N.H. Senate revises Medicaid work requirement

Monitor staff
Published: 3/28/2019 6:28:28 PM

The New Hampshire Senate voted to scale back the state’s newly-approved work requirement Thursday, a day after a pair of federal lawsuits sowed doubts about it short-term future.

In a 14-10 vote that sparked heated commentary over a bill that had bipartisan support last year, Democrats moved to pass Senate Bill 290, which would make a series of changes to New Hampshire’s requirement.

The present work requirement, which applies to 50,000 low-income Granite Staters currently receiving Medicaid expansion and which was approved by the federal government last November, mandates that those benefiting from the program log 100 hours a month in work or community engagement. Under the rule, those that don’t meet the requirement can be removed from insurance coverage until they come back into compliance.

The rule allows for a series of exceptions to be made by the Department of Health and Human Services for those who might not be able to find work, whether because of hardship, disability or other limitation. Senate Bill 290 broadens the definitions of those who could be exempt, and adds self-employment to list of qualified states of employm

But the bill, sponsored by Sen. Cindy Rosenwald, also includes several trigger mechanisms that would end the work requirement entirely if certain conditions are met. The program would end if 500 or more of the program’s beneficiaries find themselves cut off from their insurance or if providers are saddled with uncompensated care as a result of beneficiaries losing coverage.

Republicans in the chamber took issue with a provision in the bill allowing the possibility of state funds to be used toward the program, with Sen. Chuck Morse of Salem calling the move a reversal of longstanding policy. Since its first creation in 2014, New Hampshire has funded the state’s share through indirect payments from hospitals.

Sen. Cindy Rosenwald, the bill’s sponsor, countered that the change was only meant as a contingency should there be major increases in costs and the existing funds come up short.

“By doing this, we’re not making any moves, but we’re planning if other moves are made that have a negative effect on us,” Rosenwald said. “That’s good government. That’s good policy.”

Sen. Jeb Bradley, meanwhile, took aim at one provision that would end the work requirement if the federal government declined the proposed changes. Because the agency in question, the Centers for Medicare and Medicaid Services, is already on record opposing one of the proposals, that contingency is a self-fulfilling prophesy, Bradley argued.

“It is something that ends the work requirement,” Bradley said. “Make no mistake about it. Sorry for the hard cold truth. That’s what it is.”

Rosenwald’s bill was submitted well before the announcement last week of a federal lawsuit to end New Hampshire’s requirement. Yet inescapable from debate Thursday were question marks surrounding that lawsuit, submitted by last Thursday by two national health advocacy organizations in conjunction with New Hampshire Legal Assistance.

On Wednesday, a judge in the United States District Court for the District of Columbia issued rulings invalidating similarly approved work requirements in Kentucky and Arkansas. Senators on both sides of the aisle cast little doubt over whether New Hampshire would be next.

“Unfortunately I think this bill is moot,” said Bradley, referring to the new rulings. “Events outside our control will be taking over us.”

The lawsuit, Bradley continued, could upend years of bipartisanship and make future agreements over the program potentially unreachable.

Democrats, meanwhile avoided much reference to the lawsuit, whose backers are seeking the termination of the work requirement, instead focusing on tweaks.

“The bottom line is none of us is perfect,” Sherman said. “It’s time for this body to stop being reactive and say what if this goes wrong.”




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