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‘A Uniquely New Hampshire Approach’ To Medicaid Expansion

New Hampshire became the 26th state today to embrace the federal health law’s expanded Medicaid program, with as many as 50,000 low-income residents expected to begin signing up.

Coverage for those who enroll this month will take effect Aug. 15. Initially, most New Hampshire enrollees will join one of two Medicaid managed care plans in the state. That’s the way most other states expanded Medicaid earlier this year.

But New Hampshire officials hope that up to 10 percent of those who sign up will eventually enroll in employer plans — using federal money to subsidize that coverage.

In addition, the state plans to seek federal approval to shift most Medicaid enrollees into private insurance plans sold in the online federal marketplace beginning in 2016. Earlier this year, Arkansas and Iowa took this approach, which has become popular among Republicans because it makes use of the private insurance market.

If the federal government approves that plan, the state would shift all enrollees from Medicaid-only managed care plans to marketplace plans in 2016. The only exception would be those who can take advantage of subsidized employer-based coverage. They would remain in their employer plan, if the state deems it is less costly than a Medicaid managed care plan.

New Hampshire and other states have had an employer-subsidy option for years, though few people have used it because most poor people are not offered coverage at work, or the coverage is not as good as Medicaid, according to study by the General Accountability Office.

Joan Alker, executive director of the Center for Children and Families at Georgetown University, said no states have been able to get more than 1 percent of their Medicaid recipients enrolled in employer-subsidized coverage.

Mary Ann Cooney, an associate commissioner of the New Hampshire Department of Health and Human Services, said she expects a higher pickup rate because enrollees will be required to use the employer-subsidy option if they are eligible.

As of today, all New England states have expanded the federal-state health program for the poor except for Maine. There is no deadline, though full federal funding for the expansion ends after 2016, when states have to start picking up some of the tab, though never more than 10 percent.

New Hampshire’s decision to expand was the result of a political compromise reached this spring between the state’s Republican-controlled Senate and Democratic governor and House.

“This is a uniquely New Hampshire approach to try to keep businesses and insurers in the loop and try to maintain employer-based insurance for those that can access it,” said Cooney, whose agency oversees Medicaid. “The state does not want to upset the market for employer-based coverage.”

Pennsylvania and Indiana are seeking federal approval for their Medicaid expansion plans.

The health law allows states to expand Medicaid to cover everyone with incomes under 138 percent of the federal poverty level, or $15,900 for a single adult. Nationally, Medicaid has added 5 million since October, which includes millions who became eligible under the law as well as those who were previously eligible but had not yet enrolled.

State officials have been holding  town hall meetings to publicize the program and plan to use traditional and social media advertising, Cooney said. The state will also be sending direct mail to people enrolled in food stamps and other programs for the poor who likely would qualify for Medicaid. The state also will be contacting people who sought to sign up for Medicaid on

Consumer advocates in New Hampshire are ecstatic. “We are all grateful the state has made this decision,” said Tom Bunnell, a policy consultant with New Hampshire Voices for Health.

As more people gain coverage, employer groups hope that will lead to lower health insurance costs because doctors and hospitals will have less need to charge higher rates to the insured to make up for unpaid bills they incur for treating the uninsured.

“Our hope is this will start to have an impact on the health care and health insurance costs,” said Adrienne Rupp, spokeswoman for the New Hampshire Business and Industry Association.

New Hampshire’s plan to move to the “private option” is also expected to attract more insurance carriers to the market which could also help make prices more competitive, Rupp said.

The New Hampshire legislature will have to reauthorize Medicaid expansion for it to continue past 2016 after the 100 percent federal match ends.