By CHRIS POWELL
State Comptroller Sean Scanlon warns that Connecticut’s state budget is in danger of being devoured by its Medicaid program, whose costs are soaring even as federal aid to the program is being reduced. To ensure that the state’s approximately one million Medicaid recipients maintain their health insurance coverage, Scanlon says “every option should be on the table.”
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But Scanlon doesn’t really mean that. He means that every possibility for raising more money for Medicaid should be considered, not every possibility for economizing.
There are obvious opportunities for economizing.
Since Connecticut is a “sanctuary state,” a state facilitating and extolling illegal immigration, many recipients of Medicaid and other forms of state medical insurance are illegal immigrants and there is clamor to make still more illegal immigrants eligible. Of course the more that illegal immigrants are made eligible, the more other illegal immigrants will be drawn to the state. State government could save millions by disqualifying illegal immigrants from state insurance and all state government benefits. Like all people, they go where they are subsidized.
Even California, the most populous “sanctuary state,” is reducing state medical insurance for illegal immigrants because of its exploding cost.
How about reducing state financial grants to Planned Parenthood, which provides most abortions in Connecticut? Most are performed on poor women who qualify for Medicaid. State government has given much money to Planned Parenthood and Governor Lamont just awarded the organization another $10 million from the emergency $500 million slush fund the General Assembly recently created for him.
But Connecticut’s chapter of Planned Parenthood has an endowment of nearly $50 million and is in better financial condition than state government itself. So state grants to Planned Parenthood could be suspended until the organization spends its endowment down to, say, $10 million.
Most important, to reduce Medicaid costs state government should examine the causes of poverty that arise from mistaken public policy. After all, Medicaid is insurance for the poor. If, as state Comptroller Scanlon says, about a million state residents are on Medicaid, that is more than a quarter of the state’s population, and if Medicaid expenses are soaring, it’s partly because poverty in Connecticut is soaring as well, even as government spends much in the state in the name of reducing poverty.
Could someone in state government, maybe even the comptroller himself, ask why poverty is worsening?
Is it because so many Connecticut residents lack job skills?
The state’s economy long has lagged the national economy and is not creating jobs, particularly high-skilled and high-paying jobs, as fast as many other states are. So how come?
Connecticut has a high cost of living, which makes people poor, so where is state government’s program to reduce that cost? Who in authority is reviewing state government’s costs to ensure that all spending is essential and efficient?
Of course it’s always much easier to increase Medicaid spending instead.
* * *
Why should Connecticut be refusing to give its voter registration rolls to the U.S. Justice Department for its investigation of possible election fraud? The Justice Department has had to sue for it.
Connecticut’s own freedom-of-information law makes most of the data public. Secretary of the State Stephanie Thomas says the Justice Department also wants the voter registration data that shows Social Security and driver’s license numbers, which state law forbids disclosing outside government.
But the federal government already has all Social Security numbers, and driver’s license numbers are typically available to the federal government through law enforcement data banks.
So it seems that Thomas and state Attorney General William Tong oppose providing the data simply because they detest the Trump administration and don’t want it to pursue the possibility of election fraud.
If there’s no fraud and no illegal immigrants have registered to vote in Connecticut, disclosure of the voter roll data may help confirm that. And if the data does provide evidence of fraud, shouldn’t it be disclosed even if that scares the secretary and the attorney general?
Chris Powell has written about Connecticut government and politics for many years. (CPowell@cox.net)
Chris Powell column 
From ChatGPT ” how could connecticut reduce the taxpayer cost of medicaid?Thought for 22s
Connecticut can lower state (taxpayer) Medicaid costs in three broad ways: (1) slow the growth of the biggest cost drivers, (2) capture more federal dollars for the same services, and (3) cut waste/inefficiency without cutting eligibility.
Here are the most practical levers CT policymakers talk about, with why they matter:1) Focus hard on long-term services & supports (LTSS)
This is where a lot of Medicaid growth lives (nursing homes, home-care waivers, personal care, etc.). CT’s own trend materials show home health waiver/CFC-type services taking a large and growing share of spending (mid-teens % of total).
Cost reducers that don’t require “cuts”:
2) Reduce preventable ER visits + hospitalizations (especially behavioral health + SUD)
Connecticut has used waivers to build out substance-use treatment across a continuum of care. Keeping people engaged in outpatient + step-down care lowers expensive inpatient utilization over time.
Examples:
3) Pharmacy: squeeze better net prices (rebates) and manage high-cost drugs
CT has authority to do value-based supplemental drug rebate agreements (a CMS-approved SPA). That’s a direct “lower net cost” tool if executed aggressively.
Other standard pharmacy savings:
4) “Third-party liability” and program integrity (pay last, not first)
When Medicaid pays for something another insurer should cover (commercial coverage, Medicare, auto/work comp), taxpayers eat avoidable cost. Stronger TPL recovery + data matching typically has high ROI. (CT also runs detailed billing/EVV workflows for certain services.)
Practical moves:
5) Improve rate-setting smartly (yes, sometimes raising rates can lower total cost)
It sounds backwards, but too-low rates can push care into more expensive settings (ER, hospital outpatient, institutional care) and shrink provider participation (access problems → late care). CT has active debate and legislation around rate increases and “site-neutral” reimbursement concepts.
Best practice: raise targeted rates (primary care, behavioral health, dental access) tied to outcomes/utilization goals, not across-the-board.6) Get more federal match / maximize financing tools (without gimmicks)
CT’s budget discussions include hospital-tax/provider-tax approaches intended to draw additional federal matching dollars (the administration estimated additional federal reimbursement from a restructuring proposal).
Key principle: if designed compliantly, this can reduce state share—though it’s politically and legally contentious and can create instability if federal rules change.7) Keep eligibility accurate and renewals smooth (reduce churn, reduce improper eligibility)
Post–COVID “unwinding” made eligibility operations a big deal. The goal is accurate enrollment (not dropping eligible people, but also not keeping ineligible people). This is mostly admin/process work, not policy ideology.8) Value-based payment + accountability for contractors
CT runs Medicaid largely in an ASO-style arrangement (rather than classic managed care) and uses contractors/fiscal agents for administration.
Savings levers:
9) Be candid about the “budget reality”
Recent reporting shows CT has had meaningful Medicaid cost overruns (hundreds of millions across fiscal years in some accounts).
That matters because the cheapest “solution” is often earlier action—once utilization rises, reversing it takes time.If you want the biggest bang for buck (typical in many states)
If you tell me what kind of solution you’re thinking (e.g., “no eligibility cuts,” “protect nursing homes,” “protect kids,” “reduce admin,” etc.), I can map these into a short set of CT-specific proposals with tradeoffs.
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