Ayotte's budget will lead to premium hike for some on Medicaid

Feb. 25—State Medicaid officials propose raising monthly premiums for some families and having others pay more for prescription drugs to generate nearly $27 million for Gov. Kelly Ayotte's two-year state budget.

When Ayotte presented her budget proposal earlier this month, she said it included making some Medicaid clients pay what those on the federal-state health insurance program already pay in other states.

"We brought our adult Medicaid eligibility back in line with pre-pandemic levels and joined our neighbors in requiring nominal copays for those receiving these benefits," Ayotte said.

House budget writers learned last week state officials seek to raise nearly all that revenue by requiring some to pay monthly for their Medicaid coverage.

House Democratic leaders raised concerns about the specifics of the proposal, which will require some recipients of the Medicaid programs to pay 5% of their income each year for health care coverage:

Children's Health Insurance Program: Families with children in CHIP would pay if they made at least 255% of the federal poverty level, which is roughly $72,500 a year. The 5% premium would be about $300 a month or $3,600 a year.

Granite Advantage: The premium would be charged to low-income adults in the Medicaid expansion program who made at least 100% of the federal poverty level, which for a single person is about $16,000 annually. The 5% translates to about $66 a month or $800 a year in client payments.

All other clients in Granite Advantage who make less than the federal poverty level would see copayments for prescription drugs rise from $1 or $2 to $4 for each medication.

Democrats' warning

Rep. Mary Jane Wallner, D-Concord, is the ranking Democrat and former chairman of the House Finance Committee.

"That's a family's car payment, it is the portion of their rent, their child care expense," Wallner said of the premiums charged to CHIP families. "You are going to see a number of families that aren't going to be able to do it."

State Medicaid Director Henry Lipman said the premiums would apply to about 8,600 families, or about 10% in the CHIP program.

In Granite Advantage, the premiums would apply to 12,000 clients, or about 20% of that population.

Lipman said 18 states require some Medicaid recipients to pay monthly premiums, including Massachusetts and New York.

The agency decided to pursue the monthly premium rather than copayments to raise most of this revenue because the cost to administer it is much cheaper.

New Hampshire offers the CHIP benefit to families that make up to 323% of the federal poverty level, which is the fifth highest eligibility standard in the country, Lipman said.

Ayotte adviser John Corbett said the change is needed to help produce a "responsible, balanced budget for all of New Hampshire" as the state deals with a loss of billions in federal pandemic aid and a declining rate of growth in state revenues.

Federal law permits states to charge those on Medicaid premiums of up to 5% for families that make at least 150% of the poverty level, which is $48,200 for a family of four.

The premiums from CHIP families will raise $3 million next year and $11 million in 2027, state officials said.

Charging those in the Granite Advantage program will require approval of a federal waiver, so those premiums would not begin until 2027 and would raise $12 million a year.

The copayments for prescriptions for all others in Granite Advantage would raise $750,000 a year, officials said.

Lipman said these estimates assume some families will be unable to make these payments, so it will be up to policymakers to create policies for those who can't afford the premiums.

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