N.H. Buys Time  On Medicaid Choice

Concord — During the first few days of budget talks last week, House and Senate negotiators were greeted at the Legislative Office Building by a woman wearing a homemade can costume.

The message from the New Hampshire Citizens Alliance for Action was written on its side in bold letters: “don’t kick the can” down the road by delaying a decision to accept federal money and add an estimated 58,000 low-income New Hampshire residents to the Medicaid program.

But the final budget deal hammered out by Republicans who control the Senate and Democrats who control the House does delay that decision.

Assuming the budget passes Wednesday, a special study commission will get to work next month and issue a final report by Oct. 15 on whether the state should expand Medicaid, and if so, how.

Studying Expansion

Expanding Medicaid to cover adults with incomes up to 138 percent of the federal poverty line is one of the pillars of the 2010 federal health care reform law championed by President Obama. The federal government would cover 100 percent of the cost of the expansion for the first three years, from 2014 through 2016, and pay at least 90 percent in future years.

In New Hampshire, a study last year by the Lewin Group estimated the state would take in about $2.5 billion in federal money over seven years and add an estimated 58,000 people to the Medicaid rolls. The state’s cost over seven years would be $85.5 million, according to the report.

When the Supreme Court ruled in June 2012 that Affordable Care Act was constitutional, it also decided that states’ participation in the Medicaid expansion was optional, not mandatory.

Since then, 23 states plus the District of Columbia have decided to go forward with the expansion and 21 have decided to pass, with six still debating the issue, according to the Kaiser Family Foundation.

One of those six is New Hampshire.

When final negotiations on the state budget began June 14, Senate Republicans and House Democrats were on opposite sides of the issue of Medicaid expansion. The House, along with Gov. Maggie Hassan, wanted to use the budget to expand the program starting Jan. 1. The Senate wanted to study the pros and cons of expansion first, with a commission filing its final report by Dec. 1, 2014.

After trading offers and counter-offers for several days, a deal was reached early Thursday morning: the Senate gets its study commission, but the House gets a speeded-up timeline. Along with the rest of the budget, it goes before the House and Senate for final approval Wednesday.

The commission will have nine voting members: three senators, three representatives and three members of the public. Insurance Commissioner Roger Sevigny and Nick Toumpas, commissioner of the Department of Health and Human Services, will be nonvoting members.

Five of the nine voting members will be appointed by Democrats: two representatives and one public member by House Speaker Terie Norelli, one senator by Senate Minority Leader Sylvia Larsen and one public member by Hassan. Four will be named by Republicans: two senators and one public member by Senate President Peter Bragdon and one representative by House Minority Leader Gene Chandler.

The commission has a budget of $200,000 and a wide mandate to explore partial or full expansion as well as ways to tailor the program.

At one point during the budget negotiations, Bragdon, R-Milford, dismissed a House proposal for a study wrapping up by the end of July as “a make-believe study committee.”

Rep. Mary Jane Wallner, D-Concord, chairwoman of the House Finance Committee, retorted that a shorter study could and should work.

“I know that when we get ready to do the work, we can get it done and we can get it done in a timely manner,” Wallner said.

Under the final agreement, the commission’s report will be due Oct. 15.

Arlinghaus, who describes himself as a skeptic on Medicaid expansion, said that’s still not ideal, and the commission won’t have the benefit of observing what happens in states that do expand their Medicaid programs next year.

“By the time they get things rolling, that’s three months of work,” he said. “That’s better than one month, and not as good as six.”

Special Session Likely

So what happens once the study commission’s report is out?

The Legislature typically comes back in January for the second year of its session, and legislation to expand Medicaid could be filed then. But the House proposed calling a special session before then to debate and vote on Medicaid expansion, so that if it passes the program could expand on or close to Jan. 1.

The Senate refused to commit to coming back early. But the study timeline leaves time for a special session to be called between mid-October and the end of 2013 to deal with legislation on Medicaid expansion.

Bragdon could balk at calling a special session then, but it’s not entirely his decision. The state Constitution also allows the governor and Executive Council to call a special session, and three of the council’s five members are Democrats, as is Hassan.

“I am confident that once members of the Legislature see the results of the study, they will want to move forward as quickly as possible through a special session,” Hassan said in a statement Thursday.