New Hampshire Senate Opens Door to Medicaid Expansion

It’s still cold here in New Hampshire, with more than a foot of hard-packed snow covering the ground. But that didn’t stop the Republican-led Senate from warming up to the idea of expanding Medicaid to cover an estimated 50,000 Granite Staters.  The proposal moves over to the House, where representatives are expected to support the measure, having voted in favor of Medicaid expansion on three previous occasions.

New Hampshire’s proposal seeks to “maximize the use of private insurance and federal assistance.” The concept would implement a mandatory Health Insurance Premium Payment (HIPP) program, whereby federal funds are used to enroll individuals in employer coverage. HIPP programs are also known as Section 1906 Medicaid premium assistance and they do not require a waiver. The longer-term plan is for individuals without access to employer coverage to enroll in a qualified health plan (QHP) available through the federal marketplace (like Arkansas’ private option). But with only one issuer currently offering QHPs in New Hampshire, the proposal creates a “temporary voluntary bridge” to coverage by allowing individuals to enroll in one of New Hampshire’s three Medicaid managed care organizations between now and 2016.

The waiver is expected to include co-payments and mandatory wellness programs, although neither is detailed in the legislation. Unemployed individuals will be referred to the Department of employment security for the purpose of helping the individual find a job but, unlike Pennsylvania’s original waiver proposal (which has now seemingly been modified – stay tuned to Say Ahhh! for more on this), enrollment is not predicated on any work search requirement. The bill mentions covering the cost of enrollee cost-sharing and benefit wraps but whether the state will ask for waivers of either is not clear.

One key provision is that each QHP in the New Hampshire’s federally-run marketplace must offer each federally-qualified health center the opportunity to contract with the plan.  They must reimburse each center an amount that is “equal to 100 percent of the average of the costs of providing such services” as required by existing Medicaid law. This is an important provision to ensure that New Hampshire’s strong community health center network remains a source of care for many of their uninsured patients who will gain coverage under the proposal.

As always, the devil will be in the details of New Hampshire’s waiver. But while the proposal is being developed and negotiated with CMS, the use of the “voluntary bridge” to enroll individuals in Medicaid managed care could open the door to coverage as early as July 2014.

Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families