Prognosis for N.H. Medicaid On Upswing

DHMC, Other State Hospitals Sign Contracts With Providers

Lebanon — New Hampshire’s newly established managed care network for Medicaid received a big boost yesterday, as Gov. Maggie Hassan announced that all of the state’s hospitals have either signed up for the program or have agreed to do so. The news from the governor’s office last night followed Dartmouth-Hitchcock Medical Center’s announcement earlier in the day that it has signed contracts with the state’s three statewide health plans to provide care to eligible beneficiaries.

The state’s largest health care provider will work with Well Sense Health Plan, Granite State Health Plan and Meridian Health Plan of New Hampshire under the first phase of the program, officials said.

Dartmouth-Hitchcock CEO Jim Weinstein praised the benefits of the managed Medicaid system yesterday, declaring in a statement that a “truly sustainable health system” requires all New Hampshire residents to have access to “high-quality, coordinated health care when and where it’s needed.”

“Until New Hampshire plans a strategy to create a sustainable health system, we will keep putting fingers in the dyke to fix the leaking but not the problem,” he said in an interview. “And the small businesses of New Hampshire are having to pay the price for the state not taking on a larger solution.”

Steve Ahnen, president of the New Hampshire Hospital Association, said DHMC’s participation in Managed Medicaid was a significant step in the state’s hospitals “moving forward ... to provide better health and health care for New Hampshire residents on the Medicaid program.”

Under the New Hampshire Medicaid Care Management program — also known as New Hampshire Managed Medicaid — the state pays an advance fee to the three health plans to care for Medicaid clients, who will be asked to select a plan this fall. The state will assign a plan to people who fail to choose one. DHMC officials said providers initially will be reimbursed under a fee-for-service payment model which may include incentives for improving the quality of care delivered to patients.

The state has been trying to move from a fee-for-service model to managed care for its Medicaid clients but needed participation from hospitals to make it work. New Hampshire’s Medicaid program covers children of low-income families, parents with nondisabled children under 18, pregnant women, senior citizens and people with disabilities.

The state budget that was adopted two years ago, written by Republicans, cut state hospital aid for all but a handful of critical access hospitals. Hospitals, mental health clinics and other providers refused to participate in the managed care system because of low reimbursement levels for treating Medicaid patients.

The 10 largest hospitals, including Dartmouth-Hitchcock, sued over Medicaid rates, which complicated efforts to negotiate over managed care. (Weinstein yesterday said the lawsuit and DHMC’s decision to join managed medicaid are unrelated.)

The new budget restores some of the aid, but require d hospitals to agree in writing to participate in the managed care network by July 1 with a final agreement by Aug. 1 to receive the aid. New Hampshire’s Department of Health and Human Services also changed key rates to entice providers — especially hospitals — to participate in managed care.

An 11-member commission appointed this year by Gov. Maggie Hassan will monitor the program.

Meanwhile, the state budget also requires a nine-member commission to begin meeting this month to study the impact and possible alternatives to expanding Medicaid under the federal health care overhaul. Hassan and the Democratic-led House wanted to authorize expansion Jan. 1 in the new state budget, but the Republican-led Senate insisted on considering the impact on New Hampshire first.

Weinstein said New Hampshire — “a state that likes to extol its independence” — should have its own solutions if it won’t accept federal support.

But he added that “the state should avail itself of the federal support as part of its solution to maintain the ability ... to control its own destiny, which is what I believe the House and Senate and governor would like to occur.”

Ahnen, of the New Hampshire Hospital Association, said Hassan’s goals for Medicaid expansion and the state’s managed care networks would be complementary.

“We think it’s very important that we have the managed care networks up and running in advance of (Medicaid expansion) to help complement the effort as we bring more people into the Medicaid program, which is the right thing to do,” Ahnen said.

Sen. Chuck Morse, a Salem Republican and chairman of the Senate Finance Committee, released a statement yesterday calling DHMC’s decision “a major step forward to building the network necessary to get Medicaid Managed Care up and running here in New Hampshire.”

“Republicans in the legislature spear-headed this drive to reform Medicaid two years ago, so we are pleased these critical changes will soon be put into play,” he said. “Those individuals who believe expanding Medicaid is the key to saving the state money need to understand that these savings will be realized beginning with the implementation of Managed Care — not the other way around.”

Material from the Associated Press was used in this report. Maggie Cassidy can be reached at or 603-727-3220.