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State lawmakers optimistic on Medicaid expansion but split on way forward

Jeb Bradley

Jeb Bradley

Leaders of both political parties said yesterday they are optimistic a compromise on Medicaid expansion in New Hampshire can be reached before a special session of the Legislature concludes next Thursday. However, after several hours of debate on nearly a dozen amendments, the House and Senate are still working with different proposals for how and when to expand the program.

In the House, the finance committee voted, 15-10, almost along party lines, to adopt a plan floated Wednesday by Democratic leaders, including Gov. Maggie Hassan and Speaker of the House Terie Norelli.

Their plan would give adults earning up to about $16,000 coverage through the same managed care insurance companies now overseeing most of the state’s Medicaid program, until multiple companies sell plans on the federal insurance marketplace for New Hampshire. Then the program would give those people federal dollars to purchase plans on the exchange.

Republican leaders in the Senate have said that indefinite timeline is unacceptable, and a special committee agreed yesterday, 4-2, to recommend a plan by Sen. Jeb Bradley, a Wolfeboro Republican.

Bradley’s plan hinges on when federal regulators agree to a provision that both parties and both chambers in New Hampshire support: HIPP. The Health Insurance Premium Payment program pays the employee portion of insurance premiums for low-income people who can get insurance through their employer, but who can’t afford the out-of-pocket costs.

Right now, the program is voluntary. However, both parties agree on making it mandatory for people who could be eligible for Medicaid, because it will be significantly less expensive for the state.

Once the federal government agrees, which Bradley said is expected between February and April, his bill would start a 365-day countdown to when other newly Medicaid-eligible people will be moved off managed care plans and onto the open marketplace.

Hassan, Norelli and officials in the state Health and Human Services department have argued that one year is not enough time to develop the marketplace and obtain necessary federal approvals, but Bradley said the delay of waiting for the approval of mandatory HIPP enrollment should be enough to get done everything that needs to get done.

Yesterday morning, in an interview with the Monitor, Bradley said he’s confident the Centers for Medicare and Medicaid Services, the federal agency that would approve the plan, would be willing to work with the state on the timeline.

“People are looking at CMS as an implacable immovable bureaucracy, but looking at some of the things that have happened on the Affordable Care Act since 2010, we’re saying, ‘Wait a minute,’ ” he said.

“Why are we saying ‘can’t,’ when we’re hoping for a bipartisan agreement here that has the reform that Republicans want and that has the coverage that Republicans and Democrats want and actually probably has the reform that Democrats want? . . . I think that, if we can . . . come up with a rational plan that moves the Medicaid reform ball forward . . . we’ll get the necessary waivers,” he said.

Bradley also said that one major force behind his party’s insistence that newly eligible enrollees move to the marketplace in 2015 is that the governor has made it a priority to begin the program Jan. 1, or as soon as possible.

Keeping the “bridge” of managed care to one year is “very important to us because we feel that’s what drives the reforms to Medicaid that we feel are very important,” he said later in the day.

Norelli, in a response yesterday, referred to testimony from state officials, a consultant who worked with Arkansas – so far the only state that received federal approval for its alternative to Medicaid expansion – and representatives from the managed care companies, who have all said 2015 is an unreasonable deadline for several reasons.

State officials and the outside consultant have said the waiver can’t be written, vetted in public hearings and approved by federal officials in one year.

The managed care companies believe their contracts, which run to July 1, 2015, include the expansion population, and having to compete for them on the marketplace before then would be a violation of their terms.

And, in order to sell plans on the marketplace in 2015, the companies would have to submit them to the state Insurance Department in May 2014, and that might not be enough time to write and price them, one managed care company representative said.

“It’s clear from testimony that anything prior to July 1, 2015, is not workable,” Norelli said yesterday. “We don’t know if anything between July 1, 2015, and (Jan. 1, 2017) would be workable.”

The special session on Medicaid ends next Thursday, and negotiations between the parties will continue behind closed doors.

Bradley said yesterday morning that he and Senate President Chuck Morse want to reach a compromise.

Ending the session without a deal “would not be an outcome that either Chuck or I would be happy with,” he said.

(Sarah Palermo can be reached at 369-3322 or or on Twitter @SPalermoNews.)

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