Special Session on Medicaid Begins in N.H.

Concord — Today, lawmakers will begin meeting in a special session to negotiate a potential agreement on expanding access to health insurance to many of the state’s poorest residents.

Today’s meetings of the House and Senate will be for setting the rules of the session, which lasts until Nov. 21. Officials on both sides of the issue have said they are meeting frequently to negotiate.

Leaders of the Democratic majority in the House, along with Democratic Gov. Maggie Hassan, have said they want to expand Medicaid effective Jan. 1, to ensure access to all available federal funding. Republicans in the Senate, lead by Sen. Chuck Morse of Salem, want any deal to focus on increasing access to private insurance plans, not Medicaid.

Medicaid is available in New Hampshire for children and parents in very low-income families, senior citizens and people with disabilities.

Under the federal Affordable Care Act, states can expand the Medicaid program to all individuals earning up to 138 percent of the federal poverty level, or about $15,900 for a single person and $32,500 for a family of four. The federal government would pay 100 percent of the cost for the first three years and then gradually reduce its share to 90 percent by 2020. About 58,000 additional people would be eligible for coverage in New Hampshire.

A bipartisan commission recommended last month that the state expand Medicaid to all eligible participants, but it should require that anyone with access to an employer-sponsored plan first sign up for that and receive state funding for the individual’s share of the premium costs.

Yesterday, Hassan said the decisions for all involved should keep uninsured New Hampshire residents at the forefront of their minds as they deliberate.

“What we will all be focusing on is that our decision affects real people with real lives,” she said. “Finding a way forward will allow them to get access to the care they need.”

Morse said this week his priorities are simple but different from those of the governor and House leaders: “58,000 people going on Medicaid (is) not acceptable to the Republican Senate,” he said.

“We won’t be voting for Medicaid expansion.”

Instead, he’s hoping “to work toward a compromise that creates better access to private health insurance plans.”

He said Tuesday he’s confident some pieces of such a plan, such as expanding the state’s premium assistance program to approximately 24,000 people with access to insurance through their employer could be in place within 60 days. Granting premium assistance to other people to purchase plans on the federal marketplace could be achieved within a year, he said.

Several other states have worked under the federal guidelines for Medicaid expansion to develop programs giving more people access to private insurance.

In September, the federal government approved one: Arkansas officials’ request to use Medicaid dollars to purchase private health insurance for about 225,000 residents.

The state applied through a waiver that requires changes to Medicaid cost the federal government the same or less than traditional Medicaid expansion.

Approval for those waivers typically lasts for five years, but a different federal authority will be granting waivers for expanded Medicaid after 2016, so the Arkansas plan is only approved through then.

Unlike New Hampshire, where Anthem Blue Cross Blue Shield is the only company selling plans on the marketplace this year, and is only offering 11 plans this year, more than 70 insurance plans are available on Arkansas’s marketplace from four companies, according to the Associated Press.

Arkansas is also different than New Hampshire in the way it administers its Medicaid program. While 2014 will be the first year of managed care in New Hampshire, with private companies accepting a per-person payment from the state, Arkansas’s program operates on a fee-for-service model.

In its approval of Arkansas’s plan, the federal government installed some requirements and restrictions. Medicaid offers several services that the plans being sold on the marketplace do not, including transportation to nonemergency medical appointments.

The federal government made approval of the premium-assistance plan contingent on the state ensuring people have access to that additional coverage, often called “wrap-around” services.

Iowa has also applied for a waiver to provide Medicaid to newly eligible people who earn up to 100 percent of the federal poverty level through a managed care contract similar to New Hampshire’s about-to-launch program, and to provide financial assistance for people earning up to 138 percent of the federal poverty level to buy insurance on the marketplace.

However, Iowa’s proposal included a request to waive providing wrap-around services and require individuals to pay a higher share of their health costs than is typically allowed under Medicaid.

Iowa officials proposed requiring a $20 monthly premium for new Medicaid enrollees who earn between 100 and 138 percent of the federal poverty level, but federal law limits total expense to recipients to no more than 5 percent of the household income.

The state would waive some or all of the premium if people completed certain health-related activities, such as an annual physical.

The federal government has not yet ruled on Iowa’s application.