Recognizing and addressing social determinants of health can have a great impact on our overall well-being. That also goes for the people who are responsible for the care of others, be it their children or an aging or sick relative. Connecticut has a number of services and programs available to help, and Department of Social Services Commissioner Andrea Barton Reeves joins Dr. Anthony Alessi to explain them, clear up misconceptions around some of these programs, and discuss some of the challenges around social services in 2026.
Commissioner Barton Reeves recently joined the UConn Heath Board of Directors.
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Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide up to date, medical and timely information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your healthcare, which should only be done by your physician.
I'm your host, Dr. Anthony Alessi, and it gives me a great pleasure to have as my guest today, Commissioner Andrea Barton Reeves. Commissioner Reeves is the commissioner for the Department of Social Services here in Connecticut. She's also a recently appointed member of the Board of Directors of UConn Health.
Welcome to the podcast.
Commissioner Barton Reeves: Thank you for having me.
Dr. Alessi: Let's start out. You're an attorney. What drew you to your career in advocacy?
Commissioner Barton Reeves: I would say that my parents were always, they were people that were very clear that we owed more to our community than just being three privileged children. So my father was a physician, he was a board certified child and adolescent psychiatrist, and my mother was a nurse.
She held a master's degree and she taught at Columbia and worked at a large hospital in New York. But they were immigrants. They came really with nothing and worked very hard to get their own educations and to educate my brothers and I. But in the course of that, they made it clear that they actually had careers and, you know, in the medical profession that gave back to people.
And because so many people had made their lives and the success in their lives possible, that we had a responsibility to do that as well. So I think it's been ingrained from the time I was very young. It's my nature and all my brothers and I, we all are in similar fields in the helping professions and do very similar work.
Dr. Alessi: What a great legacy for your parents. You might be wondering why I'm having you on. Most of our guests have been physicians, but I wanna let you know that I firmly believe that the key to better health starts with the social situation of patients, whether they're homeless, whether they have enough to eat, and now we're hearing a new term, right? The social determinants of health.
Commissioner Barton Reeves: That's right.
Dr. Alessi: And with that here in the state of Connecticut, we have a Medicaid program. Can you talk a little bit about the program and somewhat profile the people who are on it because there's so much misinformation and disinformation out there. I read a recent opinion piece where they touted the fact that the people on Medicaid are here illegally, they are undocumented people.
And I know that for a fact that that is not the case. So can you really talk to us a little bit about who are the people on Medicaid in Connecticut? Are they working? Who are these people?
Commissioner Barton Reeves: Sure. And thank you for this opportunity because there is so much disinformation and really I think negative stereotyping of people who are on Medicaid. People who are on Medicaid can be individuals or families. And your eligibility for Medicaid depends on what percentage of your income places you at or below the federal poverty level.
And it's a large, complex calculation with lots of charts and we won't go into that, but in this state, over a million people are on Medicaid. What people also don't understand is Medicaid is complex in the sense that it's not just an individual or collective insurance policy for working adults or for children.
Medicaid dollars also pay for care in hospitals, and they pay for long-term services and supports with people who are at home. And Medicaid dollars also pay for federally qualified health centers and places where people get lots of care, and I don't think people really understand that, and they believe that we're spending the amount of money that we spend, we have a $9 billion budget for Medicaid in this state, but it also goes to pay for pharmacy.
And as I mentioned, it pays for people to be able to live at home, to stay out of nursing homes. It pays for acute care in nursing homes. It pays for a number of things that aren't necessarily what people believe is their own belief around Medicaid, which is a person who is deliberately trying to suppress their income so that they can become Medicaid eligible. That is far from the truth of how this works. It also covers so many people who are disabled and can't work. And so that there is no single profile of people who are on Medicaid, simply put. For every person that's on Medicaid, it is a different and unique story.
Dr. Alessi: More recently, there have been changes in the regulations, right? Especially with result to the Supplemental Nutritional Assistance Program in terms of work requirements. And when looking at that, I found that interesting because it's almost like the old HUSKY C we used to have where someone would have to be either working, looking for work, but in this case volunteering is one of the factors.
As I'm sure you are, I've been a big advocate for volunteerism, even in people when a patient tells me, “well, I'm retired”. Well, what does that mean? What are you doing? Okay, because there are people who need your help. So, can you talk to me a little bit about how is that gonna work?
How are people supposed to do that? We know, and I think the number is what, 350,000 people, or some ridiculous number. They're not gonna go out and find a job, so they're either going to have to claim disability or volunteer.
Commissioner Barton Reeves: Well, let me try to provide some context around the numbers.
The changes that happened in HR1, OBBBA, the One Big Beautiful Bill, all the ways that people refer to it only reference a specific population in Medicaid. It is not the entirety of those who are on Medicaid. So the vast majority of people who are on Medicaid in this state that include all the populations that I just named, they are not impacted by this.
It's only what we call our HUSKY D because our program here in Connecticut, right, is called HUSKY. That's Medicaid, right? Lot people don't know that either, and that's what we call the expansion population. Those are people who, during the Biden administration, were given an opportunity to join the Medicaid program who normally would not have qualified because they're just a bit over income and a bit over the assets for what you would normally have, but still not enough to be able to provide themselves private insurance.
As an incentive to have more people enrolled in Medicaid, which are fewer people that are uninsured, right, conversely, we were offered, and all states who agreed to this were offered a very generous federal match of 90% of what we spend, and then the state would have to come up with the 10%.
So now for the expansion states, as we call them. In this state, we have 365,000 people about who are in that expansion population. About a third of them are at risk of being impacted by these newly changed rules for what we call HR1, meaning that if they cannot find a way to fit into the categories of exemption, then they're gonna have to find a way to provide proof of being involved in community engagement. And, you know, the same thing, it's called work requirements. Those terms are used interchangeably. But it means that they have to volunteer, they have to work, or for Medicaid, they have to have income that's equivalent to $580 a month, which is really the federal minimum wage times 80 hours or some combination of those monthly in order to continue to qualify for Medicaid. If they can't, then they'll drop off. Then they have to find a way to get back on by complying with the 80 hours.
Conversely, or comparatively, SNAP is completely different. The Supplemental Nutrition Assistance Program has always had work requirements. This is what people don't know, right, they've had it since 1971. But now with HR1, there's been some changes in the categories of people who were formally exempt from those work requirements that now are, so now it's up to age 64.
If you're caring for a child who's up to the age of 14, you may be exempt. If you're caring for a child with a disability who's up to the age of 18, you're no longer exempt because you or your child is no longer in that exempt category. Kids who were formally in foster care and then they aged out at 24, they were exempt before. They're not exempt now.
So that new category of people under SNAP now, they also have to find work using the SNAP rules, which have not changed. And then in this state, the Medicaid rules that are now nationwide apply to people on Medicaid, which has never happened in Connecticut before. There are other states that had work requirements, Kentucky, Georgia, a few others. Some were more successful than others, but now every state has them because of the new federal law.
So that's really how it works.
Dr. Alessi: So will we now have to monitor to make sure people are doing their volunteer hours?
Commissioner Barton Reeves: Well, not necessarily “we”, you know, the royal, “we” state of Connecticut. But there will be, and there have to be reporting requirements.
So that's part of what every state now has to figure out how to hire a vendor who will adjust our systems and make all the changes so that people will be able to report. Yes, I no longer fit into the categories of exemption, and I have to meet the work requirements for Medicaid and SNAP. Here's how I've been doing that.
I've been volunteering 10 hours at the library. I've been, you know, 5 hours at the hospital and I've got a job where I work 20 hours a week. Or for Medicaid, I've done those things or I don't need to do those things because I do have $580 a month in income, whatever that looks like. Yeah, so we have the responsibility to do that.
That's built into the statute. We have until January of 2027 when it becomes live for Medicaid. And we are running furiously at this moment to get everything ready so that when people start to be subject to these requirements in January for Medicaid, we will be ready for them. Yeah.
Dr. Alessi: I'm gonna shift gears a little bit.
Commissioner Barton Reeves: Sure.
Dr. Alessi: In your career, you've been a particular advocate for children.
Commissioner Barton Reeves: That's right.
Dr. Alessi: You were the guardian ad litem, and, the past few days, we have all been focused on Liam Ramos. Okay, an undocumented child. One study came out today and said that he's just one of up to 4,000 children who have been detained because their parents are undocumented.
We've not heard those stories here in Connecticut. And, for some reason I think we're somewhat protected. Are these children safe here in Connecticut and what can we be doing to keep them safe?
Commissioner Barton Reeves: I wish I knew the answer to that question. I think it's hard to define what safe looks like because the behavior of those that are charged with enforcing our immigration laws appears to be unpredictable.
So we don't really know what safe looks like. We've seen children across the country moved from schools, you know, kind of picked up off the street, at the grocery store, wherever there happens to be. But I would say this, knowing what I know, in the 10 years that I've represented children, whatever children are violently and unexpectedly separated from their families, there is significant trauma that they experience.
There is no question about it.
Dr. Alessi: Absolutely.
Commissioner Barton Reeves: And the child's ability to recover from that resiliency has everything to do with what happened to them during the time that they are away from their families and how well they're supported when they return. Some children will be deeply affected for a very long time by what has happened, and some children will be affected but not necessarily scarred, and they'll be able to move on with their lives, but will always have had that experience.
We tend to think that children sometimes are little adults or that they should be expected to get over very traumatic circumstances, but I can tell you that especially within the first five years of their development, traumatic separation from family can shape how they grow up for the rest of their lives.
So, you're absolutely right and we all are to be very careful and very mindful about the indiscriminate ways in which we've seen children separated from their families and detained because the long-term damage from that that we'll see societally, we haven't even begun to measure yet.
Dr. Alessi: Yes, and many of us are familiar with the ACEs survey, right?
The Adverse Childhood Experiences survey, in which we have found that these experiences not only lead to psychological issues of PTSD, but diabetes, hypertension, obesity. So, you know, again, we get to the social determinants of health. You know, I take care of a lot of patients who have had brain injuries as a neurologist.
And one of the programs, if you could talk a little bit about, is where in home assistance is given by a family member and, is that only for traumatic brain injury or has it been extended to other people? For example, people with stroke who would otherwise be in a skilled nursing facility?
Commissioner Barton Reeves: That's right.
Dr. Alessi: Can you bring us up to speed a little bit about that? I think a lot of physicians would be interested in that.
Commissioner Barton Reeves: So the state has a program known as Community First Choice. We refer to it by its initials, CFC as an acronym, and it is a program that is designed to provide individualized support in the home for people that need it.
Not just people with traumatic brain injury or stroke, but people who may have significant physical disabilities who without the support would most likely end up being in a long-term facility or a nursing home. There are two ways in which the state provides this support. One is what we call agency based care, and there are other private agencies that actually hire, excuse me, personal care attendants, PCAs, that go out into the community to a person's home and provide them with support.
Then there is another population that is known as self-directed care. So, we have people who act as their own employer. And they can hire the personal care attendant that they'd like to care for them in their home, and that can include a family member. And there's a whole process for that to occur. It does help people be more independent. It does help keep people out of nursing homes, which we know can be very expensive and a congregate care setting, and it can help to contribute to a much better quality of life. It can.
Dr. Alessi: You know, there are so many topics, and we could go on and on. But in closing, I'd like to ask you, if you were to design your own social services system, what would it look like?
Commissioner Barton Reeves: Such a great question. I would love to see social services be more individualized because we serve so many people, many states, not just ours. We're in a legacy system where people have to go to 1 of 12 offices. They're out usually in the middle of an industrial park, and people have to find their way to us.
It would be so much better if we had smaller spaces that were more connected to individuals in their communities where they could talk face to face to someone and not be on a line and not be in a building looks like a bus stop. You know, that's my greatest wish is that we could really deliver services differently so that people could have the dignity that they deserve.
Just because you need Medicaid and SNAP doesn't mean that you don't deserve dignity, and I'd really love to see that change.
Dr. Alessi: I think that's so important, especially the individuality of it because not everybody fits into the same box. And have different situations. So I really appreciate it.
Commissioner, I can't thank you enough. It's really been an honor to chat with you. I hope at some point we continue the conversation and thank you. Thank you for your time. But more importantly, thank you for everything you are doing for the people of Connecticut and our patients.
Commissioner Barton Reeves: I appreciate that.
Thank you so much. Thanks for having me. It's been great.
Dr. Alessi: Thanks.
If you have any questions or ideas for future programs, you can reach out to me at healthyrounds@uchc.edu.
Jennifer Walker is Executive Producer of the Healthy Rounds podcast.
Chris DeFrancesco is the Studio Producer for the Healthy Rounds podcast.
Tessa Rickart is in charge of social media.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.
