Manatt on Medicaid: New Hampshire Elects to Expand Medicaid Using Private Plans

By Deborah Bachrach, Partner, Healthcare Industry, Manatt | Patricia Boozang, Managing Director, Manatt Health | Jocelyn Guyer, Director, Manatt Health

Editor’s Note: Last week, New Hampshire joined Arkansas and Iowa in adopting Medicaid expansion plans that rely on premium assistance for coverage of expansion adults. Our new issue of “Manatt on Medicaid,” summarized below, provides insights into the main features of New Hampshire’s new legislation, including how it compares to other recent state expansions. To download the full “Manatt on Medicaid” brief, click here.

Last week, New Hampshire’s governor signed a law (Senate Bill 413-FN-A) that will expand Medicaid to adults with incomes up to 133 percent of the federal poverty line. The law is expected to result in some 50,000 New Hampshire residents securing coverage through private plans (both Medicaid managed care plans and Qualified Health Plans in the marketplace), with enrollment beginning as early as July 1, 2014. The new legislation:

• Is contingent on the federal government funding 100% of the cost of covering newly eligible, low-income adults.
• Requires adults with access to employer-sponsored insurance (ESI) to enroll in that coverage, if it is cost-effective.
• Requires adults covered by the expansion who lack access to ESI to enroll in Qualified Health Plans (QHPs), the private plans sold in the federally facilitated marketplace.
• Provides transitional or “bridge plan” coverage, letting adults temporarily enroll in existing Medicaid managed care plans (or in a QHP, if cost-effective), while the mandatory premium assistance program is being established.
• Emphasizes personal responsibility, including cost sharing; disincentives for inappropriate emergency room use; wellness programs; and, when the individual is unemployed, assistance in finding suitable employment.
• Requires federally qualified health centers (FQHCs) to have the opportunity to provide ambulatory services.
• Establishes the New Hampshire Health Protection Trust Fund that will receive and expend federal funds to cover the costs of services for the expansion adults.
• Establishes a process for the Joint Legislative Fiscal Committee to review any amendments or waivers prior to their submission to the federal Department of Health and Human Services.

How the New Hampshire Expansion Compares to Other Recent State Expansions

New Hampshire’s decision to rely on a Medicaid premium assistance program for coverage of its expansion adults builds on the Arkansas and Iowa waivers, which also rely on premium assistance, with an emphasis on personal responsibility. (In New Hampshire, that includes a particular focus on inappropriate emergency room use, as well as cost sharing, wellness programs and assistance in finding employment.) Like Iowa, New Hampshire is coupling its QHP premium assistance program with a mandatory HIPP program for Medicaid-eligible adults who have access to ESI.

While New Hampshire had recently initiated a Medicaid managed care program, the proposed legislation deploys Medicaid managed care plans only as an interim coverage vehicle until the QHP premium assistance program can be approved and operationalized. By amending existing managed care contracts, New Hampshire will be able to initiate the expansion relatively quickly and take maximum advantage of the three years of 100% federal funding.