CONCORD — Lawmakers are expected to meet in November to decide whether the state expands Medicaid eligibility to low-income adults, after the Commission to Study Medicaid Expansion unanimously approved its final report Tuesday.
The report recommends the state expand the Medicaid program to low-income adults up to 138 percent of the federal poverty level, but makes expansion contingent on federal officials approving the use of private insurance.
Today, Gov. Maggie Hassan will ask the Executive Council to approve the special session.
House and Senate leaders say the commission’s work is the framework for lawmakers to reach compromise on a plan that will expand health insurance coverage to the state’s low-income adults, yet guard against runaway costs for taxpayers.
The New Hampshire plan would have the state expand Medicaid eligibility in order to maximize the available federal money, while using private insurance to cover as many newly eligible people as possible.
“I fully agree with the commission’s recommendation that New Hampshire should move forward with expansion prior to Jan. 1 — after which we will begin to lose hundreds of thousands of dollars per day that we can never recover,” Hassan said. “After consulting with Senate President Morse and Speaker Norelli, I am confident that a November special session will allow for thorough consideration and enactment of a New Hampshire plan for expansion in time for federal approval before Jan. 1.”
State officials estimate that about 49,000 low-income adults will be eligible for the Medicaid rolls under expansion and the state’s health care providers would receive $2.4 billion over the next seven years.
The commission included safeguards to halt expansion if the federal government does not live up to its financial commitment or expands program benefits. Lawmakers would need to act to allow the program to continue.
The commission included a minority report that said there should be greater private insurance options for the state and more protection for taxpayers.
Hassan and the Democratically-controlled House favor expansion, but supporters will need to persuade some Senate Republicans to win passage. The Senate voted down party lines 13-11 to block expansion in June.
Morse said the report contains areas that are critically important to the Senate: using private insurance, obtaining federal waivers before starting the program, and protecting taxpayers from future liabilities.
“This report is just the first step,” said Morse. “To be clear, significant work remains to take the recommendations of the commission and turn them into a bill that can pass both bodies of the Legislature.”
Norelli praised the commission’s work, saying the members worked hard to find the best solution for the state.
“Through the private-insurer-based, managed-care system and an expansion of the Health Insurance Premium Payment Program, the Commission’s recommended New Hampshire Access to Health Program would maximize private coverage and minimize cost to the state,” Nerelli said. “I look forward to continuing to work together with Senate leadership and Gov. Hassan to reach an agreement to expand access to health care for working families across the state.”
The Health Insurance Premium Payment program would pay premiums for those on their employers’ health plans.
Mandating the program requires a federal waiver that is expected to be approved quickly, although a waiver to require those between 100 and 138 percent of poverty to use the health insurance exchange could take up to six months.
House Republican leader Gene Chandler noted the minority’s recommendations for greater use of private insurance and greater protections for taxpayers.
“We all want to find ways to increase access to affordable health care for our low-income citizens,” Chandler said. “We don’t want to face the possibility of an income or sales tax if and when Medicaid costs become unmanageable.”
The conservative advocacy group Americans for Prosperity, which fought Medicaid expansion during the 2013 session, cautioned that the program would put thousands with good health insurance into inferior policies and force many without coverage into the health insurance exchange with limited networks and high deductibles.
“Making health care worse for 32,000 people to offer a benefit to 22,000 is fundamentally poor public policy and jeopardizes our ability to remain one of the healthiest states in the nation,” said Greg Moore, AFP-NH director. “We should be looking for a state-run plan to find coverage for the remaining group that our Legislature could closely monitor and not be subject to huge new federal regulations.”
The Legislature is expected to meet Nov. 7 to introduce the bill or bills, hold public hearings the week of Nov. 11 and vote the week of Nov. 18.
The federal government would pay 100 percent of the cost for the newly eligible and then reduce its share to 90 percent after seven years and thereafter under the ACA.
Those eligible under the program would be individuals earning about $16,000 a year, and three-member families earning $23,000.
New Hampshire is one of a about half dozen states that have yet to decide whether to expand Medicaid eligibility.