×

Capital Beat: Waiver to decide fate for N.H. Medicaid

  • The State House, Concord, NH. Oct. 18, 2017. (ELIZABETH FRANTZ / Monitor staff) Elizabeth Frantz



Monitor staff
Sunday, October 29, 2017

It’s a date etched into the language of New Hampshire’s Medicaid expansion reauthorization bill: Dec. 31, 2018 – the day the program “sunsets” if lawmakers fail to reauthorize it next session.

But included in House Bill 517, which modified the 2018 budget, is another effective deadline: April 30, 2018.

According to the bill, New Hampshire’s Department of Health and Human Services must apply to the federal government for a waiver to establish a work requirement for certain residents benefiting from the Medicaid expansion. The waiver must be granted by the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the program, by April 30.

Without that waiver, reads the statute, New Hampshire’s program, which presently serves about 50,000 people, will automatically terminate at the end of 2018.

Now, New Hampshire officials are putting in their best effort to get the job done. On Oct. 20, the House fiscal committee approved DHHS’s waiver application. On Oct. 24, Gov. Chris Sununu sent a letter to the acting Secretary of the U.S. Department of Health and Human Services – which oversees CMS – formally submitting the application.

How successful it will be is hard to nail down. To date, CMS has not granted a similar requirement, which some Democrats have opposed as an unnecessary barrier to insurance.

But Republicans are hopeful.

“Washington, in my opinion, is going to pass the work requirement,” said Senate Minority Leader Jeb Bradley, R-Wolfeboro, who helped to craft the 2016 reauthorization bill.

Part of that optimism is based around the new occupant of the White House. Under former President Barack Obama, efforts to secure work requirement waivers were unsuccessful; President Donald Trump’s Department of Health and Human Services appears more amenable, according to Bradley.

“There was never a discussion of a work requirement prior to the Trump administration,” Bradley said.

Whether that prediction bears out remains to be seen: In recent weeks, the Trump administration has sent mixed signals on Medicaid waivers – and only two of eight states that have applied for waivers have ever received them, according to NPR. One of those states, under President Obama, was New Hampshire.

But Granite State officials say they’re also emboldened by the tone of conversations with the federal department. Jake Leon, a spokesman for the state’s DHHS, said the department and governor have been in direct contact with officials at CMS for months.

“We’ve had great conversations with CMS on a variety of issues, whether it’s on the work requirement waivers – all of these things have come to bear, and they know that it’s on its way,” Sununu said Wednesday.

Leon added that the department is waiting on expected guidelines to be released by CMS regarding work requirement waivers soon.

A representative for CMS did not answer questions on the status of New Hampshire’s attempt. But with the application in the mail, there’s little left to do but wait.

Flooded inboxes

We’re months away from a floor vote on Senate Bill 193 – a transformative piece of “school choice” legislation likely to set off a pitched political battle. The bill, which would allow parents to use state adequacy funds currently intended for public schools for use at private institutions, was recommended “ought-to-pass” in a 6-3 vote by a House subcommittee last week.

But ahead of the bill’s appearance before the Education Committee on Nov. 8, lobbying efforts against members of that committee are in full swing.

An email circulated by Monadnock United – a Cheshire County-based advocacy organization that opposes the bill – identified four Republican representatives it said were undecided: Terry Wolf of Bedford; Robert Elliott of Salem; Michael Moffett of Loudon; and Dan Wolf of Newbury.

The email called on opponents to contact the legislators directly. Committee members, contacted by the Monitor, confirmed the pressure is on.

“If you want to answer my phone for me, be my guest,” quipped Dan Wolf.

The pressure has been persistent, Wolf added – conservative groups such as Americans for Prosperity have flooded his home with mailers and phone calls. Progressives, he said, seem to prefer email.

It’s perhaps understandable: New Hampshire’s bill would include one of the more far-reaching implementations of education savings accounts, a lightening rod issue with fierce support and opposition across the country.

Despite it all, Wolf said he’s leaning against the bill.

“My qualm is very simple: that you’re taking money out of the public school system,” he said, adding that little could be changed to the bill that would win his support.

Moffett has also been deluged, with the majority of communications opposing the bill. Firmly undecided, he said he supports the underlying aim of the bill but wants a limit imposed on the number of students that can use the funds in any one public school, to prevent a mass exodus.

“It would be easier for me to be open to this if there was a limit or cap,” he said.

Terry Wolf, for her part, indicated she’ll support the bill, after her initial concerns with spending accountability were addressed with a recent redraft. Elliott couldn’t be reached for comment.

Lobbying efforts aside, some say the Republican-supported bill has a bright future. Even with two potential defections, the 11-8 Republican majority could still eke out an “ought-to-pass” vote; meanwhile, the bill already passed the Senate 14-9 before being retained in the House.

Ann Marie Banfield, Education Liaison of Cornerstone, a right-leaning advocacy group that supports the bill, expressed optimism.

“I think this is going to be a done deal,” she said.

A better life experience

A long effort to introduce new savings options for people with disabilities took a major step forward Wednesday, after the Executive Council approved a contract to set it in action.

“ABLE accounts” – named for the federal Achieving a Better Life Experience Act – are tax-exempt savings accounts for those with disabilities and their families. Passed in 2014, the act allows disabled people to save up income without breaching the poverty thresholds that could cut off federal disability assistance.

The program is established at the state level; Bradley co-sponsored the bipartisan effort to bring it to New Hampshire, which cleared the Senate unanimously. On Wednesday, the state entered into an agreement with the state of Ohio to implement it.

“This is a good, innovative federal program,” Bradley said. “I think it’s an effective use of the tax code and I’m glad we’re implementing it here.”

Sununu agreed.

“Today is a great day for New Hampshire,” he said in a statement.

(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter @edewittNH.)