Update on the New Hampshire Health Protection Plan (Medicaid Expansion) January 2016

By Marie Mulroy, NHPHA Past President

As of this writing, two very different bills have come out of the House to address the need to expand the New Hampshire Health Protection Plan (Medicaid Expansion) beyond its December, 2016 expiration date.  The bills are HB 1690 from Rep Thomas Sherman which proposes to have Medicaid Expansion move forward without any expiration date  and HB1696 from Rep. LaChance  which has the support from the Senate and House Republican leaders and has the following major components.  


Please note that there are potential revisions to some of the components, so by the time of the hearing on either January 26th or 28th several of these could look very different.  At present, however, the components are:

·       Extending the expiration to December 31, 2020

·       Dedicated premium insurance tax revenues from Medicaid Expansion

·       Retaining some of the Medicaid Enhancement Tax (MET) dollars that  normally would go to the hospitals

·       Having an “active work seeking” requirement for any unemployed, but able-bodied individual seeking coverage under Medicaid Expansion.

·       Premiums for all but the medically frail to be collected by the insurers

·       A 6-month disenrollment provision to anyone on Medicaid Expansion who fails to make a premium payment within 60 days.

·       A co-pay penalty of $8 for the first non-emergency visit to an emergency room and $25 for each additional non-emergency visit thereafter.

Even though we do not know what components are in the process of revision,   it is most likely that the section regarding charging premiums to enrollees will change.   If this happens, it is in direct response to insurers who have raised issues of how difficult and expensive the mechanism to collect those premiums will be.  They point to  the state of Arkansas, which had similar proposal and who found that the cost of collecting the premiums far exceeded the premiums that were collected.   Some sources are saying that it cost Arkansas $1.5 million to collect just $200.000 in  premiums.  In addition, the “actively seeking work” component could come under scrutiny because it would require that New Hampshire seek a waiver from the federal government.   Historically CMS, who oversees Medicaid, generally has disallowed “work” requirements for individuals who seek Medicaid coverage.

Regardless of party affiliation and ideology, what is becoming apparent is that most of NH state legislators do not  want  to see approximately 47,000 to potentially 58,000 New Hampshire citizens suddenly having no healthcare coverage.    While both sides of the aisle are looking to see what initial economic benefits have occurred since Medicaid Expansion, the point of division between the parties is how New Hampshire pays for its portion of expenses.   The cost to New Hampshire in 2017 should be around $13 million for the balance of the 2016-2017 budget and then rise and level off around $20-$25 million by the year 2020.     Republican leadership feels that is not the taxpayers’ responsibility to cover the cost and that the expense to the State should be borne by those who benefit most from the expansion of Medicaid.  Namely, the current and potential insureds, the hospitals and the insurance carriers are who they feel should pick up the cost.   In addition, the Republicans have ruled out the possibility at this time of any new taxes to pay for the extension this program.    While Democratic leadership, on the other hand, regard insuring the health of 47,000 citizens on Medicaid Expansion as an investment in New Hampshire’s future.   In an interview with NHPR, Senator Woodburn  said  “I think the Democrats believe that wise and prudent use of our taxpayer dollars is important, but so are investments — investments like the gas tax, that is making great roads, our roads much better, our bridges much safer, and is important to the economic development of our entire state”.   At NHPHA, we could not agree more with Senator Woodburn.

Below are resources for additional information:

NH Health Protection Plan Fact Sheet

Affordable Health Care Coverage for Over 44000 Granite Staters


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