Commission faces deadline for decision on Medicaid expansion

New Hampshire Union Leader

Oct. 05--Commission faces deadline for decision on Medicaid expansion

By DAVE SOLOMON

State House Bureau

October 04. 2017 10:09PM

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-- A legislative commission set up to evaluate the future of expanded Medicaid in New Hampshire will likely recommend that the program continue past its current expiration date of Dec. 31, 2018, but the lingering question is in what form.

"The charge to the commission was to look at whether Medicaid expansion is working, and I think 50,000 people are benefiting, hospital uncompensated care has gone down significantly, and employers have access to a healthier population," said state Sen. Jeb Bradley, R-Wolfeboro, "so I think you can make an argument that it's working well. But there is also an argument that it's one of the causes of the individual market premium increases, and we've got to try to resolve that."

New Hampshire was one of 32 states that agreed to expand eligibility for Medicaid under the Affordable Care Act, or Obamacare. The expansion embraced a portion of the population that was not poor enough to qualify for traditional Medicaid, but still could not afford subsidized policies on the Obamacare marketplace.

About 50,000 Granite State residents obtained Medicaid coverage under the more liberal income guidelines, but the so-called Premium Assistance Program sunsets at the end of next year.

The 15-member Commission to Evaluate the Effectiveness and Future of the Premium Assistance Program has until Dec. 1 to submit its report to the Legislature, and the question of whether the program should continue appears to be largely settled.

The commission met on Wednesday and the discussion revolved around how Medicaid expansion should continue, not if it should continue.

Senate Majority Leader Bradley, who chairs the commission, said after the meeting that the group is most focused reducing the impact Medicaid expansion has had on premiums for non-Medicaid customers buying insurance on the Obamacare individual marketplace.

New Hampshire did not put the 50,000 new enrollees into the same traditional Medicaid program that was already serving 100,000 residents through managed care organizations that control costs.

Instead, the expanded Medicaid population obtained coverage from one of the companies offering plans on healthcare.gov, mostly the Ambetter plans offered by New Hampshire Healthy Families.

The result has been an increase in premiums on the exchange between 40 and 50 percent in some cases due in large part to the high claims costs of the Medicaid enrollees.

"We've got to make the program more cost efficient," said Bradley. "There are about 25,000 to 35,000 people whose rates have gone up significantly, not only because of Medicaid expansion, but that's one of the drivers."

The commission is debating three options in the hope that it can finalize a recommendation by Nov. 1. They are:

--Leave the situation as it is, with the expanded Medicaid population purchasing insurance on healthcare.gov, with Medicaid paying the premiums;

--Move all 50,000 of the expanded Medicaid population into the traditional Medicaid program in which Medicaid pays for services through managed care organizations like Well Sense Health Plan.

--Move only the sickest of the 50,000 into the traditional Medicaid program and leave the remainder in the individual market pool with the other Obamacare customers.

New Hampshire was one of only five states that chose to use the private market for the expanded Medicaid population, and whether it will continue to be an outlier on that score remains to be seen.

But the question of ending the program entirely appears to be off the table.

"It's been a benefit to New Hampshire to have $400 million of federal money helping people have access to health insurance, helping employers, helping people in their individual lives," said Bradley. "If we took testimony from people who've been helped, the line would be out the door. The trick is to make sure we do it in the most cost effective way and try to mitigate the impact on the individual market."

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