New Hampshire is about to become the next state to adopt the Affordable Care Act's expansion of Medicaid.
The Democratic-controlled House voted 202-132 to approve the expansion plan Tuesday, extending coverage to adults below 138 percent of the federal poverty level. The Republican-controlled Senate passed the bipartisan bill 18-5 earlier this month.
The Senate bill will be sent to Democratic Gov. Maggie Hassan as early as this week. Hassan has already said she will sign the legislation.
The bill will expand Medicaid — a state-run, federal program to provide health insurance to people with low incomes — to over 50,000 New Hampshire residents.
The plan seeks a premium assistance model for Medicaid expansion, similar to that implemented in Arkansas. The state would accept federal funds and use them to buy private insurance plans for low-income individuals on the exchange.
However, the private model will require a waiver from the Centers for Medicare and Medicaid Services, a process that can be quite lengthy. In the meantime, the state plans to move the majority of the newly eligible residents onto the state's Medicaid managed-care program beginning July 1.
An estimated 12,000 adults could begin getting covered in just a month through an existing program to subsidize employer-based coverage, according to the Associated Press. The remaining 38,000 will be put on the Medicaid managed-care program until the federal waiver is approved in 2015, and will be transitioned to the private market following CMS's response.
If the waiver is rejected, the coverage for these individuals would be phased out over the course of three months.
Under the ACA, the federal government will cover the full cost of expansion for the first three years, after which it will gradually drop to 90 percent, where it will remain. The New Hampshire plan requires the Legislature to reauthorize the program once federal contributions drop below 100 percent at the end of 2016.
"This bipartisan plan is a uniquely New Hampshire solution and it exemplifies New Hampshire's tradition of collective problem-solving, demonstrating what is possible when we remain focused on solutions and reach across the aisle to achieve progress for our people," Hassan said in a statement Tuesday.
"I look forward to signing this bill into law as quickly as possible and to working with members of both parties throughout the implementation process in order to maximize the benefits of health care expansion for our people and economy."
Under the Affordable Care Act as passed, Medicaid expansion was mandatory nationwide, but the Supreme Court struck down that portion of the law and left the decision to each state.
States may change their decision on Medicaid expansion at any point, and a handful have already shown signs of movement. New Hampshire pushes the tally to 26 states plus the District of Columbia that have opted in to expansion, while 19 are not currently participating.
Five states still remain undecided: Pennsylvania, Virginia, Missouri, Utah, and Indiana.