N.H. Officials Push Medicaid Growth

Concord — New Hampshire health officials outlined Tuesday how the state could expand Medicaid to cover 49,000 more poor adults and still save $46 million over the next seven years.

Department of Health and Human Services officials presented the details to a special commission weighing whether to recommend that lawmakers expand the Medicaid program under the federal health care overhaul law.

They told the commission the state would save $85 million if it does nothing, but said it still could save money if it expands Medicaid while aggressively working to keep poor workers who are insured from signing up for Medicaid. The state could take advantage of other savings under the federal law and could use Medicaid funds to pay for the workers’ premiums through an existing state program if it saves money, they explained.

New Hampshire’s current Medicaid program covers low-income children, parents with nondisabled children under 18, pregnant women, senior citizens and people with disabilities. The expansion would add anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult.

States can choose to expand Medicaid as part of the new federal law, which will be implemented starting Jan. 1. If New Hampshire were to expand the program, the federal government would pick up the full cost for the first three years and 90 percent over the long haul. States can withdraw from covering adults at any time without penalty.

State Sen. Nancy Stiles, a Republican commission member from Hampton, asked what guarantee the state has other than letters from federal officials that New Hampshire could later choose to eliminate the expanded services.

“The (U.S.) Supreme Court has made it clear it is optional,” said Jeff Meyers, the department’s director of intergovernmental affairs.

State Rep. Neal Kurk, a Weare Republican, later pointed out that providing coverage for 49,000 of an estimated 170,000 uninsured New Hampshire citizens dropped the percentage of uninsured only a few percentage points.

State Medicaid Director Katie Dunn replied that New Hampshire should not look at the issue solely in terms of percentages. She said the uninsured show up in hospital emergency rooms and often have chronic conditions that go untreated.

“I just don’t want to lose that humanistic perspective,” she said.

“I appreciate that, too,” replied Kurk.

The commission was established as a compromise in the budget debate. Democratic Gov. Maggie Hassan and the Democratic-led House wanted to authorize Medicaid expansion in the budget bill, but the Republican-led Senate insisted on establishing a commission to study the issue first.

The commission is to report Oct. 15 to lawmakers to give them time to come into special session this fall and vote whether to authorize an expansion. That’s when an estimated $2.4 billion in federal funding the state would get over seven years would kick in.

The commission was told Tuesday that Medicaid currently pays to keep 175 people enrolled in employer health plans, but as many as 14,000 of the 17,000 workers who might switch from employer plans to Medicaid under expansion could be kept on their employers’ plans.

The state also could ask the federal government to waive some of the law’s requirements to allow New Hampshire to explore encouraging some adults who would qualify for Medicaid into an insurance marketplace and using Medicaid funding to pay for the private coverage, Meyers said.

Under the overhaul law, new insurance marketplaces will offer individuals and their families a choice of private health plans resembling what workers at major companies already get.