After revisions, Medicaid expansion heads to N.H. House floor for final vote

  • The House Finance Committee faces a packed room as it votes in favor of Medicaid expansion plan, 24-2, on April 25, 2018. Ethan DeWitt / Monitor staff

Monitor staff
Published: 4/25/2018 5:55:03 PM

An amended plan to continue New Hampshire’s Medicaid expansion program cleared the House Finance committee nearly unanimously Wednesday in a 24-2 vote that sets the stage for a final vote on the House floor.

After limited discussion, members recommended renewing expansion – which provides Medicaid coverage to about 50,000 low-income residents in the state – for another five years.

As created, the program extends Medicaid coverage for those who earn up to 138 percent of the poverty line and provides money for drug treatment and mental health services within New Hampshire. The latest version requires participants meet a work requirement – or qualify for an exemption – to be eligible.

In passing the bill to the House floor, the committee added a handful of amendments. The latest version would remove a 90-day retroactivity clause allowing those eligible for coverage to sign up after they receive their care, though the change would likely not affect hospitals.

It would include a waiver to extend coverage to those who receive care while incarcerated. And it would reduce the age range of a person’s children that could exempt them from a work requirement – from up to 13 years old to up to 6.

The work requirement, a new addition to the four-year program that is awaiting approval by the Trump administration, had made some Democrats wary that it could reduce enrollment. But Deputy Democratic Leader Cindy Rosenwald, D-Nashua, a member of the committee, expressed support for the package ahead of the vote.

“I don’t particularly like the work requirement, but I think as finally crafted, it’s fair and it won’t arbitrarily kick anyone off of health insurance,” she said.

The measure is “entirely a reasonable compromise to a bill that I think is critical,” she said.

But some conservatives say the work requirement is too watered-down, carrying so many exceptions as to be ineffective. And they oppose what they say is an unwise and unsustainable use of federal money.

Rep. David Bates, R-Windham, one of two Republican committee members to vote against the bill, took issue with the funding. Under the arrangement, profits from the state’s liquor sales would go toward the state’s 7 percent portion of the bill – $30 million to $40 million – through the governor’s alcohol and drug abuse treatment fund. Hospitals have pledged to backfill the fund and keep it whole.

That, Bates said, amounts to a budget trick designed to mask the program’s true cost.

“There’s always been the promise from the very beginning that this wasn’t going to cost the state any money” he said. “That’s clearly not the case. ... We’re telling people there’s no cost to the general fund. Well. all they’ve done is move things around.”

The bill, which passed the full House. 222-125. earlier this month, moves to the floor again next week.

(Ethan DeWitt can be reached at, or on Twitter at @edewittNH.)

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