Suellen Griffin: Medicaid expansion reauthorization is critical for state

For the Monitor
Wednesday, March 07, 2018

Two years ago at this time, Annette Carbonneau of NAMI-NH and I authored an opinion piece in support of House Bill 1696, the legislation that reauthorized the N.H. Health Protection Program, also known as Medicaid expansion. As advocates for persons with mental illness and those dealing with substance abuse and addiction, we wrote that HB 1696 – which proposed a continuation of Medicaid coverage for individuals in our state who otherwise had no access to health care – was the most important piece of legislation the N.H. General Court would consider in 2016.

Our 2016 op-ed emphasized that the N.H. Health Protection Plan represented the front line in our efforts to stop the state’s opioid crisis, and that it helped ensure that those with mental illness and substance abuse and addiction didn’t see barriers in other parts of their lives, including their families, work, housing and education. In 2016, the impact of untreated mental illness and addiction on the workplace was one reason that the business community stepped up and strongly supported HB 1696. Luckily for all of us, the majority of the House and Senate agreed and passed HB 1696, which was signed into law on April 5, 2016.

Fast forward to 2018. Sadly, the state’s opioid crisis has not abated. In fact, NAMI-NH reported just last week that New Hampshire leads the nation in overdose deaths per capita from fentanyl. But even more lives would be lost and even more families destroyed without the mental health care and substance abuse and addiction treatment that Medicaid expansion provides. It’s now time to move forward with Senate Bill 313, which will extend the program under a new name and a new managed care structure, for five more years.

The new N.H. Granite Advantage Health Care program established in SB 313 is not just a carbon copy of the earlier N.H. Health Protection Program. Rather, it was developed over the past 18 months by the legislators, advocates and stakeholders, citizens and state officials who served on the Commission to Study the Effectiveness and Future of the Premium Assistance Program. The key recommendations of the commission were to transfer the PAP population to managed care; increase reimbursement rates for mental health and substance use disorder treatment services; provide continuity of care for those covered by Medicaid expansion; and extend the program for five more years.

Ensuring access to mental health and substance use disorder treatment services through proper rate setting is of particular importance to the 10 community mental health centers that make up the Community Behavioral Health Association and have not seen a Medicaid rate increase since 2006. That wage gap significantly contributes to the workforce problem we have in behavioral health, with 275 open positions across the 10 centers, over 200 of which are clinical positions. And that lack of staff on the community level directly contributes to the hospital emergency room backup issue, with scores of adults and children waiting daily for a bed at N.H. Hospital. What goes around comes around.

Not everyone is 100 percent pleased with the PAP Commission’s recommendations or with all the elements of SB 313, but as bill sponsor Sen. Jeb Bradley often likes to say, if everyone hates something about a piece of legislation he’s worked to find consensus on, then he’s done his job. New Hampshire’s unique way of addressing Medicaid expansion and how to fund it will continue to evolve and will need additional tweaks as the process and deliberations on SB 313 continue. The important thing is to make sure New Hampshire citizens who have been receiving coverage aren’t kicked off the program and that we continue to use this as a way to combat the opioid crisis.

HB 1696 was clearly the most important piece of legislation considered in 2016; SB 313 is clearly the most important in 2018. For the many individuals and families in this state who are dealing with mental health issues and addiction, this is a lifeline. We need the N.H. Health Protection Program reauthorized now, and SB 313 is the right vehicle. Please contact your legislators and ask for their support of SB 313.

(Suellen M. Griffin is president of the N.H. Community Behavioral Health Association and CEO of West Central Behavioral Health in Lebanon.)