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End to pandemic-era Medicaid rules could affect health coverage for thousands of Granite Staters

Allison Quantz for NHPR
The state is encouraging people to submit updated proof of eligibility as soon as possible, so they can keep receiving coverage after the rules expire in March.

Temporary federal rules have allowed many people to maintain Medicaid coverage throughout the pandemic, despite changes in income or other circumstances.

But those rules — known as continuous enrollment — are set to expire March 31, a change that could jeopardize the health coverage of thousands of Granite Staters. Of the 102,000 or so people at risk of losing coverage, New Hampshire Medicaid Director Henry Lipman said about 47,000 are in the Granite Advantage program for low-income adults. More than 35,000 are children.

In April, the state will begin reviewing whether those Medicaid recipients are still eligible for coverage. Officials plan to spread that process out over nine months. People affected by the change will receive yellow notices informing them of their redetermination dates and any steps they need to take.

Officials are encouraging people to submit updated proof of eligibility to the state as soon as possible. That will help ensure they keep receiving coverage, if they’re entitled to it.

“Our mission here is, if you should have coverage, we don’t want you to lose it,” Lipman said.

Lipman said the change won’t affect everyone enrolled in Medicaid. People who signed up in the past year, for example, will simply have their annual redeterminations when they normally would.

State health officials say they’ve been preparing for this moment for years, trying to educate people about the upcoming transition in various ways. They’ve mailed pink renewal notices, held in-person events, partnered with local health care centers to get the word out and hired more staff to handle calls. The state has also engaged in targeted outreach to people experiencing homelessness, seniors and people with limited English proficiency.

Lipman said more than 28,000 people have already completed their redeterminations thanks to those efforts. But more than 72,000 have not yet taken that step, meaning the state doesn’t yet know how many will still qualify.

New Hampshire’s Medicaid enrollment has grown throughout the pandemic, from about 180,000 in March 2020 to around 250,000 today.

The biggest increase came from Granite Advantage — New Hampshire’s Medicaid expansion program — which now has more than 95,000 participants, compared to around 51,000 pre-pandemic. Lipman said those people are now the most likely to lose coverage this year, due to changes in income.

He expects Granite Advantage enrollment could drop to around 64,000 by the end of the year, though cautioned that estimate is preliminary.

People who lose Medicaid coverage because of changes in eligibility may qualify for free or low-cost private health plans through marketplace.

Congress approved the March 31 end to the continuous enrollment requirement as part of the spending package it passed in late December. Gov. Chris Sununu and other Republican governorshad called for an end to that requirement, saying it was costing their states millions to keep people enrolled in Medicaid who would otherwise be ineligible.

An analysis by the Kaiser Family Foundation found that nationally, the continuous coverage requirementboosted Medicaid enrollment and cut the uninsured rate. It also reduced “churn,” with fewer people experiencing gaps in coverage because of temporary changes in income or administrative hurdles.

Paul Cuno-Booth covers health and equity for NHPR. He previously worked as a reporter and editor for The Keene Sentinel, where he wrote about police accountability, local government and a range of other topics. He can be reached at
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