N.H. Said Its Medicaid Work Requirement Would Be Different, Early Numbers Suggest Otherwise

Jul 9, 2019

Credit Allegra Boverman for NHPR

Ever since New Hampshire’s Medicaid work requirement was approved by the Trump administration last November, critics have warned it would be plagued by the same problems that beset another Medicaid work requirement in Arkansas.

On Monday, the first numbers from the state Department of Health and Human Services suggests those critics were right. Nearly 17,000 people, or 68% of those subject to the work requirement, were in non-compliance for the month of June.

“I think [the numbers] are startling but they’re also not surprising, given how complicated any work and community engagement requirement is,” said Kristine Stoddard with Bi-State Primary Care Association. Her organization, which represents community health centers in New Hampshire and Vermont, holds that the work requirement violates federal law.

The data lends credence to anecdotal reports from healthcare providers and Medicaid recipients which indicated many on Medicaid were confused, frustrated, or unaware of the work requirement.

The numbers have also prompted state health commissioner Jeffrey Meyers to pause the work requirement until at least September 30th. In a letter to the governor and legislative leaders, Meyers said the move was necessary to avoid the “unintended loss of coverage for thousands of beneficiaries.”

Arkansas vs New Hampshire

In Arkansas, many people who were subject to the work requirement were unaware that it even existed. Those who did know about it had difficulty reporting their work hours.

Before the Arkansas work requirement was halted by a federal judge, more than 17,000 people lost their health insurance, even though evidence suggests more than 95% of the targeted population would have met the requirement.

For months, New Hampshire state officials, including Meyers, argued that the problems in Arkansas were the result of a botched rollout, and that here in New Hampshire things would be different.

“One of the real problems in other states, what I’ve read about Arkansas and Kentucky, is that the states may not have done a really good job to outreach to the population impacted before they turned the program on,” Meyers said last December.

In March, Meyers said New Hampshire’s campaign to educate Medicaid recipients about the requirement went “well above and beyond what other states have done.”

Attorneys for the state took similarly optimistic positions. In a court filing last month, Senior Assistant Attorney General Anthony Galdieri said there was nothing to suggest the work requirement “will result in any number of New Hampshire Medicaid recipients losing their coverage.”

He also wrote that comparing New Hampshire’s work requirement to Arkansas’ would be unfair because the states “had different programs, different populations, and different infrastructures.”

Yet, when the first numbers were released by state officials on Monday, they show that if not for a newly passed piece of legislation backed by Democrats that allowed the requirement to be paused, nearly 17,000 people would be at risk of losing their health insurance.

That bill was signed into law by Republican Governor Chris Sununu on Monday when the numbers were released. It marks perhaps the biggest difference between the two states’ approach to the work requirements. In Arkansas, the work requirement went ahead even as thousands lost coverage each month.

An “Aggressive” Outreach Effort

The Department of Health and Human Services has been working since last summer to reach out to people affected by the new work requirement. There have been mailings to all Medicaid expansion beneficiaries, more than 50,000 phone calls, radio ads, public information sessions, and in recent weeks, door-to-door home visits.

On Monday, Meyers said only about 1% of those phone calls were successful. Between the phone calls, office hours at DHHS locations, and home visits, only about 1,500 people were reached directly, according to Meyers.

About 48,000 people receive health insurance through expanded Medicaid in New Hampshire, and roughly 25,000 of them are subject to the new work requirement.

With additional time now added before implementation, Meyers says his department will continue in their efforts to educate Medicaid recipients, and he pledged to step-up the number of home visits.

But many, including Kristine Stoddard with Bi-State Primary Care Association, remain skeptical.

“They’ve been doing outreach for months. I know that they’ve come to Bi-State’s member meetings at least three times. They’ve been working directly with our community health centers on getting the word out,” said Stoddard. “But this work requirement is very, very complicated and this is a complicated population and I don’t think that adding [time] is going to reduce the number to a number that people will be comfortable with.”