NOTICE:

Learn about potential changes to DSS benefits due to the federal budget reconciliation bill (H.R.1) in our article, What will change with DSS benefits following the passing of federal H.R.1?

Covered Connecticut Demonstration

Overview

Click this link to subscribe to updates regarding this project.

Covered CT 1115 Demonstration Waiver Overview 

The Covered CT program was established by state legislation in sections 15 through 19, inclusive, of Public Act 21-2 of the June 2021 special session.  The intent of the program is to help close the health insurance affordability gap in a cost-effective manner for individuals who earn too much to qualify for Medicaid but not enough to afford coverage through the state’s Health Insurance Marketplace, d.b.a Access Health Connecticut (AHCT).  The law also directed the Connecticut Department of Social Services (DSS) to submit a demonstration waiver application pursuant to section 1115 of the Social Security Act (Demonstration) to the U.S. Centers for Medicare and Medicaid Services (CMS) to provide federal matching funding for the program.  DSS worked in collaboration with the Office of Health Strategy (OHS), Access Health Connecticut (AHCT), the Connecticut Insurance Department and other state stakeholders in the design and implementation this program which provides eligible individuals with Qualified Health Plan (QHP) coverage available through Access Health. Enrollees also receive dental care and non-emergency transportation (NEMT) services, comparable to the benefits under Connecticut Medicaid and provided through the Medicaid delivery and payment system, also known as HUSKY Health. No cost sharing requirements apply to benefits provided under the Demonstration.  This program is available to parents and needy caretaker relatives, and their tax dependents under age 26, and non-pregnant childless adults ages 19 to 64 who have income that is above the Medicaid limit but does not exceed 175% of the federal poverty level (FPL) and who enroll in a silver-level QHP available through Access Health using all available federal premium subsides and cost-sharing reductions.

Demonstration Goals 

  • Demonstration Goals Improve the affordability of health insurance coverage
  • Promote health insurance coverage
  • Ensure stable coverage
  • Reduce the statewide uninsured rate
  • Improve oral health
  • Enable access to medical appointments 

Federal Submission

On April 1, 2022, DSS formally submitted the following documents for the Covered CT demonstration waiver application under section 1115 of the Social Security Act to the federal Centers for Medicare and Medicaid Services (CMS). On December 15, 2022, CMS approved the Covered Connecticut 1115 waiver demonstration. The approved Covered Connecticut waiver demonstration is funded through December 31, 2027.

On June 25, 2025, the Centers for Medicare & Medicaid Services (CMS) updated the section 1115 demonstration monitoring approach to reduce state burden, promote effective and efficient information sharing, and enhance CMS’s oversight of program integrity by reducing variation in information reported to CMS. Federal section 1115 demonstration monitoring and evaluation requirements are set forth in section 1115(d)(2)(D)-(E) of the Social Security Act (the Act), in CMS regulations in 42 CFR 431.428 and 431.420, and in Connecticut’s  section 1115 waiver demonstration special terms and conditions (STCs). Monitoring provides insight into progress with initial and ongoing demonstration implementation and performance, which can detect risks and vulnerabilities to inform possible course corrections and identify best practices.

Key changes of the monitoring redesign initiative include introducing a structured template for monitoring reporting, updating the frequency and timing of submission of monitoring reports, and standardizing the cadence and content of the demonstration monitoring calls. The CMS Overlay letter below details the changes to the Covered Connecticut section 1115 waiver demonstration with attached Special Terms and Conditions (STCs).

Responses to Public Comments

After completion of the public comment period and public hearings described below, DSS has issued formal responses to comments.

Public Comment & Public Hearings – Covered CT Section 1115 Demonstration Waiver

The Department of Social Services (DSS), in collaboration with the Office of Health Strategy, Access Health CT, and the Connecticut Insurance Department, proposed the Covered CT demonstration waiver under section 1115 of the Social Security Act, described below.  Public review and comment included the following documents:

Public Comments: Written comments were accepted from February 3, 2022 through March 11, 2022. Members of the public were asked to send comments to: Public.Comment.DSS@ct.gov.

Public Hearings: Two electronic public hearings (accessible by electronic device and telephone) were held on February 10, 2022, from 9:30 a.m. to 12:00 p.m., hosted by the Medical Assistance Program Oversight Council (MAPOC) and another on February 16, 2022 from 9:00 to 11:00 a.m. hosted by DSS. 

General information about section 1115 demonstrations is posted to the CMS website at this link: https://www.medicaid.gov/medicaid/section-1115-demonstrations/index.html.   The Covered Connecticut 1115 application and all approved federal reporting and demonstration deliverables are accessible from this webpage: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html (select the appropriate filters within the webpage to find the relevant waiver application).

Chat With Us