Medicaid expansion commission lays outline for their debate, reveals some positions
The commission charged with recommending whether New Hampshire should expand the Medicaid program as authorized under the federal Affordable Care Act spent several hours yesterday moving point-by-point through a series of topics, as members of the commission said what they would want to include in the debate on each topic.
The members held a wide-ranging conversation, and “it was very complete for what it was and very incomplete for what it wasn’t,” said member Charlie Arlinghaus, president of the Josiah Bartlett Center for Public Policy. “We discussed what we’re going to discuss.”
Commission members said they were offering up topics to talk about as they continue their work in the coming weeks, not giving their opinions, but some consensus appeared to have formed about a few issues.
Most agreed that if the state moves forward, the new enrollees in Medicaid should be part of the managed care program that is due to launch Dec. 1.
“Managed care was a ‘Kumbaya’ moment for the Legislature. They’re rare but they do happen,” said Rep. Neal Kurk, a Weare Republican.
“Fiscal conservatives liked it because if there are cost overruns, the three companies managing the program are at risk, not the state. Social liberals liked it because it promised to improve care. . . . To the extent the state can put the expansion population into managed care, the state would save money,” he said.
Many commissioners also seemed to agree that if the state moves forward, it should aim for Jan. 1 to start covering new enrollees and include a mechanism for reviewing the program before the federal government is scheduled to decrease its contribution from 100 percent of the cost to 90 percent, in 2017.
“Whatever plan we come up with, I encourage us to move with alacrity and try to take advantage of what is being offered. But I am concerned, and many of my constituents are concerned, about what if Congress changes their mind. . . . There may need to be circuit breakers and a review at regular points to decide if this is really effective, and do we continue,” said Rep. Tom Sherman, a Democrat from Rye.
Commissioners seemed to disagree about, but most wanted to discuss, the manner in which potential enrollees would be required to have a “skin in the game,” including whether co-payment requirements could be effective at reducing inefficient use of services such as hospital emergency rooms.
Commissioners also disagreed about whether and how the state’s Health Insurance Premium Payment program might be used as a complement to Medicaid expansion. The HIPP program pays the employee contribution to private, employer-sponsored health plans for qualifying individuals. There are fewer than 200 people on the program, said Marilee Nihan, a deputy commissioner at the state Department of Health and Human Services.
Discussion will likely focus on whether the state should require or offer the program to people newly eligible for Medicaid, if the program expands.
Offering enrollment in the HIPP program could be done alongside expansion and would not require any federal input or approval, said Jeff Meyers, assistant commissioner at HHS.
But requiring people who become eligible for Medicaid under the expansion, but who could have employer-sponsored insurance, to enroll in HIPP instead would require a waiver from the Centers for Medicare and Medicaid Services.
Amendments to state Medicaid plans are often approved within 30 to 90 days, Meyers said.
A simple, straightforward waiver that pertained only to making HIPP enrollment mandatory for Medicaid expansion beneficiaries might be approved in that time period, he said. An application for a more complicated waiver could take much longer, he said.
However, “the state has not submitted any HIPP proposal to CMS or consulted with CMS concerning an approval process for a waiver for mandatory HIPP (participation),” he said. “In light of the current program, we would hope a waiver proposal for mandatory HIPP (participation), if New Hampshire submitted such a proposal, could be reviewed in a short time frame.”
Expanding Medicaid would give health coverage to about 50,000 New Hampshire residents.
(Sarah Palermo can be reached at 369-3322 or
firstname.lastname@example.org or on Twitter @SPalermoNews.)