N.H. Medicaid Enrollment Surging

Monday, July 20, 2015
Concord — New Hampshire got off to a late start compared to many other states that expanded Medicaid under the Affordable Care Act, but it quickly made up for lost time in terms of enrollment.

Thirty states and the District of Columbia expanded Medicaid eligibility to include all non-disabled adults with incomes at or below 138 percent of the federal poverty level, which currently is about $16,000 for an individual. In a dozen of those states, enrollments have significantly outpaced projections, including in New Hampshire, where enrollment started July 1, 2014.

Enrollment under the Affordable Care Act has surged beyond expectations in some states, raising concerns about costs straining budgets. At least seven states have increased their cost estimates for 2017, according to an Associated Press analysis.

In New Hampshire, state officials had estimated that there would be 34,000 new enrollees in the first year. Instead, it came close to that number in the first six months, and as of June 30, there were 41,018 new enrollees, according the state Department of Health and Human Services.

New Hampshire’s Gov. Maggie Hassan included $12 million for Medicaid in her state budget for fiscal years 2016 and 2017, assuming the expansion would be reauthorized once the federal government, now paying 100 percent of the costs, starts lowering its share.

But after lawmakers said they would rather wait until next year to debate whether to continue the program, Hassan vetoed the Legislature’s $11.3 billion budget proposal, and the state is now operating under a six-month temporary spending plan that keeps funding at existing levels.

Hassan and fellow Democrats charge the uncertainty hurts those receiving health care under the expansion. Republican say they hope to debate the issue next year when the state has better data on how the program is working.

New Hampshire received a federal waiver to structure its expansion differently than most other states. Participants sign up either through the state’s managed care program for Medicaid or through a program that subsidizes existing employer coverage. Those who initially signed up for managed care, however, will be moved to private plans through the Affordable Care Act marketplace using federal Medicaid funds.

Insurance companies have cited the influx of Medicaid recipients to the health insurance exchanges set up by the federal law as the chief driver of their requests to increase premiums. In preliminary filings this spring, two companies that sell plans under the Affordable Care Act requested double-digit premium hikes next year for plans that currently cover more than 13,000 residents.

Hospital officials have praised the expansion, however, saying it has significantly reduced the number of uninsured patients showing up in emergency rooms or being admitted to hospitals. They say that in turn will reduce the costs that businesses and those with insurance pay to care for the uninsured given that New Hampshire hospitals provided more than $425 million in such uncompensated care in 2013.

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