“The number of uninsured people living in Connecticut has been cut in half from over eight percent to under four percent. Because of the Affordable Care Act, half a million people in Connecticut have gained health coverage that they previously did not have access to, and in return, greater access to the care and advice they need to live healthy, productive lives. Our state has been a national leader in health and human services, especially the implementation of the Affordable Care Act, and we want to continue to make gains that support public health care and economic security.”
—Governor Dannel P. Malloy on the seventh anniversary of the Affordable Care Act, March 23, 2017
Governor Malloy and Lieutenant Governor Wyman were champions for access to affordable health care and making Connecticut a healthier place to live, work, and play. Under their leadership, Connecticut expanded access to and improved the quality of health care. At the same time, the state took steps to also significantly control the cost of care.
Progress during the Malloy administration
|Successfully implemented the Affordable Care Act (ACA) thereby reducing the state’s uninsured population to an all-time low of 3.8%.
|Established Access Health CT, the most successful state-sponsored health insurance exchange.
|Successfully implemented expanded Medicaid coverage, with largest increase in coverage for childless adults, resulting in an additional 240,000 covered under Medicaid.
|Provided access to more health care services than ever before under Medicaid, including new family planning services, tobacco cessation, and services for children with autism spectrum disorder.
|Rebalanced long-term services and supports by transitioning over 4,700 people out of nursing homes and into more appropriate community-based care.
|Implemented comprehensive, proven actions to combat the opioid crisis and was nationally recognized for these efforts.
|Created a universal childhood vaccine program, which resulted in a drop of instances of whooping cough by 31% and chicken pox by 65%.
|EXPANDED ACCESS TO HEALTH INSURANCE
Access Health CT
Connecticut led the nation in implementation of the Patient Protection and Affordable Care Act (ACA), with the creation of Access Health CT, Connecticut’s health insurance exchange. The state executed one of the first federal Health Insurance Exchange planning grants, and in 2011 established the Exchange as a quasi-public agency.
Upon taking office, Governor Malloy asked Lieutenant Governor Nancy Wyman, a health care policy leader, to lead the state’s efforts to implement the ACA. As chair of the Access Health CT Board of Directors, Connecticut was one of the first states to develop a state-based Health Insurance Exchange with its launch in October 2013. It was widely regarded as the most successful in the nation at that time.
Access Health CT helps eligible consumers to obtain tax credits that defray the cost of health insurance. With persistent outreach and personal assistance for applicants, Access Health CT helped cut the state’s uninsured rate by half — to 3.8 percent in 2017. Despite numerous efforts by Republicans in Congress and the Trump administration to repeal and undermine the ACA, the 2017 open enrollment surpassed all expectations. 114,134 Connecticut residents signed up for private health insurance through Access Health CT — a 2.3 percent increase from 2016. In addition, Access Health CT helped tens of thousands of Connecticut residents with Medicaid enrollment.
Connecticut consistently defended the ACA and fought against Republican attempts to repeal the ACA and jeopardize the health insurance of tens of thousands of Connecticut’s residents. After these attempts to strip health care coverage from millions failed, the Malloy administration called on all parties to come together to stabilize the health insurance market and make improvements to the health care system to benefit all Americans.
In 2018, Access Health CT took significant steps to ensure Connecticut residents would have more affordable health plan options in 2019 by adding ACA compliant health insurance plans that offer enhanced product designs and network options. The state also prevented further destabilization by installing safeguards against the Trump administration’s attempts to create short-term and association health plans that provide substandard care and fail to cover even the most essential health care needs.
Connecticut became the first state in the nation with a “network adequacy” bill in 2016. It gives the Insurance Department enhanced oversight of health insurance networks in the state ensuring that consumers have access to robust networks of doctors and specialists in their area.
The state fostered an environment that allowed health insurers to offer new products that gave consumers more choices and improved competition. For the first time, dental-only HMOs are offering consumers another dental coverage option. In 2015, the Insurance Department secured authority to review small employer group health insurance rate. Also, traditional HMOs are now allowed to create products that use coinsurance — a change that will allow more products in the market and more options for consumers.
Connecticut was also the first state in the nation to take advantage of the ACA’s Medicaid expansion option. In June of 2010, the state gained approval from the federal government to expand Medicaid coverage bringing on an estimated 45,000 low-income adults who had been previously enrolled in a more limited health benefit package under the State Administered General Assistance (SAGA) program. Connecticut also significantly expanded Medicaid coverage again in 2014 to include low income adults with incomes up to 138 percent of the federal poverty level. Because of these expansions, approximately 240,000 low-income adults now have coverage and access to Medicaid benefits under HUSKY D, with more than 90 percent of the costs covered by the federal government.
Moreover, expanded Medicaid provides comprehensive preventive medical, dental and behavioral health benefits to all members and covers more health care services than ever before, including new family planning services, tobacco cessation, services for children with autism spectrum disorder and services and supports for people who are transgender.
In contrast to the majority of states, Connecticut moved away from capitated managed care contracts to a self-insured, managed fee-for-service model and launched the new HUSKY Health program on January 1, 2012. This self-insured model has been incredibly successful, leading to improved client care experiences, quality of service, supports for providers, and overall cost-effectiveness. It provides centralized, standardized, and streamlined guidance and support for both members and providers, all while reducing administrative costs. Further, it enabled the Department of Social Services to collect a fully integrated statewide set of claims data for the more than 800,000 members of the program. HUSKY Health has utilized this data to identify and provide care coordination to members with complex needs, to equip providers to better support their patients, and to direct policy-making, program development and operations. The program has also made targeted investments in rate increases and practice coaching that increased the participation of primary care providers from 1,622 in January 2012 to 3,454 in July 2018, and implemented value-based payment arrangements focused on primary care and obstetrics. These efforts have improved health outcomes and care experience while controlling costs. Lastly, by emphasizing primary and preventive care, increasing payment for improving birth outcomes, and annual screening of children and teens for developmental and behavioral conditions, HUSKY Health is making substantial investment in Connecticut’s future generations.
Rebalanced Long-Term Services and Supports
Since 2011, Connecticut moved more than 4,700 individuals from nursing homes to community based care and prevented the institutionalization of many others. A broad range of home and community-based services enabled the transformation of Connecticut’s long-term services and supports, including expanding the Money Follows the Person program.
Other initiatives which contributed to the rebalancing care from institutions to communities, include: the Department of Mental Health and Addiction Service’s (DMHAS) management of the Mental Health Waiver which encompassed services designed to support successful community placements. DMHAS’ Nursing Home Diversion program which strengthened the home care workforce by increasing pay for personal care attendants in self-directed waiver programs to $14.75 per hour; reducing the cost of medication administration which allowed more individuals to choose home-based care over institutional care. These changes created adult family living opportunities; capital funding to allow nursing homes to diversify their businesses; enhanced transparency in nursing home finances; required nursing homes to notify residents and the state of expected Medicaid eligibility, and provide community living assessments and care plan development. In addition to these initiatives, DMHAS has realigned older adult services to create a statewide Senior Outreach and Engagement Program. This program complements existing programs which divert older adults from long term care and develop home and community-based services to assist older adults who “age in place.”
Independent Practice for Nurse Practitioners
Every state in America is facing a shortage of primary care providers. Other states’ experiences and data indicated that implementing full practice authority for Advanced Practice Registered Nurses (APRNs) could help reduce costs, streamline care, protect patient choice, and lead to comparable or higher patient satisfaction scores than those of physicians. In 2014, Connecticut established a pathway to independent practice for APRNs to increase access to primary care for Connecticut residents.
|ADDRESSING THE OPIOID CRISIS
From 1999 to 2016, more than 350,000 people in the United States died from an overdose involving an opioid. In 2016, two-thirds of total drug overdose deaths involved an opioid. In Connecticut, there were 2.2 million opioid prescriptions in 2017 alone — however, this is a decrease from 2.6 million in both 2014 and 2015.
In April 2018, Connecticut was one of only thirteen states, to receive the National Safety Council’s highest mark of “Improving,” indicating that the state had implemented comprehensive, proven actions to eliminate opioid overdoses and protect its residents. While the crisis of opioid abuse is far from over, Connecticut put the tools in place to address both the opioid crisis, and to respond quickly to any future prescription drug abuse emergencies.
The state was awarded more than $30 million by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to address the opioid crisis by expanding the use of the medication and recovery coaching to treat opioid use disorders, and increasing prevention, treatment, and recovery supports. As a result, substance abuse treatment agencies in 11 cities and towns in Connecticut now offer buprenorphine and naltrexone to people seeking help from opioid addiction. Additionally, the funds support the use of medication for discharged inmates, plus supply Narcan to parole officers and purchase/provide training on the use of Narcan to numerous groups and various locations statewide. Also, the state was also awarded more than $10 million in Partnership for Success (PFS) and Prevention Framework for Prescription Drugs (SPF Rx) to support opioid prevention work.
Preventing Overdose Deaths
The state expanded access to naloxone, the overdose reversal drug, to first responders, family, friends, and for those struggling with addiction themselves to prevent overdose deaths. In 2014, Governor Malloy directed the Connecticut State Police to universally carry naloxone in their cruisers. This policy alone saved more than 230 lives between October 2014 and June 2018. Municipalities were required to update their emergency medical service plans to ensure that certain first responders were equipped and trained to administer naloxone. Stakeholders across the state are working to deploy naloxone to higher risk populations.
The administration also prioritized increasing accessibility and affordability of naloxone to individuals. Consensus-driven legislation passed to allow pharmacists to prescribe naloxone and to permit the prescription of overdose reversal drugs to individuals other than the direct user, enabling family and friends to take steps to protect their loved ones.
Strengthening Prevention Tools for Providers and Consumers
Public Act 15-198, An Act Concerning Substance Abuse and Opioid Prevention increased practitioner awareness through required continuing education on proper pain management and controlled substance prescriptions. It also greatly enhanced the effectiveness of Connecticut’s Prescription Drug Monitoring Program (PMP) by requiring practitioners, or their authorized delegates, to check the PMP prior to prescribing certain controlled substances. In addition, the PMP was strengthened further by requiring data to be uploaded by pharmacists each business day, rather than weekly. Together, these two provisions ensure that practitioners have comprehensive, accurate data so they can make informed treatment decisions. Public Act 17-131, An Act Preventing Prescription Opioid Diversion and Abuse built on this progress by requiring that certain high-risk drugs be electronically prescribed, making it more difficult to forge prescriptions.
Six in ten people who are prescribed opioid painkillers expect to have leftover medication. Governor Malloy championed legislation to help facilitate the destruction of unused prescription drugs. The administration also worked with private partners to spearhead a public awareness campaign to encourage the public to safely dispose of unused medications, limiting their accessibility for misuse. Moreover, Connecticut established prescription length limits for opioid drugs for adults and minors, with certain exceptions, and requires prescribers to discuss the risks of such prescriptions with patients.
Additionally, a voluntary non-opioid directive now exists to give patients the ability to formally tell their practitioners they do not want to be prescribed or administered opioid drugs. While this directive is voluntary and can be revoked by a patient or their health care proxy at any time, it is another tool that can be used to prevent opioid addiction or help a person in recovery communicate their needs to their health care provider.
In November 2017, the State launched its first web-based real-time bed availability system for the public, which tracks DMHAS-funded detox, residential addiction treatment and recovery house availability. Programs enter the number of beds available each day and sometimes multiple times per day to keep the public informed and to increase access to services.
Enhancing Access to Treatment
Other efforts to combat the opioid crisis include:
- The publication of information online by the Department of Public Health (DPH) about how prescribers can obtain certification for suboxone and other medicines to treat opioid use disorder.
- The requirement that individual and group health insurers cover medically necessary detox treatment, as defined by American Society of Addiction Medicine criteria.
- The addition of the MAT locator to the Connecticut Behavioral Health Partnership (BHP) website to help residents find treatment.
- The BHP also implemented Project ECHO, which provides telehealth consultation and education services to qualified Medicaid Program providers who are interested in expanding their knowledge, confidence, and utilization of MAT for Opioid Use Disorders. A primary goal of the program is to expand access to and utilization of MAT, particularly buprenorphine, through the provision of education and support of Data 2000, waived providers who are operating well below the prescribing capacity are allowed under the waiver.
|IMPROVED QUALITY OF HEALTH CARE
Enhanced Primary Health Care
In 2014, the state was awarded a $45 million competitive federal grant to transform its health care system by improving outcomes and quality, improving access to care, reducing health inequities, and reducing health care costs. Through a federally sponsored initiative known as the State Innovation Model (SIM), the state brought healthcare payers, including Medicaid and commercial payers, employers, providers, and consumers together to begin implementing outcomes based on, value-based care where outcomes and care experience are tied to payment. For example, the Patient Centered Medical Home+ program, Connecticut’s Medicaid first shared savings program, improves outcomes for Medicaid beneficiaries of participating community health centers and advanced networks through data sharing, improved coordination, and community linkage.
Improved Quality of Health Care
In partnership with three Administrative Services Organizations, the state’s Medicaid program has implemented a range of care delivery interventions that have dramatically increased use of preventive care, reduced non-urgent use of hospital emergency rooms and inpatient care, reduced hospital re-admissions, and yielded improvements in measures related to many common health conditions such as diabetes and asthma. These interventions recognize that a one-size-fits-all disease management approach is inadequate, and that an array of supports is needed to address the wide range of patient needs. Reforms have included Intensive Care Management through expanded care teams that include community health workers, coordination with hospital discharge processes, transformation of primary care practices under the Person Centered Medical Home initiative, and integration of behavioral health and medical care through health homes. The program has also regularly assessed the care experience of its members and has documented that members have better access to care and feel more respected by their providers.
The state implemented a behavioral health in-home effort in which local mental health authorities and their affiliates integrated behavioral health, primary care, and community-based supports for people with serious and persistent mental illness. The administration also expanded use of Assertive Community Treatment teams, an evidence-based practice that offers treatment, rehabilitation, and support services, using a person-centered, recovery-based approach to individuals that have been diagnosed with a severe and persistent mental illness. To enhance access to quality behavioral health providers, Connecticut increased Medicaid rates for mental health providers in Fiscal Year 2015.
Public Act 13-3 and Public Act 15-5 also increased access to behavioral health treatment. Among other things, the laws updated standards for utilization review and clarified health insurers’ responsibilities relating to behavioral health utilization review — a result of the 2015 Behavioral Health Working Group convened by the Insurance Commissioner.
Overall, DMHAS obtained more than $90 million in federal discretionary grants between 2011 and 2018 to support behavioral health services including helping individuals with serious mental illness to secure employment and provide integrated mental health, substance abuse, and primary care to more than 2,200 individuals in three urban hubs.
Reproductive health care was expanded through the implementation of innovative Medicaid policies. A family planning coverage group for individuals of childbearing age who are not otherwise eligible for full Medicaid coverage became available in 2012. Also, obstetrical pay-for-performance programs were instituted to improve care for pregnant women and the outcomes for their newborns. Finally, Medicaid reimbursement rates for long-acting reversible contraceptives were increased to ensure continued access while new devices have been added when they became available.
In 2017, to ensure Medicaid coverage of family planning services if the federal government defunds Planned Parenthood, Public Act 17-2, June special session, was enacted. Any family planning clinic that meets DSS’ requirements for participation in the Medicaid program, but is restricted from receiving federal Medicaid funding, may now continue to receive state-only funding provided the General Assembly approves.
In addition, the Governor signed Public Act 18-10 which ensures that regardless of actions taken by the federal government, Connecticut will preserve access to coverage of women’s preventive health services provided by the Affordable Care Act. For certain health carriers the state regulates, these benefits include well-woman visits, STD testing, breast cancer screening, domestic and interpersonal violence screening and counseling, and FDA-approved contraceptive drugs.
The sudden rise of urgent care centers prompted new licensure in 2017 of urgent care centers. The 2017 legislation promotes public health and enables the Department of Social Services to emulate Utah’s “Safe to Wait” project, which reduced repeat non-emergent emergency department visits by Medicaid beneficiaries. It provides with information and education on alternatives to the emergency department, connects Medicaid beneficiaries to primary care, and shares a list of urgent care clinics throughout the state.
Medical Marijuana Program
In 2012, the state created Connecticut’s Medical Marijuana Program (MMP) to help patients with debilitating conditions by giving them access to marijuana as a medication. The goal of the program was to create a new pharmaceutical marketplace so that patients, for whom traditional medications were not working, would have an alternative that research indicates is helpful in treating certain conditions. The law and regulations, limit the number of businesses that can sell marijuana and place restrictions on advertising so that the product is not marketed in a way that encourages recreational use.
Consistent with the program’s mission, Connecticut’s Department of Consumer Protection (DCP) has instituted a true medical model to ensure Connecticut patients are receiving quality care and product. Marijuana producers are regulated like manufacturers of pharmaceutical products, all products must be laboratory tested and labelled, and dispensaries are regulated like pharmacies. Also, DCP has approved research programs designed to increase knowledge on the medical uses of marijuana and to offer prescribers and patients the best possible information when choosing treatment plans.
As of October 2018, the 6-year-old program had 977 participating prescribers, four producers, and nine dispensaries, employing more than 450 people that serve almost 28,000 patients. In 2016, the program was expanded to include minors with certain high need medical conditions. The state is looking to add additional dispensary facilities.
Established the Office of Health Strategy
Lieutenant Governor Wyman created the Office of Health Strategy (OHS) in 2018 to enhance coordination of the state’s health care reform strategies, including a coordinated response to the Trump administration’s proposed changes. Combining the state’s major health care planning and reform initiatives into one office prevents the duplication of efforts, the waste of resources, and streamlines efforts to improve access to quality health care services while reducing costs. The new Office of Health Strategy consolidated oversight of the All-Payer Claims Database, the SIM initiative, the Office of Health Care Access (OHCA), and the state’s health information technology initiatives into one state agency.
Connecticut has consistently been ranked as one of the healthiest states in the country by the United Health Foundation. The Foundation looks at health determinants categorized as community and environment, policy, clinical care, and behaviors to determine its rankings. Connecticut’s low incidences of infectious disease, low prevalence of smoking, and high childhood immunization rates all contribute to Connecticut’s high ranking at number three.
Universal Childhood Immunization Program
In order to provide more life-saving vaccines to children at a lower cost, in 2012 Connecticut required health care providers who administer pediatric vaccines to participate in the state’s universal childhood immunization program. In addition, this administration secured multiple expansions of the vaccines covered under the childhood immunization program, adding vaccines for flu, pneumonia, Hepatitis A, and in 2017, for Human Papillomavirus. Between 2011 and 2016, the vaccination rate in Connecticut, already among the highest in the nation, increased by eight percent. More importantly, children are healthier: cases of whooping cough were reduced by 31 percent and cases of chicken pox were reduced by 65 percent from 2010 to 2017.
Protected Drinking Water
To address waning federal funds and ensure that Connecticut residents continue to have access to high quality drinking water for years to come, a safe drinking water assessment was developed in consultation with the water utilities. The assessment was designed to assure continued support for DPH’s oversight and regulation of the more than 2,500 public water systems that serve Connecticut residents. The state has aggressively addressed lead in public drinking water systems — between 2016 and 2018, DPH issued over 50 administrative orders to remediate findings of lead levels that exceeded acceptable standards at schools and child day care settings.
Additionally, the state provided matching funds, sale of bonds, and repayment of loans for the federally funded Drinking Water State Revolving Fund (DWSRF) which provides low interest loans to eligible public water systems for drinking water infrastructure improvement projects. As of June 30, 2018, 162 loans have been executed for approximately $327 million.
As a result of ongoing efforts, DPH has consistently exceeded the national Government Performance and Results Act goal for providing drinking water that meets all applicable health standards. Connecticut has approximately 99 percent of its population served by community drinking water systems that meet all applicable health standards.
Reduced Use of Tobacco
Connecticut has made great strides in decreasing cigarette smoking. From 2011 to 2016, cigarette smoking fell by 23 percent among adults and 60 percent among youth. These improvements are the result of a variety of efforts, including increasing the taxes on tobacco products, enhancing access to prevention and cessation services, and the expansion of Connecticut’s Medicaid program to cover cessation services.
Tobacco sales to minors dropped from 11.3 percent to 8.8 percent. This success was only possible because of the state’s strong commitment to enforce state tobacco laws.
From 2011 to 2018, the Tobacco and Health Trust Fund also distributed more than $29 million to support anti-tobacco efforts in the state such as counter-marketing, cessation services, prevention services and information, and referral. In 2014, Governor Malloy spearheaded regulation of harmful e-cigarette products, banning the sale of electronic nicotine delivery systems and other related devices to minors, as well as other initiatives to enhance the state’s effort to prevent tobacco use among minors.
Connecticut is a national leader in healthcare. This transformation is only the beginning of an era of modernization and improvement that Connecticut must continue to embrace.
To continue to reduce the number of uninsured residents, Connecticut should continue to support a robust marketplace for insurance, starting with Access Health but also including off-exchange products by the vibrant health insurance industry headquartered here in Connecticut.
Expanding access to healthcare means reducing its cost. One necessary step toward controlling medical costs — the main driver of health insurance premium increases — is to adopt a mandated health benefit review process prior to a mandate becoming law. Another important area for cost control is Connecticut’s duplicative system of acute care hospitals. The demands by that industry for ever-increasing state subsidy will eventually crowd out more cost-effective community-based care. The state must demand accountability from this important sector.
Another key to long-term cost control is the transition to outcome-based payment rather than fee for services and grant-based payments. This transition will take many years as individual providers, insurers, and patients become accustomed to new practices such as bundled payments, shared savings and risk-sharing agreements, and health homes.
In order to fully realize the benefits of rebalancing our state’s long-term care system, Connecticut must continue to develop a strong system of providers who can meet the community-based care needs of a fast-growing panel of patients. The state must also work to ensure that the workers who have long cared for our most vulnerable seniors in nursing facilities are given opportunities to increase their skills to meet those community-care needs.
The need to expand our capacity for community-based care goes well beyond the traditional nursing home population of seniors and the disabled. The use of institutions and emergency rooms in acute care hospitals to care for children and youth, for people with intellectual disabilities, and for those with behavioral health needs should be minimized for the benefit of those served and to avoid unnecessary costs. To accomplish this, we must also develop more community-based options for children and youth with behavioral health needs, residents struggling to overcome opioid addiction, and people with intellectual disabilities.
Building on the significant progress already made by the Department of Social Services and the Office of Health Strategy, Connecticut must continue to advance comprehensive efforts to enhance access to health care and improve quality of care and outcomes for populations regardless of one's race, ethnicity, hometown, or income.
One way to accomplish this is to recognize the social determinants of health and deploy those insights for improved strategies to prevent disease and unnecessary hospitalization. These strategies include linking clinical care to other community services and integrating community health workers into the state’s health system. It is especially critical that these new modes of healthcare delivery be made available to the Medicaid population, and the state should strongly consider using the federal waiver process to allow this to happen with federal support.
Connecticut must also continue to stand up to aggressive partisan efforts to roll back access to health care, particularly for women. The state should adopt legislation in response to the U.S. Supreme Court’s ruling in NIFLA v. Becerra to ensure that women who seek counseling for pregnancy options receive complete and accurate information about available services.
Connecticut enacted meaningful policy changes on a bipartisan basis to combat the opioid crisis. At the same time, as the epidemic persists. Connecticut must continue to decrease stigma and discrimination of substance use disorders and mental health disorders. We must continue to develop our response to emerging healthcare trends including local responses to substance use “hot spots.”
Healthcare, including Medicaid, state-funded health services, public health, employee and retiree health benefits, and provider support, is and will continue to be the largest expense in the state budget. Maintaining and expanding access and quality of care are paramount goals for the state, but must be balanced with continuous effort to control costs, prioritize state initiatives and maximize federal support.
95. Public Act 11-53: An Act Establishing a State Health Insurance Exchange
96. Public Act 16-205: An Act Concerning Standards and Requirements for Health Carriers’ Provider Networks and Contracts Between Health Carriers and Participating Providers
97. Public Act 14-12: An Act Concerning the Governor’s Recommendations To Improve Access to Health Care
Public Act 14-217: An Act Implementing Provisions of the State Budget for the Fiscal Year Ending June 30, 2015
Public Act 14-231: An Act Concerning the Department of Public Health’s Recommendations Regarding Various Revisions to the Public Health Statutes
98. Public Act 15-198: An Act Concerning Substance Abuse and Opioid Prevention
99. Public Act 17-131: An Act Preventing Prescription Opioid Diversion and Abuse
100. Public Act 16-43: An Act Concerning Opioids and Access to Overdose Reversal Drugs
101. Public Act 17-131: An Act Preventing Prescription Opioid Diversion and Abuse
102. Public Act 13-3: An Act Concerning Gun Violence Prevention and Children’s Safety
103. Public Act 15-5: An Act Concerning the School Security Grant Program
104. Public Act 17-2: An Act Concerning the State Budget for the Biennium Ending June 30, 2019, Making Appropriations Therefor, Authorizing and Adjusting Bonds of the State and Implementing Provisions of the Budget
Public Act 18-149: An Act Concerning Outpatient Clinics, Urgent Care Centers and Freestanding Emergency Departments
105. Public Act 12-55: An Act Concerning the Palliative Use of Marijuana
106. America’s Health Rankings (2016) United Health Foundation: Connecticut Overall 2017