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Source of expanded Medicaid payments a mystery

  • Concord police chief Bradley Osgood explains to U.S. Senator Maggie Hassan the impact of the possible repeal of the Affordable Care Act will have on his department at a roundtable event at Riverbend Community Mental Health Friday in Concord. GEOFF FORESTER—Monitor staff

  • U.S. Senator Maggie Hassan discusses the impact of the possible repeal of the Affordable Care Act on the current mental health system at a roundtable at Riverbend Community Mental Health in Concord on Friday. GEOFF FORESTER—Monitor staff



Monitor staff
Friday, January 13, 2017

In late December, the state received a hefty $4.35 million payment from a nonprofit linked to the state’s hospital association. Three days later, another check came in for $1.7 million from a group that collects money from private health insurers in New Hampshire.

The funds ensure the state’s expanded Medicaid program will continue for the next three months. But the source of the money is largely a mystery – a lack of transparency that is causing concern among some policy experts.

“There’s a lot of political conflicts of interest associated with this, and there’s a public transparency part of this and finally a legal question about (the federal government) being able to track where matching funds are coming from,” said Steve Norton, head of the New Hampshire Center for Public Policy.

Republican leaders hatched a plan last year to fund expanded Medicaid without directly sending the bill to taxpayers. The program instead relies on “voluntary contributions” from insurance companies and hospitals that benefit from reductions in uncompensated care.

Both groups said the payments would be split evenly among them, and equitably among their members. But it’s impossible to verify whether that’s happened in practice, or whether a few organizations have shouldered the financial burden.

Neither the state nor the New Hampshire Hospital Association would reveal how much each hospital contributed.

Dartmouth-Hitchcock, which laid off 84 employees last year as it grappled with a $12 million shortfall, declined to say how much it paid and a spokesman deferred to the hospital association.

Concord Hospital donated $252,304 for six months, a spokeswoman said. It’s not clear how Concord Hospital decided on that sum. A spokeswoman directed further questions to the association, which declined to reveal a payment breakdown or formula.

“All 26 acute care hospitals provided voluntary contributions to the State of New Hampshire,” said association head Steve Ahnen in a statement. “Hospitals made those contributions in an equitable manner.”

The state says it doesn’t know how much each hospital contributed because donations are deposited into a blind trust. The lack of information makes it hard to tell whether the state plan is complying with the complex federal rules for Medicaid funding.

“We feel we meet all the requirements,” Health and Human Services Commissioner Jeffrey Meyers said recently. “The (Centers for Medicare & Medicaid Services) did not express a contrary opinion.”

The fate of New Hampshire’s expanded Medicaid hinges on donations from hospitals and insurers. If the contributions don’t materialize, the program faces repeal within 180 days and the 50,000 low-income adults covered by expansion would be off their insurance plans.

Meyers reported to lawmakers on Dec. 30 that the initial round of donations was enough to cover expanded Medicaid through the first quarter. His next report is due out before the end of March.

The federal government had previously paid the entire bill, but in 2017 began shifting some costs to the states. New Hampshire is on the hook for an estimated $50.8 million over the next two years, the bulk of which is expected to come from voluntary contributions.

The insurance companies are managing payments differently through what’s known as the high risk pool. It was created more than a decade ago to cover uninsured people through an assessment on insurance companies, but became largely obsolete with the Affordable Care Act.

The formula is now being used to raise money from insurers to cover their share of voluntary contributions, said Michael Degnan, Executive Director of N.H. Health Plan. Each insurer’s payment is dependent on its size, and comes out to $1.67 per month per resident covered. The insurers’ first quarter payment came out of the risk pool’s reserves, Degnan said.

(Allie Morris can be reached at 369-3307 or amorris@cmonitor.com.)