Under new federal rules, some people with HUSKY D will need to meet work rules to keep their health care coverage. Someone who is considered medically frail is exempt and does not have to meet the new work rules.
DSS has compiled this list of health conditions identified through diagnoses, prescription drugs, and medical procedures codes that meet the federal definition of medically frail: Medical Frailty Code List
Please note, this list may change. Check the revision date on the document to ensure you have the most current copy.
What does “medically frail” mean?
A person is considered medically frail if they have certain physical, mental, or behavioral health conditions. The federal law (H.R.1) defines medical frailty as:
- Blindness or a physical or mental disability
- A substance use disorder, or who has been in recovery for less than five years
- A disabling mental health condition
- A physical, intellectual, or developmental disability that limits daily activities
- A serious or complex medical condition
DSS has compiled a list of health conditions identified through diagnosis, prescription drug, and medical procedure codes that meet the definition of medically frail: Medical Frailty Code List.
How are medically frail individuals identified?
DSS will identify people with medically frail conditions in two ways: one, through healthcare information already known to DSS or two, through “self‑attestation” (when a person tells DSS that they have a qualifying condition).
Healthcare Information Available to DSS
HUSKY D applicants and members who meet the definition of medical frailty are identified by comparing the list of health conditions identified through diagnoses, prescription drugs, and medical procedures to healthcare information already available to DSS. This information includes Medicaid claims data and other program enrollment information. People with a Social Security Disability determination will also be identified as medically frail, if that determination is known to DSS.
DSS will check for available information to determine medical frailty for all applicants and members before asking for more information. This check will occur at application and each renewal.
DSS arrived at this method based on research from the Harvard School of Public Health, internal review by medical professionals, comparison to other states, consultations with partner health organizations, and input from advocacy and community groups. The list of codes and method is subject to change.
Self-Attestation
If a person’s health condition is not found in data available to DSS, they can report it. This is called self-attestation.
When self-attesting over the phone or online, the applicant or member will be provided the definition of medical frailty, asked for the start date of their condition (which is needed to make the determination under federal law), and then be asked to confirm that the information is correct.
Applicants or members do not need to upload or send in documents, such as a doctor's note or supplemental forms, with their self-attestation.
- In 2027, DSS will not require documentation for medical frailty. Applicants and members can self-attest that they are medically frail.
- In 2028, federal rules will likely require documentation. DSS will share more information on required documentation before those rules start.
How is the medical frailty exemption applied?
Once a person is identified as medically frail through healthcare information available to CT DSS or through self-attestation:
- The exemption is applied automatically during the application or renewal.
- No additional action is needed from the beneficiary.
- The exemption remains in place for 12 months. This is longer than other exemptions, which are in place for 6 months before requiring reverification. Renewals are still required every 6 months.
Get more information
Please visit the FAQs within the HR1 Partner Toolkit for answers related to medical frailty. You can also find information on other exemptions for caregivers, travelling for medical care, inpatient stays, and more.