Gov. Chris Sununu touted accomplishments and announced a few priorities in his State of the State address – an executive order to coordinate veterans services across the state, an initiative to develop workforce addiction programs, a new annual robotics competition.
Left far less clear was the governor’s preferred path forward for the state’s Medicaid expansion program that is due for a crucial reauthorization vote before it expires at the end of the year.
The program, which currently serves around 50,000 New Hampshire residents, has frequently found itself in the political crosshairs, scraping through a series of close State House votes since it was first authorized in 2014.
At the time of Sununu’s address, Senate Majority Leader Jeb Bradley, R-Wolfeboro, had yet to release a new version of the bill, with broad changes to its operation and funding. A placeholder bill was released online Thursday night, offering insight into how Republicans intend to achieve their goals.
While briefly touching on the issue in his address, Sununu left the details of the Senate Republicans’ bill up in the air, despite its imminent release.
“At the moment, there are several different ideas about how to move forward,” Sununu said. “And we’re working through the ideas with the federal government to ensure that our plan has a viable work requirement while maximizing our flexibilities and options.”
Under the program, the federal government extends Medicaid dollars in participating states to broader income levels; New Hampshire’s version allows those residents to purchase plans on the individual market.
The Granite State obtained a federal waiver to also use the funds for substance abuse and mental health services.
Lauded by Democrats as a flexible approach to securing federal aid, the program has come under fire from Republicans over concerns about potential state taxpayer liability. Unlike most states, New Hampshire does not currently pay for its 6 percent share with state money; last year, the federal Centers for Medicare and Medicare Services (CMS) found that the state’s alternative option – relying on hospital and insurer donations – went against its rules.
Sununu has taken several trips to Washington, D.C., in the past year, seeking to negotiate with the head of CMS on acceptable revisions to New Hampshire’s plan.
Now, as part of their revised proposal, New Hampshire lawmakers appear to be counting on the agency accepting their approach. Details were kept under wraps early in the day, but speaking after the governor’s speech, Bradley promised the general fund would stay untouched.
“We will have a plan that doesn’t raise any taxes and doesn’t cost taxpayers money in New Hampshire,” Bradley said.
The new plan still requires Washington to give the green light to two more reforms, according to Bradley: a push to move the program’s recipients off the individual market and into a state managed care organization, and a waiver from CMS for a work requirement. But most states already use a managed care system, and CMS has already approved work requirements in Kentucky and Indiana, giving hope to Republican leadership.
“We haven’t got the ‘approved’ stamp yet,” Bradley said. “But we’re getting there.”
Still, Democrats took issue with Sununu’s lack of detail Thursday.
Senate Minority Leader Jeff Woodburn, D-Whitefield, complained the governor “mumbled through Medicaid expansion.”
Without a strong public push from the governor, Woodburn added, the new bill might not pick up the momentum it needs to get through tough legislative votes.
Sen. Dan Feltes, D-Concord, who has worked with Bradley on Medicaid expansion reform, was more diplomatic on hopes for the plan.
“I think everyone in this building has a slightly different approach, and so we’re going to try to iron it out and work together in a productive way,” Feltes said, calling the program “the single most effective way to deal with the opioid epidemic.”
Democratic leadership met with the governor once in recent weeks but didn’t discuss anything of substance, according to House Democratic Leader Steve Shurtleff, D-Penacook. Shurtleff urged greater bipartisan collaboration on the plan.
For some, whatever form the bill ultimately takes is beside the point; many House Republicans are opposed to the expansion of a program they argue is a costly burden.
But Sununu made clear that he would support a forthcoming plan.
“The people of New Hampshire sent us to Concord to get things done, and that’s what we’re going to do,” he said.
(Paul Steinhauser contributed to this report. Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)