Another State Is About to Adopt Obamacare’s Medicaid Expansion

The New Hampshire House voted to approve the measure Tuesday.

Maryland Governor Martin OMalley (L), New Hampshire Governor Maggie Hassan (R) and others walk from the residence of the White House on February 21, 2014 in Washington. Members of the Democratic Governors Association spoke to the press after attending a meeting with US President Barack Obama and US Vice President Joe Biden. AFP PHOTO/Brendan SMIALOWSKI 
National Journal
Sophie Novack
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Sophie Novack
March 25, 2014, 11:48 a.m.

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.

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