Senate Republicans are keeping their final proposal for New Hampshire’s Medicaid expansion program close to the chest, but a placeholder bill released Thursday provided a glimpse into potential ways forward.
Senate Bill 313, released online Thursday, would replace the state’s existing New Hampshire Health Protection Program – which currently provides services to around 50,000 low-income residents – and create a new, five-year initiative carrying significant changes to structure and funding.
The new program would continue to not rely on state taxpayer funds to operate, according to the bill’s text.
The proposal, dubbed the “Granite Advantage Health Care Program,” would work to move the program’s present recipients off the individual insurance market and move them into the state’s existing Medicaid care organizations, the bill states.
It would implement a long-sought work requirement for applicants, an initiative for which approval is still pending by the federal Centers for Medicare and Medicaid Services (CMS) in Washington.
Under the bill, which mirrors the state’s waiver application, individuals would have to work 20 hours a week in their first year, 25 hours in their second, and 30 hours in their third and beyond.
It would introduce new income eligibility requirements – an “asset test” in which those whose bank accounts, cash and possessions are assessed at below $25,000 – excluding the person’s primary home, primary car and furniture – would be considered “asset eligible” for the program.
And it would include a waiver for a requirement under the present federal law to provide 90-day retroactive coverage, which currently allows those who receive care before signing up to get that care compensated after the fact.
Finally, the bill includes an amended approach to how the program is paid for.
Among numerous persistent questions facing New Hampshire’s present program has been how the state will pay for its share. In 2018, according to the law the state must contribute 6 percent of overall costs, with the federal government paying the other 94 percent; that number is set to increase to 10 percent in 2020.
A decision by CMS last year found that New Hampshire’s present solution – to allow insurers and hospitals to pick up the tab and exempt taxpayers – violated its rules, citing a rule stating that those entities can’t contribute because they directly benefit from the program’s continuation.
As with the existing program, the newly proposed programs would create a trust fund to allow “any gifts, grants, donations, or other funding from any source.” The fund could be used for virtually all state costs associated with the program; there appear to be no restrictions on contributions from the health care industry.
The most notable difference: The suggested program would remove a provision that puts voluntary contributions from insurers and hospitals directly on the hook for paying the costs once other local funding sources, like state premium taxes, run out.
Under the new law, participating insurers and hospitals can pay in what they want to the fund, and their contributions can be spent as the commissioner sees fit. But the arrangement is no longer directly tied to the costs of the program.
It’s a potentially savvy legal workaround to last year’s CMS decision. But it comes with a possible downside: Without a direct funding arrangement, there’s no guarantee that the new, voluntary contributions will cover the state’s expenses, according to a state Department of Health and Human Services analysis included in the bill’s fiscal note. That means the program could launch without a guaranteed source of funding.
It remains unclear whether CMS would approve such a revised funding scheme. On Thursday, Republican leaders said they were waiting for the federal agency to sign off on the arrangement.
Implementing the program would require the Commissioner of the Department of Health and Human Services to apply for numerous waivers with CMS before it reauthorizes New Hampshire’s Medicaid expansion, which is set to “sunset” on Dec. 31 of this year.
The bill, sponsored by Senate Majority Leader Jeb Bradley, R-Wolfeboro, is meant to be a placeholder ahead of an expected amended version, according to Sen. Dan Feltes, D-Concord. But a timetable has been set; the temporary legislation has been referred to the Senate Finance committee and is set for an initial hearing Tuesday at 1:30 p.m. at Representatives Hall.
Neither Bradley nor Senate President Chuck Morse, R-Salem, were immediately available to comment Thursday evening.
(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)