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State Senate unveils new Medicaid expansion plan

Staff Report
February 12. 2014 10:14PM

CONCORD — Senate leaders unveiled a bipartisan plan Wednesday to add low-income adults to the government-paid health care program under the Affordable Care Act, something lawmakers failed to do last year.

The plan is similar to one put forth last year, but disagreement over when it would begin and how quickly newly eligible recipients would have to move to private insurance killed the proposal during a special session in November.

The new proposal would allow the state to begin the program by July, although it would end in a year if the state does not receive federal waivers for key aspects. It would end Dec. 31, 2016, anyway if the Legislature does not reauthorize the program.

Previously, Senate Republicans insisted the state receive federal waivers before the program could begin.

Gov. Maggie Hassan, who pushed for Medicaid expansion last year, praised the work of the senators.

“The bipartisan legislation released today by the Senate represents a compromise plan that will allow us to use federal funds to extend critical health care coverage to more than 50,000 hard-working Granite Staters,” Hassan said in a statement. “I thank senators from both parties for their efforts to reach common ground on health care expansion, which will boost New Hampshire’s economy, reduce cost-shifting on businesses, and improve the health and financial well-being of our families. I encourage both the House and Senate to pass this bill and send it to my desk as soon as possible.”

Since November’s special session, Senate Republicans and Democrats have quietly negotiated a plan that relies on private insurance to provide coverage to an estimated 50,000 low-income adults between zero and 138 percent of the federal poverty level.

Those newly eligible for the Medicaid program would join the state’s current managed care program and would remain on ‘the bridge program” until Jan. 1, 2016, when they would have to go on a private plan offered through the state’s health insurance exchange, although Medicaid would pay the premiums.

The proposal will require three federal waivers, including one that could mean between $25 million and $200 million in additional federal money for the state to cover services currently being provided but not federally reimbursed.

The new program would sunset after three years or if the federal government fails to pay 100 percent of the cost through Dec. 31, 2016.

The three managed care companies that currently administered the state Medicaid program would be able to automatically enroll current patients when they are required to transition to private health insurance.

Senate Majority Leader Jeb Bradley said the plan addresses the uncompensated care problem facing the state’s hospital. Medicaid rates that pay about 50 cents on the dollar for services and many people are unable to pay for services.

Uncompensated care is the hidden tax that is driving up the costs of health care in New Hampshire, he said.

Bradley said the plan would provide reimbursement rates closer to what private insurers and Medicare pay for services.

“We’ve said right along it has to be right for New Hampshire,” said Senate President Chuck Morse, R-Salem. “Heading toward private insurance is the right direction for New Hampshire.”

Senate Minority Leader Sylvia Larsen, D-Concord, said the plan provides a solution that expands access to health care for low-income state residents.

Lawmakers debated Medicaid expansion all last year, often degenerating into partisan bickering.

The plan announced Wednesday uses the existing Health Insurance Premium Payment program for those with insurance from their employers, so they could continue their coverage while Medicaid would pay the premiums. The program would cover about 12,000 of the 50,000 people helped by expansion.

Bradley said the HIPP program only requires an amendment to the state’s Medicaid plan and could be up and running within 30 to 60 days after the bill passes.

The senators agreed to require the jobless to participate in Department of Employment Security training and job search programs, and to establish a separate trust to accept federal money to pay health care providers rather than using the state’s general fund as the conduit.

With Anthem Blue Cross Blue Shield the only insurance carrier offering general health insurance coverage in the state exchange, Democrats had argued more private companies have to join the electronic marketplace for private insurance to be viable.

Since that time, two other carriers have indicated they intend to offer plans beginning next year and Bradley said they hope the three managed care companies also join the exchange.

That should provide competition, something everyone believes the state needs in its health insurance market, Bradley said.

Under the ACA, state health care providers would receive about $2.4 billion in federal money.New Hampshire is one of six states currently deciding whether to expand Medicaid eligibility under the ACA. To date 26 states and Washington D.C. have agreed to expand Medicaid eligibility.

A public hearing on the bill is tentatively scheduled for Tuesday. The House will have to approve the plan as well.

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