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Sheldon Toubman: PCCM is a new, exciting option.

John Smith doesn't have to worry when he gets sick. He's not rich, and he doesn't carry health insurance per se, but he's one of 165 lucky patients participating in an innovative state health program called Primary Care Case Management. It doesn't cost him a dime; instead, the state pays his doctor $7.50 per month to provide treatment.

The amazing part: Doctors want to participate and the state saves millions of dollars.

The mind-boggling part: The state is dragging its heels in implementing the program.

Smith isn't a real person; he's a stand-in for one of the patients enrolled in the program. (Due to confidentiality requirements, we did not interview patients.) But the scenario is real. While officials in Washington and Hartford debate health care reform, the future of health care is happening now in just 50 doctors' offices in Waterbury and Windham. PCCM is a micro version of what a national or statewide health care system could look like: The government directly pays doctors to take care of patients and coordinate their health care. There's no insurance middlemen to create a bureaucratic boondoggle and ratchet up costs.

But Connecticut has resisted making the program more widely available, despite the fact that it improved care and saved money in other states. By some estimates Connecticut could save $100 million with PCCM.

All 165 John Smiths are HUSKY recipients — Connecticut's version of Medicaid for the poor (for a family of three, that's income up to $33,000). Doctors in PCCM become a patient's "medical home," meaning they keep all the patient's records and coordinate any extra care, like dental appointments.

Doctors say, and President Obama believes, that "medical homes" offer more streamlined and efficient care. But the vast majority of folks on HUSKY (there are more than 345,000 of them) haven't signed up because the state, through the Department of Social Services, has discouraged participation by both docs and patients, say health care advocates.

"DSS resisted doing this, and they backtracked from what they committed to do," says New Haven Legal Assistance attorney Sheldon Toubman.

"I think its been a little troubling for everyone that not only are they not doing what they promised, but they're not doing what was instructed by the legislature," says Kevin Lembo, the state's Healthcare Advocate.

The legislature wanted the program to be statewide. But after 300 docs from across the state signed up, DSS changed course and only started PCCM in Waterbury and Windham, saying it would expand if the program worked well there.

"It doesn't matter what was [originally] planned," David Dearborn, the DSS spokesman says. "What matters was what was approved by the legislature in March" — a scaled-back version of the more ambitious statewide plan — "and that's the policy for the state." Since the legislature approved the scaled-back plan, "criticism now about our approach seems somewhat revisionist."

Advocates say there are other hurdles, too: Doctors in the program are subject to state open records laws — a strange requirement since doctors who treat other HUSKY patients aren't (but the insurance companies are).

DSS was also supposed to market the program, but hasn't done a good job, says Toubman. To make the program economically feasible, doctors need a lot of patients because PCCM calls for a dedicated staff member to manage the program — to be paid for with the $7.50 a month patient fee. "They're in a bad spot because DSS has failed to do the marketing to build up the numbers to make it feasible," says Toubman.

This month — six months after the program began — DSS sent a brochure to HUSKY patients in the Waterbury/Windham area about PCCM. That's not enough, says Toubman, citing billboards and TV ads run by the insurance companies competing for HUSKY business. There's no marketing budget for PCCM.

On top of that, the doctors' PCCM contract severely limits what or how they can talk to their patients about the program. "Our understanding was we could not market it and advertise it to our patients. The state would tell the patients. But how do patients know about this if the doctor can't advocate for the patient?" says Dr. Sunil D'cunha, of Waterbury's StayWell Health Care. "We need to say, 'This is a good program and it might work for you.'"

About 60 percent of StayWell's 1,700 patients have HUSKY. Only 42 signed up for PCCM.

"Our job is to do the work DSS hasn't done," says Toubman. "We need to educate the public that this is a new, exciting option."