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Some Urge Medicaid Expansion

Friday, March 22, 2013
West Lebanon — New Hampshire’s Medicaid program may have problems, but expanding it to cover more Granite Staters will improve the overall health of the population and could save the state tens of millions of dollars, according to health advocacy groups.

“Getting people covered is the right thing to do,” said Steve Ahnen, president of the New Hampshire Hospital Association, in an interview yesterday with the Valley News editorial board. “Do we have challenges? We absolutely do. Do we need to fix them? Yes. But we shouldn’t lose this opportunity to expand coverage to people who don’t currently have it, especially when the federal government is going to be picking up the vast majority of those costs.”

Gov. Maggie Hassan included the Medicaid expansion, part of the Affordable Care Act, in her proposed budget for the next biennium and the issue has been hotly debated among lawmakers in Concord recently.

The federal government would reimburse the state for at least 90 percent of the cost for newly eligible adults, estimated at 58,000 people in New Hampshire. The expanded coverage would lower costs for care because people would have access to the primary care they need to stay healthy, supporters of the Medicaid expansion have said. Critics have questioned the federal government’s commitment to fund the program, and said it could cost the state money in the long run.

Medicaid is a program in which states use federal dollars to provide health insurance for people who cannot afford health care.

Currently, 132,000 New Hampshire residents are covered by Medicaid. The expanded coverage would apply to all adults who earn 138 percent of the federal poverty level, or $15,856 per year, and could begin as early as 2014.

The total cost to the state to expand Medicaid over the next seven years would be approximately $85 million, according to an analysis by the New Hampshire Fiscal Policy Institute, a Concord-based nonpartisan organization.

But after factoring in federal subsidies, new revenues and cost savings, some of which come from going to a managed care system for Medicaid, there could be a net savings to the state of $47 million over the next seven years, according to the Institute. Managed care is a system in which third-party companies contract with states to manage their Medicaid programs. New Hampshire began moving toward managed care last year.

“There is no net general fund cost for the upcoming biennium for the Medicaid expansion,” said Thomas Bunnell, a consultant with the advocacy group New Hampshire Voices for Health.

Led by former House speaker William O’Brien, R-Mont Vernon, Republicans have tried to block the Medicaid expansion. However, those efforts were dealt a blow this week when the House rejected a bill 206-155 that would have prevented the expansion from going forward.

Not all of the challenges facing Medicaid expansion are political.

There are questions about whether New Hampshire has enough doctors and nurses to absorb thousands of new patients. Those concerns are valid, Ahnen said, but there is money available to help the state’s providers meet additional demand.

“The Affordable Care Act provides some increased reimbursement for primary care providers,” Ahnen said. “Can I say that we won’t have a bump or a challenge today? I don’t think I can say that. But I think, in some respects, that will be a good challenge to have.”

These efforts come as Dartmouth-Hitchcock and nine other large New Hampshire hospitals fight the state over how they are reimbursed for Medicaid.

In 2011, hospitals sued New Hampshire over changes that essentially meant hospitals would lose hundreds of millions of dollars in uncompensated care claims, and then get charged a “Medicaid enhancement tax” on top of that.

In all, New Hampshire hospitals are expected to provide $358 million worth of charity care in the 2013 fiscal year, $305 million of which will not be reimbursed, according to figures from the New Hampshire Department of Health and Human Services.

Hospitals have been working with the state to address concerns over Medicaid payments, Ahnen said. Until some of those issues are resolved, however, hospitals have been reluctant to sign on with the managed care companies and join their networks of providers.

Ahnen said neither the lawsuit nor discussions with managed care companies should get in the way of expanding Medicaid in New Hampshire.

“We’re trying to work through these issues now, and to the extent we can, we will move forward,” Ahnen said. “We can’t just say we’re going to fix this problem then we’ll fix this problem. ... It’s important for our patients that they have a viable sustainable Medicaid program that can serve them now and into the future.”

Chris Fleisher can be reached at 603-727-3229 or

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