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NH told: No work rules for Medicaid


CONCORD - The Obama administration denied New Hampshire's bid to make 50,000 low-income adults face a work requirement to receive taxpayer-paid coverage under an expansion of Medicaid.

The decision, while expected in many quarters, was stunning in its timing coming on near the eve of an election in which this issue has been a hot topic for months.

The Centers for Medicare & Medicaid Services also rejected provisions of the 2015 New Hampshire Health Protection Program that would impose more rigorous standards to prove U.S. and New Hampshire citizenship to be eligible.

"After reviewing New Hampshire's amendment request to determine whether it meets these standards, CMS is unable to approve the following requests which could undermine access, efficiency, and quality of care provided to Medicaid beneficiaries," said CMS Director Vikki Wachino in her letter to NH Health and Human Services Commissioner Jeffrey Meyers.

The program still stands precisely because the Republican-led Legislature narrowly agreed to set up this program with a clause that allowed it all to go forward even if parts of it were judged to be illegal or unconstitutional.

Gov. Maggie Hassan's spokesman said GOP lawmakers knew no state had been granted a work requirement and getting one for New Hampshire past federal regulators was at best a long shot.

"Governor Hassan worked across party lines to reauthorize the bipartisan New Hampshire Health Protection Program because it is providing critical health coverage to more than 50,000 hard-working Granite Staters, reducing healthcare cost-shifting on all of our people and businesses, and boosting our economy - which CMS recognized and lauded in its letter," Hassan Communications Director William Hinkle said.

"The governor and Legislature were aware that it would be difficult to receive federal approval for some of the requirements insisted upon by some legislators, which is why there were mechanisms put in the bipartisan reauthorization measure to ensure that this critical program continues to move forward."

Conservative Republicans tried to force the entire program to rise and fall as one but House Speaker Shawn Jasper, R-Hudson, cast the deciding vote to reject that course.

Greg Moore is state director of Americans for Prosperity, a fiscally-conservative group that fought the New Hampshire Health Protection Program.

"The rejection of New Hampshire's ObamaCare waiver shows just how serious the ramifications were from Speaker Jasper's deciding vote to strip out the severability clause," Moore said in a statement.

"Ultimately, it turned all the accountability that supporters talked about into window dressing. There is no New Hampshire solution to ObamaCare, there's just ObamaCare."

The ruling comes in the closing days of this wild election with Medicaid expansion a top-tier issue in the wide open race to replace Democratic Gov. Hassan and in Hassan's bid to unseat Republican Sen. Kelly Ayotte.

Democrat Colin Van Ostern of Concord has repeatedly attacked Republican Chris Sununu of Newfields for opposing the Medicaid expansion during their campaigns for governor.

Hassan has accused Ayotte of trying to "pull the rug" out from under those who got coverage by voting to end the expansion states could pursue under Obamacare.

Ayotte and Sununu both said they support an extension of the program to retain coverage so state lawmakers could pursue an even better "New Hampshire solution" that doesn't create much higher costs for taxpayers in future years.

"Now that it's been confirmed that New Hampshire has been denied by the federal government any flexibility in a Medicaid waiver request, it's clear that we are stuck with a one-size-fits-all Washington solution," said David Abrams, communications director for Sununu's campaign.

"Colin Van Ostern's support for Obamacare has caused premiums to skyrocket, hurting real New Hampshire families. His continued advocacy for making it permanent is disconnected from reality."

Van Ostern's campaign said this doesn't change the reality that the expansion delivered health care with substance abuse coverage and Sununu tried at every turn to kill it.

"It took Democrats and Republicans to come together to pass the bipartisan expansion of Medicaid, which has provided healthcare coverage to over 50,000 Granite Staters, including over 7,500 who have received substance abuse treatment," said Ben Wexler-Waite, Van Ostern's press secretary.

"As governor, Colin will work to continue the successful implementation of Medicaid expansion and make this permanent."

Ayotte said the decision is consistent with the Obama administration's rigid insistence there be a national solution to get all Americans health care and not one that she supports that is tailored to each state's needs.

The requirement in the legislation Hassan signed in 2014 said those who were able-bodied and getting coverage had to either be working, training for a job or actively searching for work for at least 30 hours a week.

Consumer groups had criticized the work requirement.

"Linking Medicaid eligibility to employment has no connection to the purposes of the Medicaid program," Community Catalyst, a consumer advocacy group, said in a statement.

CMS had rejected similar work proposals that Ohio and Arizona had requested.

"New Hampshire has made significant recent commitments to improving payment and strengthening delivery systems for New Hampshire's Medicaid beneficiaries," CMS Director Wachino wrote. "CMS stands ready to continue to assist you as you continue in this important work."

As of August 2016, New Hampshire has enrolled 185,767 individuals in Medicaid and the Children's Health Insurance Program (CHIP) - a net increase of 46.18% since 2013.

The ID section that was also rejected by federal regulators would have required newly-eligible adults to verify that they are U.S. citizens by providing two forms of identification. They also would have had to prove New Hampshire residency with either a state-issued driver's license or a state issued identification card.

The Obama administrative did approve one provision Republican lawmakers pursued and Hassan agreed to which is an $8 co-pay for the first, unnecessary use of the emergency room and $25 every time after that is repeated.

The ruling's timing may have been because state Medicaid directors across the country were scheduled to meet for an annual meeting this coming week in Arlington, VA.

klandrigan@unionleader.com


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