Amber MacQuarrie

Amber MacQuarrie, a day care provider in Manchester, qualifies for expanded Medicaid but knows very little about how to comply with new work requirements that took effect June 1.

MANCHESTER — When Nancy Glynn struck up a conversation with her next-door neighbor about the new work requirements for people on the state’s expanded Medicaid program, she was surprised by the response.

“She had no idea that this is even going into effect,” said Glynn.

The new work or community engagement requirement kicked in as of June 1, requiring anyone covered by expanded Medicaid, known as Granite Advantage, to complete 100 hours of work or approved community activities each month to maintain medical coverage, unless they are exempt due to medical frailty or other circumstances listed in the law.

Department of Health and Human Services spokesman Jake Leon provided a lengthy list of outreach efforts by the department, including letters and phone calls, as well as texts, emails, in-person information sessions, videos, local meetings with beneficiaries, community organizations and providers, and interactions with DHHS client services staff.

(A full list of all the DHHS outreach efforts is available with this article at unionleader.com.)

Despite those efforts, the message may not be reaching all of its intended recipients: the 50,000 Granite Staters enrolled in Granite Advantage.

People like Glynn, who was on expanded Medicaid until June 1, are concerned that hundreds if not thousands will lose coverage, not because they don’t work the required number of hours, but because they are unaware of the reporting requirements or unable to fulfill them.

She works three different jobs for three different non-profits, and as of June 1 no longer qualified for expanded Medicaid after reporting income that exceeded the qualifying amount based on federal poverty definitions.

In her job as community engagement coordinator with Granite State Progress, she comes in contact with people on Granite Advantage, and has found many to be vaguely informed or not informed at all about the work requirement.

“I’m extremely nervous about how they are going to roll it out and hold everyone accountable because communication with (DHHS) has never really been that great,” says Glynn.

“I just worry about the people who have not been properly informed losing their coverage. I’m privileged to be able to work in environments where these are things that are brought to my attention on a regular basis,” she said.

She points out that many of the people on expanded Medicaid are suffering from mental illness or struggling with addiction, couch surfing to survive, and not in a position to consistently receive mail, let alone access a computer or phone.

Not the stereotype

Amber MacQuarrie, covered by expanded Medicaid since 2016, is not one of those people. She’s well-educated, articulate and runs an in-home day care to make ends meet.

“I’m a moderately intelligent person,” she said. “I’ve received schooling, and definitely don’t fit the stereotype a lot of people have about people on Medicaid. I definitely meet the 100 hour a month requirement through self-employment, but I have no idea how I’m supposed to report it. I don’t know who I send it to. It’s disconcerting.”

MacQuarrie is fairly confident she’ll be able to figure it out, even though the requirements for reporting self-employment are a bit more complicated than for so-called “W2 employees.”

“The people who don’t know any better, who are doing the best they can to survive, maybe need an interpreter, are not going to have any idea about this,” she said.

Republicans in the Legislature reluctantly agreed to the Granite Advantage program last year, under the condition that a work requirement be instituted for able-bodied adults up to age 64, and Democrats went along.

With Democrats in the majority this year, they are working to basically revoke the work requirement by amending it through a bill, SB 290, that among other things would terminate the requirement if more than 500 people lose coverage.

The bill cleared both the House and Senate, but the House made some changes that the Senate did not agree to, and a conference committee has been scheduled for Monday.

Letters went out

Letters from DHHS went out on May 8 to notify mandatory participants in the work requirement program that they could lose their health insurance if they don’t comply.

Those receiving the letters have a July 7 deadline to report June hours. That’s also when the appeals process begins for anyone who did not meet 100 hours or get an exemption. It will be some time in August before people start to receive loss-of-coverage notices.

Much of the concern about people losing coverage stems from the experience of Arkansas, which instituted a work requirement for its expanded Medicaid program in 2018. Soon after, more than 18,000 enrollees lost coverage, many for reasons having nothing to do with failure to work.

Andrew Cline, executive director of the free-market think tank Josiah Bartlett Center, recently posted a blog arguing that “Arkansas Medicaid woes shouldn’t kill New Hampshire’s experiment before it starts.”

“Arkansas’ roll-out was plagued with technical problems that seem to have caused large numbers of people to lose coverage,” he wrote. “And unlike New Hampshire’s rules, Arkansas’ rules were designed to move people off of expanded Medicaid and keep them off for an extended period.”

One of the biggest problems with the Arkansas program was a lack of awareness among the Medicaid population, according to the Kaiser Family Foundation report cited in Cline’s blog.

“KFF interviews with Arkansas Medicaid enrollees subject to the work rules found a widespread failure to communicate effectively with enrollees,” he wrote. “Of focus group participants, most who lost coverage were only vaguely aware of the requirements or said they could not successfully navigate the reporting procedures.”

Waiting, watching

The work requirements in Arkansas, Kentucky and New Hampshire are all being challenged in federal court, and it’s not clear they will survive judicial scrutiny, perhaps all the way to the Supreme Court.

Meanwhile, people like MacQuarrie, in recovery from surgery to deal with a congenital heart condition, live with the uncertainty.

“Medicaid expansion is what allowed me to survive. Without it, I could not have had that surgery,” she said. “I would have been stuck in a perpetual cycle of poverty, without any way of working my way out and becoming self-sufficient.”