Now-disbanded Medicaid work requirement costs New Hampshire $187,000

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Monitor staff
Published: 9/23/2019 5:21:11 PM

New Hampshire state officials spent over $187,000 this summer attempting to get low-income residents into compliance with the now-defunct Medicaid work requirement, according to calculations released this month.

In a Sept. 3 letter to state lawmakers, Department of Health and Human Services Commissioner Jeffrey Meyers said that the bulk of that spending – $108,723 – went to an outside agency to call members of the program and get them into compliance.

An additional $42,220 went towards a door-knocking campaign to attempt to reach individual members. The department spent $23,271 on letters sent out to Medicaid participants; $12,125 on informational materials; and $1,040 for staff overtime costs, according to the letter.

In total, the spending allowed the department to assist 270 people through in-person door knocking, Meyers reported. An additional 528 were assisted via phone to get exemptions from the requirement.

But the numbers paled next to the total number of people who the department estimated could be subject to the new requirement: about 17,000. 

The letter was released publicly at a regular meeting of an oversight commission for the state’s Medicaid expansion program, which has served 50,000 low-income Granite Staters since 2014. 

In 2018, acting on a legal mandate, state lawmakers approved the addition of a work requirement to the program. The new mandate required those receiving benefits to log and 100 hours of work or community engagement with the state per month – with exemptions for those with disabilities, geographical hardships, children under six, and others.

But that work requirement, which was approved by the federal Centers for Medicare and Medicaid Services and which followed similar programs in two other states, has been tied up in legal limbo. In July, Judge James Boasberg, ruled that the federal government had misused its authority in approving the new requirement, putting its implementation to an immediate halt. 

The jury is not out; lawyers for the Trump administration have requested a final ruling from the circuit court of appeals. 

Observers are watching closely the federal appeals around two other states’ programs, in Kentucky and Arkansas, both of which were struck down by the same judge. The outcome for those states will likely influence the fate of New Hampshire’s program. 

Defending New Hampshire’s program – for which the state Department of Justice teamed up with federal attorneys – cost the state about $13,000, according to a separate letter released Monday. 

For now, the ruling effectively ended New Hampshire’s outreach efforts. But before the program was put on hold, officials were scrambling to inform members of the program before they fell out of compliance and potentially lost their insurance, the letter noted.

The timing was crucial; under the program, which started in June, members had a two-month grace period to start meeting and reporting their 100-hour work quotas. Any Medicaid recipient who failed to do so by late July could have lost coverage in August had the program not been suspended.

Officials were racing to let people know about the new mandate before that happened. 

“During the month of July 2019, the Department of Health and Human Services began a variety of community outreach efforts to inform Granite Advantage participants of the requirements for Community Engagements,” Meyers wrote, referring to the official names of the Medicaid expansion program and the adjacent work requirement.

Getting that done involved the help of another agency. According to the letter, DHHS teamed up with the Department of Employment Security to fan out across the state.

Between June 27 to July 26, officials sent ten teams of two across the state into low-income neighborhoods to attempt to tell Medicaid recipients, according to the letter. Each team took on 30 to 35 homes between 10 a.m. and 3 p.m.

But for all the cooperation, the health department was picking up the tab. One person on each team was an employee from the Department of Employment Security – each of whom needed to be reimbursed by the DHHS for their time. That came out to about $4,000 per day – or $42,220 overall. 

Meanwhile, DHHS contracted with a third-party company, Maximus, to carry out calls, and sent out 37,482 letters to those subject to the work requirement and 10,798 to those who were exempt due to medical frailty – on top of initial letters to all 49,000 people on the program. 

Reaching everyone proved a challenge. Often, residents weren’t home. Calls weren’t always answered. And if members of the program didn’t have details identifying their Medicaid status – or weren’t interested in providing them – the state employees couldn’t help bring them into compliance.

In the end, the outreach effort came up far short, according to the letter. Of the 2,011 homes the department visited in total, only 13.4% were assisted with the requirement.

That’s prompted reflection for lawmakers on both sides of the work requirement debate.

Nashua Sen. Cindy Rosenwald, a champion of the Medicaid expansion program for the Democrats, argued the money spent – which came out of the state’s Medicaid expansion trust fund – didn’t deliver sufficient returns .

“It wasn’t out of compliance with state law, but I don’t think it was the best use of those funds,” she said. “To reach, essentially, 295 people who were subject to the work requirement but the Department had not learned were in compliance yet.”

Sen. Jeb Bradley, a Wolfeboro Republican who has helped propel Medicaid expansion forward but who supports the work requirement, was more optimistic.

“I thought that the department worked really hard to try to do outreach to people that were going to be subject to the community engagement program,” he said. 

But there’s room for improvement, he added.

“I think if the temporary restraining order is ever lifted at some point in the future, we’re going to have to work with the department and with advocates to try to have a very good and effective outreach program.

(Ethan DeWitt can be reached at, at (603) 369-3307, or on Twitter at @edewittNH.)

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