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N.H. House Considers Whether to Extend Medicaid Expansion

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The plan to keep New Hampshire’s Medicaid expansion in tact for another five years got its first hearing in the House on Tuesday. Patients, health providers and other supporters spent hours urging lawmakers not to let the program expire at the end of this year.

Based on that testimony, there seems to be broad agreement — among the state's medical community, mental health providers, and even the business and industry association — that the program should continue.

But at the same time, a lot of the people who support the program have raised serious concerns about the exact proposal on the table right now.

The plan relies heavily on the federal government for support, and aims to make up the state’s share by tapping into the alcohol fund and then backfilling that with money from other sources. Critics say that plan lacks financial stability and, if not monitored carefully, could jeopardize an already depleted source of state funding for addiction treatment and prevention.

The plan also includes a work and community engagement requirement. Republican Senate Majority Leader Jeb Bradley says this isn’t meant to be punitive and is instead meant to encourage people to get involved in their communities, but others expressed worry that it could end up deterring people from seeking coverage.

Dawn McKinney, with New Hampshire Legal Assistance, said the requirement doesn’t adequately account for “fluctuation that is inherent in low-wage jobs such as seasonal work, varying hours, insufficient hours and short notice of shifts,” and could be a burden for the state to administer.

“This program supports hard working Granite Staters like childcare workers, home health aides, landscapers and many others who are juggling low-wage jobs,” said McKinney, who made sure to clarify that she supports the program overall. “And there is no doubt that some portion of these individuals who we rely on in this state will lose coverage due to the work requirement.”

Ken Norton, the executive director of the New Hampshire chapter of the National Alliance on Mental illness, also said he hopes the program continues because of the treatment it’s provided to people living with mental illness.

However, Norton took issue with an under-the-radar provision in the bill that seeks to prevent New Hampshire from reporting someone deemed a “mental defective” to the national background check system. (A similar provision exists in the current Medicaid expansion law but was the source of some controversy after the former attorney general tried to use it as the basis for reporting people with mental illness to the background check system, against the intent of its author.)

“This has nothing to do with Medicaid, and obviously the language is very offensive,” Norton said. 

The plan sailed through the Senate earlier this month. But if it falls through in the House, about 51,000 people could lose coverage at the end of this year.

With that in mind, many residents like Sandra May, of Henniker, tried to emphasize the safety net the program provides to people like her son, who lives with mental illness – and the fear that comes with not knowing whether that safety net will be there much longer.

“I live in constant dread that the life-seeking treatment that is available even to the jobless will evaporate like a mirage we never could grasp,” May said.

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Casey is a Senior News Editor for NHPR. You can contact her with questions or feedback at
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