Commission calls for 5-year extension of Medicaid expansion, with major changes

By Dave Solomon
New Hampshire Union Leader –  A commission appointed by the legislature to recommend options for the future of Medicaid expansion in New Hampshire will urge lawmakers to approve the program for another five years, but with significant changes, according to Sen. Jeb Bradley, R-Wolfeboro, chair of the commission.

New Hampshire was one of 32 states that agreed to expand eligibility for Medicaid under the Affordable Care Act, or Obamacare, starting in 2015-16. The program was then extended for another two years to cover 2017-2018.

The expansion embraced a portion of the population that was not poor enough to qualify for traditional Medicaid but that still could not afford subsidized policies on the Obamacare marketplace.

About 50,000 Granite State residents obtained new Medicaid coverage under the more liberal income guidelines but the so-called Premium Assistance Program sunsets at the end of next year.

The 15-member Commission to Evaluate the Effectiveness and Future of the Premium Assistance Program has until Dec. 1 to submit its report to the legislature. The content of that report was agreed to on Wednesday.

In addition to a five-year extension, the report will call for expanded Medicaid recipients to obtain coverage through one of the managed-care companies now handling traditional Medicaid, instead of turning to the Obamacare exchange at to purchase policies with premium subsidies.

The experience of the past two years has demonstrated that serving the expanded Medicaid population through the online marketplace pushes premiums higher for non-Medicaid customers purchasing individual health insurance policies at

“The main recommendation is that we move from a private insurance model back to a managed-care model for better coordinated care, cost effectiveness and hopefully allowing us to have some innovative use of incentives that drive wellness as opposed to emergency room visits,” Bradley said.

The state is seeking a waiver from federal Medicaid regulations to impose a work requirement on adults without children in the program.

The commission also will recommend that the legislature require higher reimbursement rates for mental health and substance abuse recovery services.

“We don’t specify what that is, but our recommendation is a higher rate,” said Sen. Dan Feltes, D-Concord, also a commission member. “We need to make sure, given the mental health and substance abuse crisis we are in, that we support the providers who support the workforce.”

The commission makes no recommendation on how the state should fund its share of the program.

Starting in 2017, the state has to pick up 5 percent of the cost, growing to 10 percent by 2020. The federal government has notified the state that its current method of funding its share through voluntary donations by hospitals and insurance companies is illegal under federal law.

“That is something the legislature is going to have to weigh in on,” said Bradley. “The commission was directed to look at the overall effectiveness of the Medicaid expansion and make recommendations for policy going forward. The finances have to be dealt with by the legislature, so stay tuned.”