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Efforts underway to make Medicaid expansion workable in New Hampshire

State House Bureau

September 24. 2013 6:50PM

CONCORD — The state may not be able to require some low-income residents to use the new health insurance exchange under Medicaid expansion through the Affordable Care Act, the commission studying expanding eligibility was told Tuesday.

The Commission to Study Expansion of Medicaid Eligibility is considering requiring those between 100 and 138 percent of the federal poverty level to buy insurance through the exchange even though Medicaid would pay the premium. The plan is similar to what Arkansas and at least one other state have proposed, although the federal government has yet to agree to the proposals.

But the Insurance Department’s Jennifer Patterson said federal officials indicate the state could not do that at least for 2013 because recipients have to be offered a choice of plans.

She said if there is more than one carrier beginning in 2015 as is expected, then the exchange provision could go forward.

“Recent guidance from CMS (Center for Medicaid Services) is they won’t grant a waiver unless there is a choice of qualified health plans,” she told the commission.

Earlier this summer, the Insurance Department told the commission that as long as the one insurer on the exchange — Anthem Blue Cross Blue Shield — offered several plans, the state would meet the requirement for a choice of plans for those who qualify for Medicaid.

On Tuesday she said it would not make a lot of sense to require people to use the exchange until 2015.

But Sen. Andy Sanborn, R-Bedford, noted Anthem is offering 11 plans on the exchange. Is there a way to get a definitive answer, he asked.

Patterson said she could probably get an answer, and noted from the department’s prospective the more choices consumers have on the exchange the better.

Committee member Charlie Arlinghaus noted there is little room for compromise between those in favor and opposed to expansion, but using private insurers in Medicaid expansion was one way to bridge the gap. “Without that option,” Arlinghaus said, “I’m not sure.”

Rep. Tom Sherman, R-Rye, said he would like to see those between 100 and 138 percent of poverty go through the commercial market on the exchange but does not believe the commercial market can handle it right now with only one insurer, but could in 2015 with other companies offering plans.

A majority of the committee favors accepting federal help for the expansion, but not on what the state should do to meet the federal requirements under the Affordable Care Act.

The commission spent much of Tuesday going through eight key points that need to be addressed if the state goes forward with expansion, although there was little agreement on most of the points.

One key point is whether the state should ask for a waiver from the federal government both to use the exchange and to expand a current program to pay employers to maintain coverage for eligible employees that is mandatory under expansion.

Sen. Nancy Stiles, R-Hampton, said she favors moving forward with a waiver and make the state’s participation in expansion contingent on it. “2017 is much too late,” she said, “We need it in hand by July 1, (2014).”

Most members of the commission agree that managed care should be part of any expansion of Medicaid and many want to take the federal funds for the newly eligible as soon as possible.

Sherman offered to put together a plan that could be acceptable to most of the commission, while other members will present alternative plans at the commission’s next meeting on Tuesday Oct. 1.

Arlinghaus said it may not be the most fruitful to come up with a plan that could be offered as legislation. He’s for developing concepts and ideas that members could support or oppose with suggestions of issues some members believe still need to be addressed.

“Maybe we can end up at the same place in the end,” he said.

New Hampshire is one of eight states that have yet to make a decision on whether to expand Medicaid eligibility. Several states have agreed to move forward, but only if receiving waivers from the federal government for proposed programs.

The battle over expansion has fallen largely down partisan lines as Democrats favor expansion and Republicans oppose it.

Expansion is supported by Gov. Maggie Hassan and the Democrat-controlled House, while the Republican-controlled Senate said it needs more information and time before deciding.

When the two sides could not agree at the end of the session in June, budget negotiators agreed to form the commission with a deadline of Oct. 15 to make recommendations.

If New Hampshire decides to expand Medicaid eligibility to 138 percent of the federal poverty level, state health and human service officials say that will add 49,000 people to the program over the next seven-and-a-half years, while the federal government will pay $2.4 billion to health care providers. The state is expected to spend about $18 million for expansion over the period.

Under Medicaid expansion, the federal government would pay 100 percent of the cost for the first three years and then gradually reduce its share to 90 percent by 2014 and thereafter.

The commission meets at the beginning of October to decide on what recommendations it will make, and then again a week later to review a draft report.

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