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New Hampshire Medicaid match among nation’s lowest



Monitor staff
Saturday, March 25, 2017

Now that the Republican effort to repeal the Affordable Care Act is off the table, New Hampshire and other states will get to keep their expanded Medicaid programs – at least for now.

Even though that outcome is being welcomed by health care providers, the fact remains that New Hampshire’s current Medicaid reimbursement rates are some of the worst in the nation.

The Granite State is among the states who receive a 50 percent Medicaid match from the federal Centers for Medicare and Medicaid – the lowest rate available for hospitals and other health care organizations.

“You can’t get lower than last,” said Frank McDougall, Dartmouth-Hitchcock Medical Center’s Vice President for Government Relations.

Hospitals receive different amounts from Medicaid based on the type of procedure, and though the program covers many different health benefits, it pays doctors and hospitals at rates well below that of private insurance.

A 2010 study by the New Hampshire Department of Health and Human Services found that private insurance rates in New Hampshire were 114 percent higher than Medicaid reimbursement rates and Medicare rates were 48 percent higher.

Furthermore, the same study found that reimbursement rates in other New England states were 26 percent higher than the average rate in New Hampshire.

In fact, the state’s hospitals have sued in an effort to recoup $224 million in Medicaid money from the state. A federal judge ruled in favor of the hospitals earlier this month, saying the state must pay them for uncompensated care.

However, the state only budgeted $191 million to make payments to the hospitals, leaving another $33 million unanswered for.

And it’s not just hospitals; New Hampshire nursing homes get about $161 per Medicaid patient, which is last in the nation. Compare that to a state like Oregon; with one of the best reimbursement rates in the nation, Oregon health care providers get about $280 per Medicaid patient.

There’s a simple reason for the state’s poor reimbursement rates; New Hampshire prides itself on the lack of a broad-based tax, but the downside of that is the state simply does not generate enough revenue to get a good federal matching rate for its Medicaid patients.

“There are definitely states that do better than we do,” said Brendan Williams, president of the New Hampshire Health Care Association.

The amount of money the state pays to help fund nursing homes is less than what nursing homes pay themselves, Williams said.

In New Hampshire, county property taxes play a big part in funding the nursing homes in each county.

“The state has very little skin in the game when it comes to nursing home care,” Williams said. “It’s in part a reflection of New Hampshire’s tax structure or lack thereof.”

Currently about 187,000 New Hampshire residents – nearly 9 percent of the state’s population – are on Medicaid, including about 50,000 people who were added to the rolls when the Affordable Care Act expanded the program a few years ago and New Hampshire signed on.

“The expansion of course resulted in fewer uninsured, that’s just the math, but there’s something more important that actually occurred,” Concord Hospital CEO Robert Steigmeyer said at a recent press conference. “The newly insured individuals began to access care. They engaged the health system for their health care, and we responded throughout the state.”

Those patients are going to be able to continue to access care, now that the Republican bill to repeal and replace the Affordable Care Act has failed.

That news was welcomed by New Hampshire’s Democratic congressional delegation and health care associations around the state, who had opposed the bill.

“This bill would have been a wrecking ball for anyone with disabilities on Medicaid, whether elderly or children being cared for at home or in the Cedarcrest Center for Children with Disabilities,” Williams said in a statement on Friday.

U.S. Sen. Maggie Hassan released a statement saying the failure of the Republican bill was “good news for people across New Hampshire.”

“Instead of continuing to try to repeal the Affordable Care Act, now is the time to come together to take common-sense steps to improve the ACA, particularly by focusing on lowering the cost of prescription drugs,” Hassan said in a statement.

Congresswomen Annie Kuster and Carol Shea-Porter reiterated Hassan’s statement, saying they were pleased to see the bill withdrawn by House Republicans.

“The American Health Care Act would have been a disaster for women, families, people 50 years of age and older, veterans and those struggling with substance use just to name a few,” Kuster said.

Republican Gov. Chris Sununu was also vocal about his opposition to the bill in its current form, even though he has been outspoken about his desire to see the Affordable Care Act replaced with something else.

“Failure to reform our health care system is not an option. It is critical that we keep this conversation moving forward,” Sununu said in a statement on Friday before the Republican bill was pulled. “My concerns with the AHCA remain firm and I expect that members of Congress will take those concerns into consideration as they work to improve our nation’s health care system.”

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)