A handful of states, including Massachusetts and New Jersey, have either begun — or intend to begin — stockpiling mifepristone to facilitate access to the drug in the wake of threats to curb its availability. Connecticut had considered doing the same, but ultimately, the Lamont administration decided against it because of concerns about cost, Rep. Jillian Gilchrest, D-West Hartford, said at the State Capitol.

“There were calls from the governor’s office and others in this building to stockpile mifepristone, and when presented with two viable options, we were met with a hesitation to put the money up,” said Gilchrest, who was spearheading the efforts and serves as co-chair of the Human Services Committee.

The two options, presented to the governor’s staff in early December, included a plan to have UConn Health stockpile the drug, which would have cost roughly $1.2 million, and another to have Planned Parenthood do so, which would have cost around $850,000, according to Gilchrest. The price tag for the Planned Parenthood option was lower because the organization purchases mifepristone at a reduced rate and already has a purchasing process in place, Gilchrest said.

The governor’s office confirmed Thursday that the state has no plans to amass and store the drug. “The Governor has a strong record of protecting and strengthening access to reproductive healthcare in Connecticut,” Julia Bergman, a spokesperson for the governor, wrote in an email. “We’ve consulted family planning advocacy organizations and healthcare providers. The state does not currently have any plans to stockpile mifepristone.”

Bergman added that the state will “continue to respond to” the needs of and “partner with” family planning advocacy organizations and health care providers.

Mifepristone is taken along with another drug, misoprostol, to end a pregnancy. The combined treatment is known as the “abortion pill” or medication abortion. The U.S. Food and Drug Administration first approved mifepristone in 2000.

Data from a 2023 study found that medication abortion is used in well over half of abortions in the United States, with the numbers increasing since 2020. In 2021, there were 9,562 abortions performed in Connecticut. Of those, nearly 64% were medication abortion using mifepristone.

Following President-elect Donald Trump’s victory in November, Connecticut Senate Democratic leadership sent a letter to Lamont urging him to work with the legislature to prepare for the incoming administration and praising him for action he’d already taken, including a plan to stockpile mifepristone.

“We appreciate the efforts of your administration, the Department of Public Health, UConn, legislators, and others who are currently developing a plan to stockpile doses of mifepristone. States such as Massachusetts, Washington, and New York have already taken similar actions, and we are pleased that Connecticut plans to follow their lead,” Sen. Martin Looney, D-New Haven, and Sen. Bob Duff, D-Norwalk, wrote in the letter.

A spokesperson for Sens. Looney and Duff did not respond to requests for comment last week.

Several states, including Massachusetts, began stockpiling the drug after a federal court ruling in Texas blocked the FDA’s approval of mifepristone in April 2023. Last June, the Supreme Court dismissed that case based on legal standing, preserving access for now.

New Jersey Governor Phil Murphy announced Tuesday that the state would join others and begin stockpiling the drug ahead of President-elect Donald Trump’s inauguration today, on Monday.

Stockpiling mifepristone would help to guard against an effort outlined in Project 2025, the conservative governing plan developed by the Heritage Foundation with assistance from many officials connected to Trump’s first term. The plan makes calls to invoke the 150-year-old federal Comstock Act in order to prosecute providers who send mifepristone by mail. Project 2025 also proposes revoking FDA approval of the drug.

“I am disappointed that at this point in time, we have yet to do anything to stockpile mifepristone in the case of a change to the Comstock Act,” Gilchrest said.

Connecticut is generally considered a “safe haven” for reproductive rights, with some of the strongest protections around the country.

Legislation passed in 2022 made Connecticut a legal “safe harbor” for those who travel here from another state to receive an abortion and for the clinicians who perform them. It also expanded the type of providers who can perform first-trimester abortions to include nurse midwives, advanced practice registered nurses and physician assistants. In 2023, lawmakers passed a bill protecting medical providers in Connecticut who face disciplinary action in other states for performing abortions.

At the recommendation of the governor, the Appropriations and Human Services Committees last week approved an additional $500,000 in federal funding for Planned Parenthood of Southern New England, under what’s known as the Social Services Block Grant, to help support the increased demand for services. The funds will go towards annual exams, cancer screenings, birth control and other family planning services.

Planned Parenthood of Southern New England President Amanda Skinner said in the two weeks following the November 5 election the organization saw a 39% increase in its number of weekly average appointments for “long-acting reversible contraceptives.”

“People in Connecticut are scared about what this means for their ability to get the care they need,” Skinner stated.

However, because the block grant funding comes from the federal government, it cannot go towards abortion-related services, which includes stockpiling mifepristone.

Sen. Cathy Osten, D-Sprague, co-chair of the Appropriations Committee, said there could be legislative proposals this year seeking to allocate funds towards stockpiling the drug. But she said she questions their chances of success if they were to make it to her committee’s desk.

“I’m not certain where we would be on that,” Osten said. “We have a lot of asks and we are not putting any one thing in front of any other thing.”

Katy Golvala is reporter for the Connecticut Mirror. Copyright 2025 @ CT Mirror (ctmirror.org).

The California-based hospital operator, which also owns facilities in California, Pennsylvania and Rhode Island, filed for chapter 11 in the U.S. Bankruptcy Court in Northern Texas. In a statement, representatives for the company said the filing would allow Prospect to “proceed on a strategic pathway to realign its organizational focus outside of California.”

Speaking at the Capitol Monday, Gov. Ned Lamont said the hospitals would stay open and that officials would hold Prospect accountable to providing high-quality care.

“Some people think bankruptcy means the lights go out and the party’s over. That’s not true at all. These hospitals are very successful,” Lamont said, reiterating that the hospitals will “stay open, stay managed.”

The state of Connecticut is listed as one of the top 30 creditors in the bankruptcy filing. Prospect owes the state more than $100 million in taxes, according to a state official at Monday’s event.

It’s unclear what the bankruptcy will mean for the pending agreement Prospect signed in 2022 to sell its three Connecticut hospitals to Yale New Haven Health for $435 million. The deal is currently mired in legal disputes, as the parties have sued and countersued over the true value of the three hospitals.

Early on at Monday’s press conference, Lamont made comments suggesting the sale process had failed, but walked them back when asked for clarification.

“We’ve worked our hearts out over the last two years trying to get this arrangement done between Prospect and Yale New Haven, just couldn’t get there,” Lamont said during opening comments. He added that his administration would be focused on quality of care while “trying to figure out who the next owner and operator of these [three] amazing hospitals is going to be.”

Later, when asked whether the deal had fallen through, he said there was still a possibility it could happen. “I’d like to see the deal get done,” Lamont said. “Yale New Haven has an agreement to purchase these hospitals. We’ll see whether that goes forward.”

Lamont also said he still doesn’t see a need for the state to provide funds to help the hospitals remain open. “Closures aren’t imminent,” Lamont said, adding that the hospitals are “doing very well” under the leadership of Deborah Weymouth, the CEO of Prospect’s Connecticut hospitals.

“I don’t see the need for taxpayer subsidies here,” he said.

But reports about conditions at the hospitals, which Prospect acquired in 2016, found worsening financial and operational problems in recent years. And in August 2023, a cyberattack crippled operations at Prospect’s facilities around the country. The following month, the presidents of Prospect’s Connecticut hospitals warned the governor that the financial situation at all three hospitals was dire.

In October of last year, the Connecticut Office of Health Strategy launched an investigation into service cuts at Rockville General Hospital in Vernon, exploring whether the cuts violated state law. Prospect was hit with federal liens for failure to pay into the pension plan for its Connecticut employees. State inspectors have also documented rusting equipment in operating rooms at Waterbury Hospital. Payments to physicians at Manchester Memorial Hospital have reportedly been delayed.

The state currently has an independent monitor overseeing operations at Waterbury Hospital. Department of Public Health Commissioner Manisha Juthani said during the press conference that the state intends to “monitor each of the facilities more in depth than they have been to date.”

“I’m just really concerned that the employees are going to see this as an unstable situation and start looking for someplace else to work,” Tammy Nuccio, R-Tolland, whose district includes Rockville General Hospital, said during an interview with the Connecticut Mirror ahead of the press conference.

Weymouth, the CEO of Prospect’s hospitals in Connecticut, said employees would continue receiving payment. “I can assure you that payroll will be made, but I cannot go any further to give you the additional details,” she said, noting Prospect is “a privately held organization.”

Attorney General William Tong referenced an ongoing investigation his office launched into Prospect in 2023, but did not provide specifics on the status of that investigation.

“The Governor and I have been working closely together, arm in arm in an effort to keep these hospitals open,” Tong said. “If I think that litigation is the best way to achieve that goal, I will not hesitate for a second to sue.”

The hospitals, which Prospect acquired in 2016, have faced worsening financial and operational problems in recent years. In 2022, Connecticut-based Yale New Haven Health System reached a tentative agreement to purchase the three facilities for $435 million, but the deal has run into numerous delays — not least of which was a debilitating cyberattack in August 2023.

Representatives from Prospect Medical Holdings and its Connecticut hospitals did not respond to requests for comment regarding the reports about bankruptcy. The company hasn’t filed for bankruptcy, according to court records.

A representative for Yale New Haven Health did not provide comment in time for publication.

Gov. Ned Lamont has worked with both health systems’ leaders to help facilitate the deal. In an emailed statement Thursday, Julia Bergman, a spokesperson for the governor said, “Our office has been in touch with Prospect Medical Holdings regarding these reports and is prepared to protect the people served by these hospitals no matter what develops.”

Bergman added the “administration has been on the ground actively monitoring the situation in all three hospitals, including the recent hiring of an independent health care monitor at Waterbury Hospital.”

State Attorney General William Tong, whose office has been conducting an investigation into Prospect’s financial practices, said in an emailed statement, “Bankruptcy changes nothing with regards to their obligations to patient care and safety.” Tong added, “We are watching this closely.”

According to The Wall Street Journal’s report, Prospect, which also owns hospitals in Rhode Island and Pennsylvania, is working with law firm Sidley Austin and consulting firm Alvarez & Marsal to explore options, including a possible restructuring. Representatives from Sidley Austin and Alvarez & Marsal did not immediately respond to requests for comment Thursday evening.

Since acquiring the three Connecticut hospitals in 2016, Prospect has garnered a reputation for draining resources from the facilities it owns around the country while extracting profits for executives and investors, according to news reports.

The Prospect-owned facilities in Connecticut — Waterbury, Rockville General, and Manchester Memorial hospitals — have suffered financially and operationally over the last several years. In August 2023, Prospect Medical Holdings was hit with a debilitating cyberattack that crippled many of its facilities around the country. The following month, the presidents of Prospect’s Connecticut hospitals warned the governor that the financial situation at all three hospitals was dire.

It’s unclear what impact a bankruptcy filing might have on the long-awaited pending sale of Connecticut’s Prospect facilities to Yale New Haven Health. The deal has been seen by many in the General Assembly and the hospital’s surrounding communities as the only path to stabilizing the hospitals. But the deal is mired in legal disputes — the parties have sued and countersued over the true value of the three hospitals.

As the deal drags on, the barrage of reports detailing deteriorating conditions at the facilities has not let up.

In October, the Connecticut Office of Health Strategy launched an investigation into service cuts at Rockville General Hospital in Vernon that may have violated state law. Prospect was hit with federal liens for failure to pay into the pension plan for its Connecticut employees. State inspectors have also documented rusting equipment in operating rooms at Waterbury Hospital. Payments to physicians at Manchester Memorial Hospital have reportedly been delayed.

Sen. Saud Anwar, D-South Windsor, co-chair of the Public Health Committee and a physician who is affiliated with Manchester Memorial Hospital, said he would work with the governor and other legislators to protect Connecticut residents.

“There are about half a million patients in our state who depend on their care at these facilities, and there are thousands of amazing, hard working, committed healthcare workers who are providing care to our community members,” Anwar said. “To see a profit driven, greedy organization take away such important assets of the community is painful.”

Katy Golvala is a reporter for The Connecticut Mirror (https://ctmirror.org/ ). Copyright 2025 © The Connecticut Mirror.

In 2023, the legislature expanded Medicaid coverage to include obesity treatment services including bariatric surgery, nutritional counseling and drugs, like Wegovy, that have been approved by the U.S. Food and Drug Administration for weight loss. Despite the mandate, the Connecticut Department of Social Services has not been covering weight loss drugs because of cost concerns, said Sen. Matt Lesser, D-Middletown, one of the legislators who worked on the bill.

“It is discouraging when we work with DSS and the administration to pass a law and then they decide that the law doesn’t apply to them,” Lesser said.

In an emailed response to questions, Christine Stuart, a spokesperson for DSS, didn’t clarify whether or not the agency is covering FDA-approved weight loss drugs for Medicaid enrollees and, if not, whether that violates state law.

“Obesity is a complex and chronic medical condition that requires comprehensive, evidence-based management,” Stuart wrote. “We are dedicated to ensuring access to approved weight loss medications while maintaining thoughtful clinical oversight to safeguard Medicaid members’ long-term health and ensure coverage for those who meet the eligibility criteria.”

Connecticut guarantees coverage of weight loss drugs and nutritional counseling for Medicaid enrollees with a body mass index, or BMI, of at least 35. It also covers bariatric surgery for anyone with severe obesity — defined in the statute as a BMI of 35 or more with another condition or a BMI of 40 or above.

Under the legislation, the agency only has to cover drugs approved by the FDA for weight loss, like Wegovy. Ozempic, on the other hand, has only been approved for treating Type 2 diabetes, so the agency wouldn’t have to cover it for weight loss.

Some providers have been prescribing drugs like Ozempic to Medicaid enrollees for purposes other than Type 2 diabetes, including weight loss. But that practice will soon come to an end. Earlier this month, the agency issued a bulletin to medical providers and pharmacies saying Ozempic may now only be prescribed to patients with a Type 2 diabetes diagnosis. If the drug is currently prescribed for another purpose, DSS said it would no longer cover the cost after Jan. 15.

Now, Medicaid enrollees who use GLP-1 agonists for weight loss won’t have many options.

Lesser said officials at DSS confirmed to him that they’re not currently covering the cost of FDA-approved weight loss drugs or nutritional counseling. But he said they were less clear about whether bariatric surgeries are covered. He also said the agency doesn’t cover Wegovy for purposes other than weight loss, like the treatment of cardiovascular disease, which would violate federal law.

Drugs like Ozempic and Wegovy are part of a class of medications called glucagon-like peptide-1 agonists, or GLP-1 agonists, which mimic the GLP-1 hormone in the body that controls insulin and blood glucose levels. Their effects on the brain can also reduce hunger and help people feel full for longer.

The treatments, while expensive, have surged in popularity because of their effectiveness. In a recent study from the Yale School of Medicine, researchers concluded that the medications could prevent more than 40,000 deaths a year in the U.S.

“Expanding access to these medications is not just a matter of improving treatment options but also a crucial public health intervention,” stated Alison Galvani, one of the study’s authors.

Last month, the Biden administration proposed further expanding access to the drugs for enrollees in Medicare and Medicaid.

Currently, Connecticut is one of fewer than 20 states that covers a GLP-1 drug specifically for weight loss under the state’s Medicaid program. In a survey by KFF Health News, many states that don’t currently cover them indicated cost was a concern.

GLP-1 drugs come with a hefty price tag. Without insurance, they can cost as much as $1,000 a month. The high costs have led some insurers to roll back coverage, leaving people who have come to depend on them in limbo.

According to December estimates from Connecticut’s Office of Policy and Management, the state’s Medicaid program is on track to have a $260 million shortfall this fiscal year. Lesser said DSS told him cost concerns drove the decision not to cover weight loss drugs.

“What they have told me, and I believe them, is that when they first negotiated the law, they looked at the prices at the moment, and that the drug companies have since raised the price, and so that has changed the calculus,” he said.

Last week, Sheldon Toubman, an attorney with Disability Rights Connecticut, wrote a letter to DSS Commissioner Andrea Barton Reeves, calling on her agency to follow state and federal mandates.

“Apparently, your agency knowingly disregarded the law for a year and half [sic], and, when concerns were raised, agency employees were told that the law was not going to be implemented because of cost,” Toubman wrote.

Lesser said the state needs to look for creative ways to “strengthen” the agency’s negotiating position with drug manufacturers. Still, the high cost doesn’t give the agency permission to circumvent statute, he said.

“The cost of this coverage is quite high but that doesn’t mean flouting the law is ever acceptable,” he said.

When the program, often referred to as ‘HUSKY for immigrants,’ launched in January 2023, officials predicted 4,250 kids would sign up. But, by April 2024, 11,000 children had enrolled.

In July 2024, the program expanded to include children up to age 16, by which time 15,000 children had enrolled, more than double the projections of 7,000 sign-ups for fiscal year 2025. The program’s supporters have celebrated the high enrollment numbers, but critics are now raising concerns about cost overruns.

The current budget earmarked $11.5 million in state fiscal year 2024, which ended in June, and $18.9 million in 2025, which goes through the start of next summer, to cover the program’s costs, but those figures assumed lower enrollment projections.

The Department of Social Services, which administers the program, still does not have a clear understanding of how much ‘HUSKY for immigrants’ cost the state last fiscal year or what it’s on track to cost this year.

CT advocates rally for further expansion of HUSKY for immigrants

DSS officials believe that some enrollees actually have citizenship status that would qualify them for traditional Medicaid, which would reduce the number of people enrolled in ‘HUSKY for immigrants.’ The department expects to have a more concrete idea of the price tag prior to the release of the governor’s new biennial budget in February 2025, according to DSS spokesperson Christine Stuart.

“The Department of Social Services is conducting a thorough review to ensure that only undocumented individuals and all kids who have immigration statuses that don’t qualify for Medicaid or CHIP are being funded through this program,” stated Stuart in emailed comments.

‘HUSKY for immigrants’ provides Medicaid-like state-sponsored coverage regardless of immigration status to children 15 and under, as well as people who are pregnant or postpartum, who have qualifying incomes.

The federal government covers roughly half the cost of coverage for traditional Medicaid enrollees, but for those who don’t qualify for Medicaid because of their immigration status, the state bears 100% of the costs. However, the feds provide 65% of the funding for prenatal coverage, even for those who wouldn’t qualify because of immigration status.

‘HUSKY for immigrants’ cost estimates

While DSS officials believe that the review will reveal that there are fewer enrollees in ‘HUSKY for immigrants,’ several estimates floated over the last year suggest the program is over budget.

In April 2024, DSS estimated that covering kids 12 and under was on track to cost the state roughly $25 million in fiscal year 2024, more than $13 million over the original $11.5 million budget.

The governor’s February 2024 proposed budget adjustments estimated that the total cost of covering undocumented children was going to run the state roughly $30 million in fiscal year 2025, compared to the $18.9 million earmarked for the program. However, Office of Policy and Management spokesperson Chris Collibee said the administration expects that figure will come down after DSS’s review.

According to draft estimates from the Office of Fiscal Analysis, the cost of coverage for children was nearly $10 million over budget in fiscal year 2024. In fiscal year 2025, it is on track to run between roughly $12 million and $20 million over budget, assuming that between 13,500 and 15,500 children are enrolled.

The program for people who are postpartum was originally budgeted at $5 million in FY 2025, but OFA estimates that the actual expenditure is somewhere between $5 million and $7 million over budget. The prenatal program expenditure, which receives federal dollars, is estimated to come in slightly below or on par with its budget of $6.5 million.

Undocumented immigrants covered by DACA soon eligible for CT health insurance

OFA’s draft analysis acknowledges that it’s “awaiting revised caseload and expenditure data to more accurately reflect the eligible population and associated state costs.”

“We’ve been trying to get this data out of DSS, and they just don’t have it. And that’s also alarming that you have a brand new program that’s not capped, and we don’t have any easy way of ascertaining the cost,” said House Minority Leader Vincent Candelora.

Amidst a Medicaid shortfall of over $200 million, Republican leadership is now calling on the state to halt ‘HUSKY for immigrants’ entirely. Stuart, the DSS spokesperson, said suspension of the program would require legislative approval.

Rep. Jillian Gilchrest, D-West Hartford, co-chair of the Human Services Committee and a supporter of ‘HUSKY for immigrants,’ called Republican demands to suspend the program “short-sighted,” given the long term benefits she said it provides by easing the burden of uncompensated care on hospitals and allowing people to get preventative care.

“I’m not surprised that the Republicans don’t see health care as a human right, but I am surprised that they don’t recognize the long-term savings from covering undocumented immigrants with Medicaid,” she said.

Candelora said he is in favor of some level of coverage for undocumented immigrants to ensure hospitals don’t have to foot the bill through uncompensated care. But, he considers the current program, which covers everything that traditional Medicaid does, too broad.

“I understand that they would never be denied health care coverage,” said Candelora. “But, I think Connecticut overstepped when they gave out this ‘Cadillac’ program.”

Gilchrest said she’s not surprised DSS is still reviewing the final cost of the program, but conceded that any conversation around increasing the eligibility age, which advocates have fought for in years past, would require knowing what the cost of the program has been.

“We’re definitely going to need to know those numbers to make any decisions about expansion,” she said.

Medicaid shortfall

The state’s $3.3 billion Medicaid program has a projected net shortfall of nearly $230 million, according to the latest monthly fiscal update from Gov. Ned Lamont’s budget office to the state comptroller’s office.

Candelora said it’s important to review all current Medicaid spending in order to find areas to trim costs, especially given potential cuts by the incoming federal administration.

“We’re seeing other programs potentially fall by the wayside because of the oversubscription of Medicaid, in particular this program,” said Candelora.

Sen. Matt Lesser, D-Middletown, co-chair of the Human Services Committee and a supporter of HUSKY coverage for undocumented children, said he doubts the program is significantly contributing to the Medicaid overruns.

“Having a better sense of what is driving that will help inform policy decisions moving forward. I just don’t think the answer is immigrant kids,” said Lesser, adding that he expects the program’s cost to fall below estimates once DSS completes its review.

However, Lesser said that the legislature needs more detailed insight into Medicaid’s budgetary issues. In September, Collibee, the OPM spokesperson, said that higher enrollment and utilization, as well as Medicaid expansions were driving the overruns.

“It’s important that the legislature has a good idea of what’s happening. And at this point, I don’t think the information that we have really gives us a deep dive,” said Lesser.

Katy Golvala is a reporter for The Connecticut Mirror (https://ctmirror.org/ ). Copyright 2024 © The Connecticut Mirror.

Under the terms of the settlement, Johnson Memorial Hospital, owned by Trinity Health of New England, must hire an independent third party to assess the need for and feasibility of establishing a free-standing birth center, an alternative to traditional hospitals for low-risk pregnancies, in the hospital’s service area. The hospital must “support” the establishment of a birthing center if the study deems services needed and feasible.

According to some of the other measures in the agreement, Johnson Memorial must also maintain prenatal, postpartum and wraparound services, as well as provide free transportation to patients for labor and delivery at any hospital within a 50 mile radius.

“This agreement permits termination of labor and delivery services at the hospital but holds Johnson Memorial Hospital accountable to the community they serve and to the State of Connecticut for maintaining access to all levels of maternal and infant health care,” said OHS commissioner Deidre Gifford in a statement released by the agency.

“We appreciate the thorough process that OHS went through to make the decision,  and we remain committed to partnering with state officials to further our efforts to provide safe, high-quality care to the greater Stafford community,” said Kaitlin Rocheleau, a spokesperson with Trinity Health of New England, in emailed comments.

State legislators who represent Stafford said they were disappointed with the state’s decision and concerned about the burden it would place on families in the area.

“As a doctor and a state senator, I’ve fought to preserve Johnson Memorial Hospital’s labor and delivery services in our region. These services are vital to expectant mothers and families who cannot otherwise access this care or easily be transported elsewhere in emergencies,” wrote Jeff Gordon, R-Woodstock, in emailed comments.

“This is a critical issue for our community, especially for expecting mothers and families in the region who rely on these essential health care services. The closure will place a significant burden on many who will now have to travel longer distances,” said Rep. Kurt Vail, R-Stafford.

Labor and delivery in rural CT

The decision marks the third application to close a rural birthing unit that OHS has considered in the past year, two of which it approved.

In addition to Johnson Memorial, the state approved the closure of the birthing unit at Hartford HealthCare-owned Windham Hospital in December of last year. The agreed settlement contained similar provisions to those in the settlement with Johnson Memorial, including that Windham Hospital must hire an independent third party to assess the need for and feasibility of establishing a free-standing birth center in the area. The study, which will be conducted by Guidehouse Inc., began last month, according to a statement by OHS.

In February, the state denied an application from Nuvance Health to close labor and delivery at Sharon Hospital. Nuvance Health is currently seeking state approval for a merger with New York-based Northwell Health, and the parties have committed to keeping labor and delivery open for at least five years as part of a deal with state Attorney General William Tong.

Johnson Memorial stopped delivering babies in April 2020 under an executive order issued by Gov. Ned Lamont allowing hospitals to temporarily shut down services to increase capacity for COVID patients. It briefly resumed services for a few months later that year, and applied to close the unit permanently in September 2022.

Johnson Memorial currently faces a potential $153,000 fine for failing to resume labor and delivery services when the executive order expired. The state’s decision regarding the civil penalty is still pending.

The stakeholder meetings were intended to collect feedback on the current state of the Medicaid program as part of the “landscape analysis” that Gov. Ned Lamont charged the department to conduct. The study is meant to explore different Medicaid models, including managed care, which 45 states use in some form for at least part of their Medicaid programs. Connecticut is one of five states that do not.

Lamont’s curiosity about managed care has drawn fierce criticism from some Medicaid providers, advocates and enrollees, who pointed to potential downsides of the model, including reduced access, increased cost and lack of transparency. A handful of participants in last week’s meetings reiterated those concerns.

“We should be very concerned about access to care in the long-term care environment, and managed care would not be an answer to any of those significant issues,” said Matthew Barrett, president of the Connecticut Association of Health Care Facilities, during one of the sessions.

David Bednarz, a spokesperson in the governor’s office, said that the study is merely a tool to ensure the state is best serving its Medicaid members, adding that Lamont is not proposing any policy changes as of now.

“This review will provide the administration and the General Assembly with information on whether there are improvements to achieving this goal that could be implemented, and we shouldn’t be afraid of receiving that data. At this time, Governor Lamont is not proposing any policy changes — whether administratively or legislatively — on this topic,” said Bednarz in an emailed statement.

The study report is due by the end of this year, stated Christine Stuart, a DSS spokesperson.

Connecticut used managed care until 2010 but then transitioned to a managed fee-for-service model, where the state pays providers directly for services delivered to Medicaid beneficiaries. In a traditional “capitated managed care” model, the state instead pays a set monthly fee per member to insurance companies to manage the Medicaid program, and the insurance companies pay providers.

States often turn to managed care for increased budget predictability and improvements to quality and access, but according to KFF Health News, its impact on both access and costs is “limited and mixed.”

Other concerns

Some critics of the governor’s plan to study managed care say that the results of last Tuesday’s presidential election make it even more important to defend the Medicaid program.

“We have a ton of work to do to adjust to the changing landscape in Washington and protect the Medicaid program, and certainly as part of that, we have to fulfill our promise to raise rates for providers,” said Sen. Matt Lesser, D-Middletown, in an interview with The Connecticut Mirror. “Throwing additional chaos into the program at a time when the very future of the Medicaid program is potentially on the line is unwise and a major unneeded distraction for the Department of Social Services and the administration.”

During President Donald Trump’s first administration, he approved Section 1115waivers that allowed states to impose certain work requirements for Medicaid eligibility, though many of the approvals were struck down in the courts.

Project 2025, which Democrats tied to Trump policies and future plans on the campaign trail despite the GOP candidate’s insistence he wasn’t tied to it, also includes a proposal to restructure Medicaid as a block grant program, which would cap the amount of federal funding it receives. Currently, the federal government pays a fixed percentage of states’ Medicaid costs, regardless of the amount. Affordable Care Act subsidies that lower the cost of buying a health plan on state exchanges are also set to expire in 2025, unless they are renewed by Congress.

Others have concerns that the study is being conducted by an organization with interests in the managed care industry.

At the beginning of November, over 30 organizations and individuals sent a letter to Lamont criticizing the selection of Manatt, one of the consultants conducting the Medicaid study. According to the advocates, several of Manatt’s clients are Medicaid managed care providers. The firm has also done legal work on behalf of Medicaid Health Plans of America, a trade association of managed care organizations.

“In sum, it is impossible for Manatt to provide an independent, evidence-based assessment of our current nation-leading, efficient managed fee for service Medicaid program,” stated the advocates.

A spokesperson with Manatt did not respond to a request for comment. DSS spokesperson Stuart and Bednarz, the governor’s spokesperson, did not address specific questions about the concerns regarding Manatt.

Rockville is one of three hospitals in Connecticut owned by Los Angeles-based Prospect Medical Holdings, along with Manchester Memorial and Waterbury Hospital. The facilities have been at the center of a long-awaited pending sale to Yale New Haven Health that’s mired in legal disputes and has at times seemed on the brink of collapse.

Questions of unauthorized service cuts come amid a barrage of revelations regarding the diminished financial and operational state of the hospitals. In just the past month, Prospect was hit with federal liens for failure to pay into the pension plan for its Connecticut employees. Reports released also documented rusting equipment in operating rooms at Waterbury Hospital and delayed payments to physicians at Manchester Memorial Hospital.

According to the notice, the state determined that Prospect may have ceased providing medical/surgical and inpatient psychiatric services without obtaining permission from the state, known as a certificate of need. In March 2020, the state granted Rockville, and other hospitals, a waiver to halt certain services in order to free up capacity to treat COVID patients. The waiver expired on July 21, 2021, at which point all services should have resumed.

“[It] appears that in actuality RGH ceased to provide all medical/surgical services around this time, did not seek a waiver for the cessation of these other services, and to date has yet to restore these other services. In addition, it also appears that RGH may have ceased providing all inpatient psychiatric services (both adolescent and adult) in or around June 2020 and has yet to restore those services as well,” OHS staff attorney Craig Sullivan stated in the notice.

A spokesperson with Eastern Connecticut Health Network, the health system that includes Manchester Memorial and Rockville General hospitals, did not respond to a request for comment.

The state’s inquiry comes a year after an investigation published by The Connecticut Mirror found that Prospect began eliminating services with the arrival of the pandemic, when the hospital received permission from the state to halt surgical services.

Records and employee testimony submitted to the state going back as far as 2021 show that the hospital took the cuts further, shuttering most of Rockville’s inpatient units. When the story was published in October 2023, longtime employees, union leaders and state lawmakers from the area said services remained extremely limited.

When asked why the state waited a year to launch an inquiry, OHS commissioner Deidre Gifford stated in an email that several factors influenced the timing, including the active certificate of need application for the acquisition by Yale New Haven and the crippling of operations at Prospect hospitals following the August 2023 cyberattack. The state said it used the agreed settlement reached between Yale and Prospect to address service concerns at Rockville.

“Taking compliance action while simultaneously negotiating a resolution to the same issues would not have been productive,” Gifford said.

“The agreed settlement reached in March 2024 included extensive provisions to address ongoing concerns at Rockville General Hospital and ensure continued community access to all required services, either at Rockville General Hospital or Manchester Memorial Hospital. The transaction has been tied up in litigation for several months … Since a resolution to the Prospect/Yale New Haven Health dispute has not been arrived at, and a court date is not set until April of 2025, OHS is pursuing further action.”

Prospect has until Nov. 8 to submit responses to the state.

“The inquiry process allows OHS to determine if and to what degree Rockville General Hospital may have ceased service delivery in several areas without state approval. We will be able to further assess appropriate action pending receipt of the facility’s response,” Gifford said in an emailed response to questions.

Termination of services by a hospital without state approval can result in civil penalties of up to $1,000 per day. If OHS pursues civil penalties, Prospect would have the opportunity to request a hearing.

The change follows a federal policy finalized in May expanding the Affordable Care Act, or ACA, eligibility to DACA recipients.

The ACA allows U.S. citizens and lawfully present noncitizens to obtain health coverage and subsidies through state-based marketplaces, like Access Health CT. But, prior to the new regulations, DACA recipients weren’t considered “lawfully present” as it pertains to the ACA.

“This really fixes that exclusion that happened when DACA was created back in 2012,” said Carolina Bortolleto, a co-founder of CT Students for a Dream, a statewide organization advocating for undocumented students and their families. “It shows that expanding coverage is something our government officials know is a good thing to do.”

With the updated regulation, DACA recipients will now be able to enroll in coverage through state-based marketplaces, like Access Health CT. They can also obtain subsidies to help cover the cost of a plan if they qualify based on their income, address, and household size.

People can enroll online, in person, or by phone. Residents can also visit one of Access Health CT’s Navigator partner locations to get help from an enrollment specialist.

The Biden administration estimates that more than a third of DACA recipients currently do not have health insurance and that the new rule could help 100,000 people across the country obtain coverage.

There are roughly 2,900 DACA recipients in Connecticut as of March 2024, according to the U.S. Citizenship and Immigration Services. Bortolleto said most DACA recipients that have health coverage get it through their employers. Some also qualify for Medicaid, known as HUSKY in Connecticut.

But the expansion could still face legal challenges.

A lawsuit filed by Kansas and 18 other states seeks to block the new rule. But no decision has been made yet, meaning DACA recipients are still eligible for marketplace plans and subsidies when open enrollment starts on Nov. 1.

‘HUSKY for immigrants’

Bortolleto said that the new federal regulation could also help bolster the ongoing push to broaden health coverage to undocumented residents in the state.

“It’s particularly significant because here in Connecticut we are fighting to expand access to HUSKY Medicaid to the undocumented population,” Bortolleto said. “It also highlights that there’s still a gap that will be left behind, even after DACA recipients are able to access the ACA.”

In Connecticut, children 15 and under, as well as people who are pregnant and postpartum, qualify for health coverage from the state regardless of immigration status.

But the effort to extend Medicaid-like coverage to children without permanent legal status has been a gradual and sometimes frustrating journey for many advocates. In 2021, legislators passed a bill opening the program to undocumented kids 8 and younger but delayed the launch until Jan. 1, 2023. In 2022, they broadened the population to include those 12 and younger.

Last year, a measure was introduced expanding it to everyone 25 and younger. But legislators settled on a pared back version, folded into the state budget, that extends coverage to kids 15 and younger regardless of their immigration status, which went into effect in July of this year.

The program has seen strong demand. As of April of this year, over 11,000 children 12 and under who wouldn’t have otherwise qualified for Medicaid because of their immigration status were enrolled in state-sponsored Medicaid-like coverage, smashing estimates that roughly 4,250 kids would enroll.

Dowd, a Coventry resident, said she feels at ease in Connecticut, which is considered a “safe haven” state for its abortion protections, but she’s wary of traveling to places where the same rights aren’t offered. Aside from a trip to Tennessee to visit her parents, Dowd doesn’t plan to travel to states with restrictions during her pregnancy in case something happens that puts the health of her or her unborn child at risk.

“Life in general is chaotic and unpredictable, and while I understand the likelihood of things going wrong is fairly low, I still worry about something like a car accident or slipping and falling,” Dowd, 35, said. “If something unpredictable did happen, I don’t want my life or the life of my future child to be at risk because I’m in a state where you have to actually be dying [to get care] versus being willing to take care of me before then.”

By The Numbers: Abortion and maternal health in CT, two years post Dobbs

In the wake of Roe v. Wade’s defeat over two years ago, access to reproductive care, including abortion, contraception and fertility treatment, has been front and center in the discourse surrounding the upcoming presidential election. Dowd said because of her fears about what could happen to reproductive access under a second Trump administration, she plans to vote for Democrats in state and national races.

“I do worry that if Donald Trump and JD Vance got into office, they would attempt a nationwide abortion ban,” said Dowd. “I will be voting a straight blue ticket.”

During a debate in September, former President Donald Trump would not answer when asked whether he would veto a national abortion ban, though he subsequently vowed to turn away any such legislation. Vice President Kamala Harris has said she would work with Congress to pass a law to codify the federal protections that existed under Roe v. Wade.

While issues like the economy and immigration consistently rank among the most important for voters overall, reproductive rights are a key focus for a subset of people.

Where Harris and Trump each stand on key issues

An October KFF survey of women voters found that abortion has become the most important issue for women under 30, surpassing inflation, which was the top issue for that demographic earlier this summer. During the September presidential debate, “abortion” was the most searched political issue in all but one state, according to a snapshot released by Google Trends.

According to a poll conducted for The Connecticut Mirror, nearly half of voters — and nearly three quarters of Democrats — identified abortion and reproductive rights as an issue that was important to them in the upcoming election.

Many Connecticut voters who see expansion of reproductive access as a crucial issue going into the November election feel, like Dowd, that while rights in the state are secure, they want to vote for candidates that will continue to defend those rights, both here and nationally. Anti-abortion advocates are also looking ahead to the election with hopes that supporters of the policies they support will win spots in federal and state government.

Voters who support the expansion of reproductive rights applaud the measures that the legislature has taken to secure access to care in-state.

An estimated 14,840 clinician-provided abortions were performed in Connecticut in 2023, according to data from the Guttmacher Institute’s Monthly Abortion Provision Study.

“The Democratic Party in Connecticut did a really great job of protecting our reproductive rights,” said Aanya Mehta, 22, a reproductive justice advocate from Simsbury who is currently completing a master’s degree in public administration at the University of Connecticut.

Legislation passed in 2022 made Connecticut a legal “safe harbor” for those who travel here from another state to receive an abortion and for the clinicians who perform them. It also expanded the type of providers who can perform first-trimester abortions to include nurse midwives, advanced practice registered nurses and physician assistants. In 2023, lawmakers passed a bill protecting medical providers in Connecticut who face disciplinary action in other states for performing abortions.

“It’s things like that that give me hope in our state — that they’re thinking about people everywhere,” said Iyanna Liles, a Hamden-based gynecologist, regarding Connecticut’s legal protections for providers regardless of the patient’s home state.

Despite the state’s abortion protections and broad access to contraception, officials with Planned Parenthood Votes! Connecticut said many believe the stakes are high at the federal and state levels this election.

“When I’m talking to supporters across our state, they are scared of what could happen not only on the national level, but also in Connecticut,” said Gretchen Raffa, vice president of public policy, advocacy and organizing with Planned Parenthood Votes! Connecticut. “Voters across our state and country are fired up and know what’s at stake.”

Liles said that, since the overturning of Roe v. Wade, she’s had patients come in concerned about what would happen if they left the state or if a national abortion ban ever passed. People are making sure they have reliable contraception and, in some cases, electing to undergo permanent sterilization at younger ages.

“Abortion is the linchpin of how we got here, but I think contraception is on the line. IVF access is on the line. Maternal mortality and morbidity is on the line,” she said. “All of women’s health is on the line.”

Mehta agrees that reproductive justice is one of the most important issues for her heading into November, but she still feels as if the topic of voting is complicated, particularly because of concerns she has regarding foreign policy.

“Specifically, our tax dollars and what they’re being used for abroad,” said Mehta, adding that other activists she knows are wrestling with the same concern ahead of November.

Anti-abortion advocates acknowledge that it’s unlikely Connecticut will overturn decisions regarding abortion access, but they hope the upcoming election will bring wins for candidates that will fight against what they called “extreme” proposals from Democrats, including bills that would legalize aid-in-dying and measures affecting Catholic hospitals.

“Maintaining religious freedom and religious precedent are our top goals,” said Chris Healy, executive director of the Connecticut Catholic Conference. “Obviously, the issue of abortion rights in Connecticut is sadly settled for now, but we’re concerned about extreme positions [that go] past that.”

Peter Wolfgang, president of Family Institute of Connecticut Action, which advocates against abortion, said Democrats and advocates for reproductive rights are being dishonest about the stakes in the election.

“Abortion is, unfortunately — as far as I’m concerned — very secure in the state of Connecticut,” he said. “The ability to have a legal abortion in Connecticut is not ending anytime soon, if ever. So what the folks on the other side are doing is pushing the panic button to juice up their base.”

But Liles said it’s critical to continue fighting, even if reproductive rights seem secure, because there is a consistent effort to curb those rights in the state. For example, in recent years, Republicans in Connecticut have introduced bills that would require minors to notify their parents when seeking an abortion. The measures did not advance.

“There is an underlying current and we are able to keep it at bay,” said Liles. “We’re trying to be vigilant. We’re trying to not be quiet, like we did with Roe.”

Katy Golvala and Jenna Carlesso are reporters for The Connecticut Mirror (https://ctmirror.org/ ). Copyright 2024 © The Connecticut Mirror.