N.H. Panel to Decide on Medicaid

Some Members Say State Should Rely on Private Insurers

Concord — A special panel that will recommend whether New Hampshire should expand its Medicaid program to poor adults will start discussing a specific plan next week.

The panel faces an Oct. 15 deadline to make recommendations to the Legislature. Last week, six of the nine members said the state should accept federal money to provide health insurance to an estimated 49,000 poor adults, but many made it clear they would like to find a way to rely on private insurance as much as possible.

At Tuesday’s meeting, the group discussed what expansion might look like if the state went ahead, working through seven topics including when coverage would start and how the state could expand an existing program in which it pays to keep people on their employers’ private insurance plans. Rep. Tom Sherman, D-Rye, said he would use the discussion to draft a proposal to be discussed at next week’s meeting.

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 and $32,500 for a family of four.

Rep. Cindy Rosenwald, D-Nashua, said she would prefer to expand the Medicaid program as close to Jan. 1 as possible rather than wait and see how the state’s recent switch to managed care for its existing Medicaid program fares. Getting the federal money as quickly as possible will help solve the problem of uninsured patients showing up in emergency rooms for care, she said.

Sen. Andy Sanborn, R-Bedford, argued that expanding Medicaid wouldn’t put as big a dent in the uncompensated care problem as Rosenwald claimed. He suggested language that would set the start date six months after the state receives any waiver it seeks to implement its expansion in a way that deviates from federal rules.

Sanborn also said the group should explore options to put those whose incomes are between 100 and 138 percent of the federal poverty level in the private insurance market.

“What options?” responded Dr. Travis Harker. “Because I take care of this population, and I’d be really interested in hearing what your option is on the table for that population without any federal subsidies or state dollars.” Sanborn did not elaborate.

Most of the committee members said they opposed the idea of requiring co-sharing provisions, such as co-payments aimed at nudging consumers to make wiser health care decisions.

Rep. Neal Kurk, R-Weare, said the state doesn’t have enough time or ideas to figure out the right incentives.

“The only reason I can see for putting in an incentive is to make the taxpayer of the state feel a little bit better about the fact that even the poor have to chip in for their health insurance the way I do,” he said.

States can choose to expand Medicaid as part of the federal Affordable Care Act. 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.