Challenges for Medicaid Patients in Connecticut

Cassidy Friedl has a vivid memory of the day her son, Luca, was born. Holding him close, she felt a mix of overwhelming joy and disbelief at his chubby cheeks and vibrant orange hair, which would eventually lighten to strawberry blond. But a few months later, something began to trouble her. She noticed one of Luca’s eyes sometimes drifting inward, and the more she observed it, the more concerning it became. After raising the issue with his pediatrician, she was directed to seek a pediatric ophthalmologist.

After some research, Friedl found Cara DeBenedictis, a pediatric ophthalmologist with excellent reviews. However, when she called to set up an appointment, she learned that the first available slot was nearly nine months out.

Friedl and her son are covered by Medicaid—the HUSKY program in Connecticut—designed for individuals with low incomes. Unfortunately, DeBenedictis’ office had limited appointment availability for HUSKY patients. “It made my heart sink to my stomach,” Friedl recalled, feeling frustrated that her child’s need for timely care was being compromised due to the insurance situation.

Many independent physicians face similar challenges, often limiting the number of Medicaid patients they see. They claim that reimbursement rates are too low for providing sustainable care. For years, doctors and legislators have voiced concerns about the inadequacy of payments from the state for specialists treating Medicaid patients, noting that this creates significant barriers to access for those needing care.

Melting down into the numbers, about a quarter of Connecticut’s population and around half of its children are covered under HUSKY. The limited access to care for these groups presents a real challenge statewide.

Across party lines, lawmakers have advocated for increasing Medicaid reimbursement rates, but Governor Ned Lamont has consistently proposed funding that falls short of what many consider necessary. In some cases, there weren’t any suggested increases at all. DeBenedictis noted the frustration, stating, “Every year, it stops at the governor’s office.”

Understanding Medicaid Funding

Medicaid is a collaboration between federal and state governments, where federal dollars often match state expenditure. States have considerable latitude in determining coverage options, eligibility, and physician pay rates.

In 2026, Connecticut adjusted its Medicaid rates to average around 60% of the Medicare rates for that year. Prior to this, rates hadn’t seen a significant adjustment since 2008, which is quite shocking when you consider how long that is—20 years without a raise. Janine Collinge, a pediatric ophthalmologist, questioned how such a situation could be sustained professionally.

While those affiliated with hospitals tend to follow employer policies regarding Medicaid acceptance, independent physicians like DeBenedictis and Collinge have the autonomy to decide based on their financial viability. Many, unfortunately, must limit the number of days they accept Medicaid patients due to low reimbursement.

A review found about 21 ophthalmology groups enrolled in Medicaid, yet there are only a handful who are currently taking new pediatric Medicaid patients. DeBenedictis mentioned that while she sees around 30 patients daily, she can usually only accept one or two new Medicaid cases without financial consequence. “I absolutely cannot see all the ones that need me,” she lamented, highlighting the emotional toll it takes on providers and patients alike.

Ultimately, Friedl’s worry shifted when Luca managed to get an appointment after a cancellation came through, rather than waiting nine months. As a result, he was diagnosed with accommodative esotropia and amblyopia, and he received glasses that helped with his vision issues. “It took all the weight off my chest,” Friedl expressed, relieved that they found help in time.

Dr. Collinge faced her own struggles when she opened her practice in 2025, attempting to accept patients regardless of insurance type but found it financially untenable. As operational costs rose, she cut back on the number of Medicaid appointments she accepted, eventually deciding in early 2026 to stop taking new Medicaid patients altogether. This was a tough but necessary choice to keep her practice afloat.

Collibee, a spokesperson for Lamont’s budget office, noted this shortage of pediatric ophthalmologists isn’t limited to Connecticut; it’s a national issue. “The shortage… contributes to long wait times,” Collibee remarked. Yet, Collinge pointed out that the adverse effects seem to hit Medicaid patients more severely than others.

The Effects on Access to Care

HUSKY covers a significant portion of the state’s population, particularly children, including many from Black and Hispanic backgrounds. DeBenedictis highlighted what she observed in her practice in Waterbury, pointing out that vulnerable communities are often overlooked: “Children — and especially Black and Hispanic children — are not getting the healthcare they need.”

This isn’t just about access for Medicaid patients; low reimbursement rates affect privately insured patients, too. Martha Howard, from Yale Medicine, explained how absorbing many Medicaid patients affects wait times for all children—eventually leading to longer waiting lists across the board, an issue that grows more complicated as more people seek care.

Senator Jason Perillo pointed out that low Medicaid rates inadvertently lead to higher insurance premiums in the private sector. “Part of the answer is Connecticut’s Medicaid reimbursement rates,” he noted, bringing attention to how interconnected these systems are.

Pressing for Change

Both physicians have taken their concerns directly to Governor Lamont but have met minimal success. Collinge said he now recognizes her after numerous encounters, jokingly referring to her as “the one with the Medicaid problem.” Yet, she insists it extends beyond just her practice—everyone involved feels the pressure of inadequate funding.

While the Lamont administration acknowledges the need for Medicaid rate adjustments, they’ve often delayed significant increases. Despite some discussions about revising rates, Friedl and others feel that the current approach prioritizes fiscal considerations over people’s healthcare needs. “Healthcare should not be a luxury,” Friedl asserted, capturing the sentiment of many who navigate these obstacles daily.