Legislature urged to extend expanded Medicaid programBy DAVE SOLOMON
New Hampshire Union Leader
November 16. 2017 3:03AM
CONCORD — After more than a year of deliberation, the commission to evaluate the future of Medicaid expansion in New Hampshire issued its final report on Wednesday, calling for the program to be continued for at least another five years but with major changes.
The commission, composed of lawmakers and stakeholders, has been meeting since September of last year, with a Dec. 1 deadline for its recommendations to the state Legislature.
The vote to adopt the recommendations was unanimous, although state Sen. Sharon Carson, R-Londonderry, expressed some reservations. Carson voted against Medicaid expansion in the Senate on two separate occasions.
“I remain skeptical as to whether or not this is the right thing to do,” she said, “but I will go ahead and vote to move this forward because we are moving in the right direction. Hopefully we will have a bill with all these recommendations, and the Legislature will have a chance to fully vet them and come up with a plan.”
New Hampshire was one of 32 states that agreed to expand eligibility for Medicaid under the Affordable Care Act, or Obamacare, starting in 2015-16 for two years. The program was expanded for another two years to cover 2017-18.
The commission recommends the program continue beyond 2018, but through one of the managed care companies now handling traditional Medicaid enrollees.
Under managed care, the program reimburses providers directly with Medicaid funds, instead of using those funds to buy private health insurance for enrollees in the individual market at healthcare.gov, as the state has been doing for the past two years.
Actuarial reports commissioned by the state demonstrated that including the expanded Medicaid population in the individual marketplace caused premiums to rise on healthcare.gov for non-Medicaid customers.
The commission recommends the change back to managed care to “reduce premium instability in the individual health insurance market … and to remove the impact of the medically frail (Medicaid patients) on the individual market.”
The report also recommends higher reimbursement rates for providers, especially addiction treatment providers and mental health services, and a transition period with no lapse in coverage.
Managed care companies like Well Sense Health Plan and New Hampshire Healthy Families, currently contracted by DHHS to manage traditional Medicaid, would have to honor pre-existing authorizations and plans, and prevent lapses in coverage, for expanded Medicaid enrollees as the transition takes place.
There’s still a long way to go before the matter is settled. A bill recently signed into law by Gov. Chris Sununu calls for the state to withdraw from the program if the federal government does not approve the state’s request to impose a work requirement on able-bodied adults receiving Medicaid benefits — something the Trump administration has said it will approve.
If the Legislature decides to move forward with expanded Medicaid, it will also have to resolve the question of how the state should fund its share of the program. Starting in 2017, the state has to pick up 5 percent of the cost, growing to 10 percent by 2020.
The federal government has notified the state that its current method of funding the program through voluntary donations by hospitals and insurance companies is illegal under federal law.
“We got to first base,” said commission Chairman Sen. Jeb Bradley as he wound up the deliberations. “That’s a good place to be, but there’s a long way to go and lots of work to do.”