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N.H. Medicaid expansion study panel looks at Arkansas, Iowa models

The commission studying the pros and cons of Medicaid expansion in New Hampshire yesterday took a look at the model offered by Arkansas and Iowa, two states that are seeking to expand health coverage for low-income residents through private insurance instead of traditional Medicaid.

Under such “premium assistance” plans, everyone who’s newly eligible for Medicaid under the 2010 federal health care reform law – people earning from 100 to 138 percent of the federal poverty level – would instead receive coverage from private insurance plans through the new marketplaces, also called exchanges. Federal aid that would have covered 100 percent of the cost of their Medicaid coverage for three years, and at least 90 percent in future years, instead helps pay for the private insurance.

Still to be seen, though, is whether the federal Centers for Medicare & Medicaid Services will give a green light to the Arkansas and Iowa plans. Arkansas was the first of the two to apply for a necessary waiver.

“We’re all curious as to how quickly the Arkansas proposal will be vetted by CMS, and interested to see how the negotiations – and it is a negotiation – go,” said Brian Osberg, program director in the health division of the National Governors Association.

The commission, which has spent the last month studying the details of a possible Medicaid expansion in New Hampshire, heard yesterday from Osberg and Joy Johnson Wilson, health policy director and senior federal affairs counsel at the National Conference of State Legislatures.

Much of yesterday’s three-hour meeting focused on the premium assistance plans being developed in Iowa and Arkansas, and whether they could provide a model for New Hampshire.

The Arkansas and Iowa plans aren’t identical. Iowa, for example, plans to charge a $20-per-month premium. And Arkansas plans to offer so-called “wraparound benefits,” ensuring participants receive the same benefits as they would under traditional Medicaid, while Iowa would not.

“Iowa’s proposal is going to meet more resistance, frankly, from CMS than Arkansas’s,” Osberg said. “Arkansas is a little more straightforward.”

Another question is whether a New Hampshire expansion plan could include cost-sharing, such as a patient co-pay or a monthly premium like the one proposed by Iowa.

Wilson said there’s not much recent data available on how much money something like that would save, or what effects there would be on patients.

“Historically, co-pays have resulted in people putting off care,” she said. “That’s probably not a good thing.”

But, Wilson added, that doesn’t mean there aren’t ways to lower costs and encourage wellness.

“Incentives work if they’re the right incentives,” she said. “I think what states have found is that it’s hard to find the right incentives, because it kind of has to be population-based, to get them to do the thing that you want them to do.”

New Hampshire is one of six states still debating whether to expand its Medicaid program, according to the Kaiser Family Foundation. Twenty-three states plus the District of Columbia have decided to expand their programs in some fashion, and 21 states aren’t moving forward at the moment.

Gov. Maggie Hassan wants to expand the Medicaid program starting Jan. 1, as does the Democratic-controlled House. But the Republican-controlled Senate in June blocked Medicaid expansion from being part of the new state budget, saying the issue needed further study.

The commission faces an Oct. 15 deadline to make a recommendation on whether – and if so, how – New Hampshire should expand its Medicaid program. Hassan has said she then expects a special session of the Legislature to vote on expansion.

The commission will meet again Tuesday, when it will hear from New Hampshire-based policy experts, and will take public testimony Aug. 27. Jim Varnum, the commission’s chairman, said he expects the panel will begin drafting its recommendations in early September.

“We’ve done a lot of work in one month,” he said yesterday.

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

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