Highlight on New Hampshire: Expanded Medicaid effective, but in jeopardy

According to the numbers, New Hampshire’s decision to expand Medicaid coverage was a successful one, but it is also in danger. In 2014, when the expansion took effect, projections hovered around 50,000 enrollees over the next five years. These projections wildly underestimated the zeal with which the newly eligible would seek enrollment: six months later, 39,500 people out of the expanded population have enrolled. Under the expansion, those making under 138 percent of the federal poverty level, or $15,900, were made eligible for Medicaid. The expanded program, known as the New Hampshire Health Protection Program (NHHPP), has also had an effect on hospital finances.

According to the New Hampshire Hospital Association (NHHA), the NHHPP is “driving a reduction in inpatient admissions, emergency visits and outpatient hospital services among the uninsured.” Since hospitals cannot turn away those in need due to an inability to pay, caring for those without insurance puts a huge financial burden on providers. The NHHA stated that over $425 million in uncompensated care was provided to the uninsured in 2013. Following Medicaid expansion, treatment for the uninsured dropped in the emergency room by 22 percent, inpatient admissions by 27 percent, and outpatient visits by 15 percent from the previous year. Genesis Behavioral Health also reported a 30 percent increase in the number of patients seeking services, but also a 30 percent drop in uninsured patients. About 2,000 new enrollees have accessed care at the 10 community health centers in the state, receiving services they could not get without the NHHPP.

The New Hampshire Medicaid expansion law included a provision that the NHHPP must be reauthorized by April 2016 to continue. The law also provides that the newly eligible population will move into the commercial market and be covered by private managed care companies. However, the House and Senate, upon creating the budget for the next two years, decided that the program should not be reauthorized. Some senators said that they would rather receive more information about the program’s effectiveness and debate the issue next year. Supporters such as Abby Shockley, executive director of the New Hampshire Alcohol and Other Drug Service Providers Association and Jay Couture, executive director of Seacoast Mental Health, said that the program is clearly working and allowing for the provision of necessary services to vulnerable residents. Governor Maggie Hassan (D) originally included $12 million for Medicaid expansion in her budget proposal, but also recommended $58 million in cuts for the Department of Health and Human Services. The Senate Finance Committee voted for removing the language and spending that extended Medicaid expansion in March.

Expanded Medicaid woes are affecting private market rates. Two carriers offering insurance to New Hampshire on the federal health insurance Exchange have requested high rate increases. Minuteman Health Inc. is making up for having the lowest premiums for the state when it entered the market this year by requesting increases for next year’s premiums from 42 to 51 percent. Maine Community Health Options premium increase were less drastic, but still in the double digits: from 19 to 22 percent. The insurers point to the Premium Assistance Program, touted as a compromise between Senate Republicans and Governor Hassan, as one reason for the increases. The program would provide Medicaid dollars to beneficiaries to allow them to pay for coverage off of the Exchange. The insurers feel that claims for Medicaid patients will be much higher than those from its current risk pool. The rates are an early filling, and proposals can be altered on July 15.