Medicaid Block Grants? Not Yet.

By John Milne on Friday, January 16, 2004.

listen:

Governor Benson's trip to Washington last week may have saved the federal aid that provides millions of dollars for New Hampshire's state budget.

When the governor returned, he said New Hampshire the first state to operate Medicaid as a block grant program.

But there's a problem.

New Hampshire Public Radio's political correspondent, John Milne, reports:

Senior state Republicans say Governor Benson likes to shake things up. He did just that last week when he negotiated Medicaid issues in Washington.

Benson said he shook hands on a deal to rework a tax scheme designed to bring millions of federal dollars to the state budget. And the governor said he talked to the agency's top man.

(blockgrant1)
The secretary of health and human services, Tommy Thompson, and I had a very nice discussion about creative ways to work together, including what?s called a block grant program, which no state has embarked on, and I told him we?d be interested in perhaps becoming that first state.

As Benson explained, a block grant would let Washington cap its budget expenses. The state could get greater control ? and less red tape ? for paying Medicaid bills. Hundreds of millions of dollars are involved.

The announcement sent off a search for law books and calculators within the State House. Would the state find ?free money? for its budget, as it did when the welfare program shifted to block grants in the 1990s?

What role will the Legislature have? Will the Legislature have a role? Will the state have a chance to say yes or no?

Representative Neal Kurk chairs the influential House Finance Committee. He wants a close look at the specifics.

(blockgrant2)
It?s very difficult for me to make a judgment at this time without knowing all of the details ? all of the limitations the federal government might place on that; all of the flexibility the federal government might give us. Generally speaking, however, the Medicaid block grant proposal has not been well received by state governors. The governors? association has told the federal government that they don?t recommend states participating in that program.

Kurk?s Senate counterpart is Rochester Republican Dick Green. Green says he doesn?t have a problem with the concept of block grants. But he wants to know what would happen if there are more Medicaid patients than there is money to serve them:

(blockgrant3)
Those services would be downshifted to the counties and the local communities, which in turn would increase property taxes to provide those services which the law requires us to provide.

In other words, the policy and budget system in Concord has been shaken up.
But in Washington, a spokeswoman for Secretary Thompson said President Bush hasn?t made any decision on block grants.

What?s more, she said Secretary Thompson hasn?t even agreed to experiment with a Medicaid block grant program ? which would need Congress? approval.

So what did Governor Benson say to Secretary Thompson? Benson was asked directly whether he had committed the state formally to a block grant program:

(blockgrant4)
We?re going to look into ? Absolute. We?re going to look into it. And the secretary?s very excited about it.

This apparent conflict may be resolved in the president?s State of the Union message next week.

For NHPR News, this is John Milne.