Lawmakers weigh reducing Medicaid expansion eligibility level

  • The State House dome as seen on March 5, 2016. (ELIZABETH FRANTZ / Monitor staff) ELIZABETH FRANTZ

Monitor staff
Thursday, February 01, 2018

House lawmakers are considering reducing eligibility for the state’s Medicaid expansion population, part of a piecemeal reform that advocates say could help shift more costs onto the federal government.

Proposed by Finance Committee Chairman Neal Kurk, R-Weare, House Bill 1813 would lower the present income cap for the program from 138 percent of the federal poverty line down to 100 percent.

“The net effect would be that the cost of most of the members of this group would be shifted from the state taxpayer to the backs of the federal taxpayer” said Kurk at a hearing Thursday.

New Hampshire’s Medicaid expansion allows those eligible to sign up for marketplace plans without paying premiums; the federal government currently picks up 94 percent of the bill, with the remainder coming from New Hampshire hospitals and insurance companies.

By lowering the cap on who is eligible, Kurk’s legislation would bar 23.5 percent of those presently in the program, according to an analysis by the Department of Health and Human Services. That amounts to roughly 12,000 people of the 50,000 enrolled in the program.

But Kurk argued that those kicked out of the state-run “premium assistance program” would still receive federal cost sharing reduction payments and advanced premium tax credits to buy plans on the state’s marketplace.

And he said the proposed change could save the state money down the line. New Hampshire doesn’t presently pay the state match out of taxpayer funds, but that arrangement might not last; the federal Centers for Medicare and Medicaid Services has ruled that New Hampshire’s reliance on insurers and hospitals violates its rules. Meanwhile, the federal share of Medicaid expansion states is set to reduce in coming years, adding a higher gap for the state to fund.

“The idea is not to harm these folks but to shift the cost to the federal government,” Kurk said.

The change would need to be made through a waiver request to the federal Centers for Medicare and Medicaid Services by the state.

Opponents said the bill would effectively strand those 23.5 percent in a vulnerable income bracket – between $24,600 to $33,948 for a family of four – because many plans available to them would be cost-prohibitive.

Those plans with low enough monthly premiums would carry high deductibles, raising the specter of low-income patients burdening hospitals with uncompensated care, critics argued.

“We believe (the bill) will not only harm patients, but also their communities and the providers that serve them,” said Christine Stoddard, director of public policy for Bi-State Primary Care Association, which employs insurance navigators to help with enrollment.

And opponents took issue with another provision of the bill that would do away with retroactive eligibility, in which the program covers care used during a period before signing. Some representatives contended that could leave hospitals – particularly rural ones – stuck with the costs of emergency room visits that could otherwise be recouped under the law.

Kurk said that he sympathized with the cost concern, but that the measure was amount of fairness to protect the system against burdensome claims.

“I can’t get fire insurance after my house has burned down,” he said.

The bill will be taken up by a subcommittee of the Health and Human Services and Elderly Affairs committee, said Chairman Frank Kotowski, R-Hooksett said.

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