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Medicaid Expansion Study Panel Recommends Shift to Managed Care

Allison Quantz for NHPR

A committee of lawmakers, health and insurance officials studying the future of New Hampshire’s Medicaid expansion voted unanimously on Wednesday to recommend moving the program toward a managed care model in 2019 and beyond.

The committee’s full report still has yet to be finalized, but it's due before December 1. As part of the move to managed care, the report will also likely recommend several other changes:

  • Higher rates for behavioral health services (including mental health and substance use disorder services) than what managed care organizations currently offer
  • Assurance of a transition period for people currently covered by expanded Medicaid, to avoid dropped coverage
  • Other measures to ensure continuity of care for people who transition out of the program because of changes in income, for example
  • A request for detailed data on the effects the program is having on uncompensated care and other costs within the state’s healthcare system

New Hampshire's traditional Medicaid population currently employs a managed care model, and so did expanded Medicaid when it first launched.
Since 2016, the Medicaid expansion population has been covered through what’s known as the “premium assistance program” — where enrollees receive subsidies to purchase private insurance plans offered through Affordable Care Act exchanges.

Department of Health and Human Services Commissioner Jeff Meyers said he hopes this move will spur both more competition and consistency across New Hampshire's Medicaid market.

The legislature has directed DHHS to put its existing managed care contracts back out to bid next year anyway, and Meyers said this is "a perfect opportunity to align what we're doing across managed care." He suggested the state might be able to attract more providers because there would be a larger pool of people potentially needing coverage.

"We would have a combined population of about 180,000 individuals," Meyers said. "That would incentivize plans, I think it would increase competition in new Hampshire and ultimately provide consumers with more choice."

State Senate Majority Leader Jeb Bradley, a leading Republican proponent of expanded Medicaid, said he plans to introduce legislation spelling out details of the committee’s proposal. Additionally, he wants to propose extending the program another five years — instead of only two, as it has operated.

One big question left unanswered by the committee studying the future of Medicaid expansion: how to pay for it.

The federal government paid the full share of coverage for the first few years of the program. In 2017, it asked states to start kicking in part of the costs.

New Hampshire lawmakers arranged to cover its share through payments from hospitals and insurers — but the federal government warned the state earlier this year that such a funding model is illegal, and the program could be in jeopardy if a new system isn’t devised by the end of 2018.

“Just as we did two years ago, we’re going to have to have some pretty frank conversations with the providers to find something that works for them but works for the state and taxpayers and the budget,” Bradley said.

Of course, it will be up to the full legislature to hammer out the details of this plan — or whether to continue Medicaid expansion at all beyond its current expiration date at the end of next year. At last count, more than 50,000 were receiving coverage through the expansion.

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