DSS to seek a Medicaid waiver to cover SAGA medical assistance recipients by March 1, 2004 (PA 03-3, June 30 SS). In 2007, the legislature extended the deadline from March 1, 2004 until January 1, 2008 and extended it to individuals with incomes up to 100% of the FPL (PA 07-185). Currently, SAGA medical assistance is available to individuals with income up to about 55% of the FPL.
Charter Oak Health Plan
Since August 2008, the Charter Oak Health Plan has offered state residents another health insurance option. Individuals must be uninsured for at least six months to qualify and benefits are provided by managed care organizations. The state provides both premium and deductible assistance to individuals whose incomes are under 300% of the federal poverty level.
Legislative History
The Senate referred the bill (File 195) to Appropriations, which removed a requirement that the waiver have a certain designation.
Related Bills
SHB 6402 (File 509) requires DSS to seek a federal waiver for SAGA and Charter Oak by January 1, 2010.
Human Services Committee
Joint Favorable"

Here is the link

It is very disappointing that the DSS Commissioner did not what was needed to help its Connecticut Residents who needed insurance and could not afford it.

Yesterday I had brunch with family for Mother's Day and I helped my Mother with the lawn.

Last week we did go out to dinner at Fiore's Restaurant in Old Saybrook, CT. This is a very popular place with the locals.
Here is a link to their menu.

I had Calamari Fra Diavlo which is served sautéed with fresh garlic, basil in a spicy marinara sauce served over linguine.
My dinner was truly excellent. If you are in the area you should stop by for some Italian. 

Be optimistic.


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