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N.H. Medicaid expansion study panel reviews costs, coverage

Expanding New Hampshire’s Medicaid program would provide health coverage to tens of thousands of low-income residents, both relatively healthy adults in their 20s and 30s and older people, 40 to 64, who have chronic conditions such as diabetes, the program’s director said yesterday.

Katie Dunn, associate commissioner of the Department of Health and Human Services, told the commission studying whether the state should accept federal money and expand Medicaid that many of the residents who would become eligible for an expanded program are already in the workforce, but can’t afford to buy insurance.

“We also know that many of us come in contact with them every single day,” Dunn said. “I did this morning when I bought my cup of coffee at Dunkin’ Donuts, and when I said ‘good morning’ to my neighbor. This is a commonplace experience for all of us. The folks who are working, they’re folks that are in the service and hospitality and tourism industries. We know New Hampshire depends a lot on those industries, and so we can’t lose sight of that as we think about who they are.”

The commission, which held its third meeting yesterday, will issue a recommendation by Oct. 15 on whether New Hampshire should expand its Medicaid program to cover residents making up to 138 percent of the federal poverty line.

Expansion was made optional by the June 2012 Supreme Court ruling that upheld most of President Obama’s 2010 health care reform law as constitutional. Twenty-three states and the District of Columbia are expanding their programs, 21 states have declined and New Hampshire is one of six states still debating the issue, according to the Kaiser Family Foundation.

Gov. Maggie Hassan, a Democrat, supports expansion, as do the Democrats who control the House. But Senate Republicans, with a 13-11 majority, last month blocked expansion from being part of the new state budget and said it needed more study. Hence the commission.

It seems likely the commission will recommend some form of expansion, since five of its nine voting members were appointed by Democrats. Hassan has said she expects a special session of the Legislature to vote on expansion later this year.

Late in yesterday’s meeting, Dunn emphasized that federal officials have said states can expand Medicaid, or drop the expansion, at any time.

But Rep. Neal Kurk, a Weare Republican and expansion skeptic, said it’s unrealistic to think New Hampshire would expand health coverage and later take it away, even if costs rose in the future.

“With all due respect, that just is not a humane or viable option,” Kurk said. “When we’re in, we’re in, and we are not getting out. It doesn’t go the other way as a practical matter, (a) political matter and, as I say, a humane matter. It can’t be done.”

Democrats quickly seized on Kurk’s comment; New Hampshire Democratic Party spokesman Harrell Kirstein said: “If repealing insurance coverage from thousands of New Hampshire families is inhumane, what is blocking that insurance coverage from ever getting expanding?”

Who and how much

The commission yesterday got a detailed review of the nuts-and-bolts of Medicaid expansion, including who would be covered and how it would be financed.

A Lewin Group study last year estimated an average of 58,000 Granite State residents would join the Medicaid program under expansion.
HHS estimates a net total of about 49,000 residents would be newly eligible for Medicaid by 2021, including 46,200 people who don’t have insurance now.

An estimated 17,200 people now covered by insurance through their employers might switch to Medicaid by 2021, but most – nearly 13,800 – could remain on private insurance if the state expanded a program that pays private-insurance premiums in situations where it saves money, said Marilee Nihan, the Medicaid program’s finance director.

If New Hampshire did expand Medicaid starting Jan. 1, according to HHS, it would collect an additional $2.44 billion in federal aid between 2014 and 2021 and spend $45.8 million less from the state’s general fund over the same period.

The general-fund savings would end after fiscal 2019, the department said, as federal aid tapered from 100 percent of the cost for newly eligible Medicaid participants to 90 percent. Starting in 2021, the state would see additional general-fund costs estimated at $21.7 million a year under the expanded Medicaid program.

Nihan also said HHS expects uncompensated care expenses for state hospitals and community mental health centers would “significantly diminish” with Medicaid expansion, by an estimated $29.9 million a year.

On the other hand, if the state doesn’t expand Medicaid, other changes coming under Obamacare mean the Medicaid program would cover several hundred fewer people by 2021, and the state would save a total of $85.2 million in general-fund spending between 2014 and 2021, according to HHS.

Who would be eligible for coverage under an expanded Medicaid program? Children up to age 19 are already eligible for Medicaid at up to 300 percent of the poverty level, and most adults qualify for Medicare at 65.

So, Dunn said, many of the newly eligible Medicaid patients under expansion would be young adults, 25 to 35, who are relatively healthy, and adults aged 40 to 64 with chronic conditions like diabetes, hypertension, heart disease or cancer.

While states have
some leeway to tailor their Medicaid expansion plans, any expanded coverage would have to cover 10 types of basic services, including prescription drugs, maternity and newborn costs, emergency services and mental
health and substance abuse treatment.

(Ben Leubsdorf can be reached at 369-3307 or or on Twitter @BenLeubsdorf.)

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