NH says many who lost Medicaid are insured

Henry Lipman is thinking about road races as he leads New Hampshire through the end of the yearlong, immensely challenging Medicaid "unwind" process. His team had 12 months to determine how many of the tens of thousands of people who qualified for benefits under pandemic protections remain eligible.

"In a road race, there's the sweeper (team) to make sure no one is left on the course," Lipman, the state's Medicaid director, said. "What could we do to make sure we haven't left anybody out on the course?"

Two things.

The state partnered with an insurance brokerage company to call all 21,300 households that were disenrolled because the state believed they earned too much to ask whether they'd found other insurance or wanted help doing so.

And Lipman is reminding the public that people who no longer qualify for Medicaid can still apply for federally subsidized, lower-cost health insurance through the Affordable Care Act Marketplace. The special open enrollment period ends July 31.

"I do feel like we did a good job overall," Lipman said. "But I do feel like there is room to make it better and not give up on people."

During the pandemic, as people lost jobs and stayed home to care for children learning remotely, the state's Medicaid numbers spiked, from about 179,000 beneficiaries pre-pandemic to a peak of nearly 252,000.

States were required to keep everyone enrolled until the end of the federal public health emergency in March. New Hampshire was one of five states to begin reviewing eligibility immediately.

Lipman has said seeing the state through that process responsibly, ensuring no one loses Medicaid unjustly, will be among the most important things he does in his career.

To that end, the state's Division of Medicaid Services launched a massive outreach campaign well before the end of pandemic protections last March, reminding beneficiaries they needed to have their benefits redetermined. In the months since, the state has worked with schools, medical providers, social service agencies, and federal insurance navigators to contact people who hadn't had their eligibility reviewed.

Applying for federal

Marketplace insurance

If you lost Medicaid when pandemic protections ended, you have five more months to apply for federally subsidized health care on the Affordable Care Act Marketplace. The extension is for only that group and includes Medicaid and Medicare. Thanks to recent policy changes, income thresholds have increased, making more people eligible, and subsidies have increased, meaning coverage could cost less. There are also new options for some families whose employers offer health insurance. The changes have led to record Marketplace enrollment of 21.3 million people, up 30 percent from last year, according to the Center on Budget and Policy Priorities. People seeking help understanding and evaluating their options have several choices. First Choice Services and Health Market Connect, federal navigators, provide free assistance in multiple languages. The New Hampshire Insurance Department is another option, as is the state's benefits assistance portal, nheasy.nh.gov.

It persuaded the Centers for Medicare and Medicaid Services to extend deadlines for people to complete their redetermination and used what existing information it had about beneficiaries to automatically maintain benefits for people who qualified.

Nearly 109,200 people have held onto their benefits, according to Lipman's office. Nearly 7,325 voluntarily gave up benefits because they no longer qualified. Almost 31,500 have failed to reply to the state's outreach.

In its latest attempts to ensure those who qualify for Medicaid get it, the state teamed up with Enhance Health, a national insurance brokerage company that offered to help Lipman and his team reach out – again – to nearly 21,300 households disenrolled because the state had concluded their financial circumstances had changed and they no longer qualified financially.

Among other things, the state's Medicaid team wanted to know whether individuals had found other insurance or wanted help enrolling in the federal Marketplace. Based on its tracking, the team knew staff had referred 24,004 to the Marketplace.

Enhance Health did the work for free as a pilot to see whether the initiative is worth pursuing with other states.

Chris Nicolopoulos, the company's vice president of government relations and the state's former insurance commissioner, said they chose New Hampshire for a couple of reasons.

"It's small and it has somebody who cared," Nicolopoulos said, referring to Lipman. "When I said to him, 'We are willing to do a survey for you, not charge anything, go though the whole state contracting process, and make a leap of faith with you,' he said, 'Let's do it.' "

Lipman said Enhance Health's team called nearly 21,300 households.

The final numbers are expected soon, but early results indicate that a vast majority knew they had been disenrolled from Medicaid. It's likely the latter have not used their benefits because they had not sought medical care or are enrolled in private or federal insurance.

The numbers are expected to show that a majority of those reached have secured another type of insurance, a step the state had hoped people would take.

The responses also helped Lipman's team know where more education is needed. Many said they were unaware the income limits are different for children and adults, meaning even if an adult in a household did not qualify, their child might.

In August, federal Medicaid officials expressed concern that states were missing chances to keep children enrolled when their parents earned too much. Lipman's team partnered with schools and after-school programs, among others, to get that message out. "We keep on turning over stones to try to find new opportunities," Lipman told the Bulletin in September.

Enhance Health also asked individuals if they wanted to work with one of its brokers to apply for insurance coverage. Lipman required the company to send the names of anyone who wanted assistance to confirm and get consent to connect them with a broker. Some did, but final count is still underway.

"We're just trying to figure out if people are falling through the cracks," Nicolopoulos said. "I'm confident New Hampshire has done a really good job. A private-public partnership like what we offer is kind of a last stop."

This story was originally published by the New Hampshire Bulletin.