With all due apologies to The Bard, it’s starting to look like last week’s brouhaha over the state’s effort to impose a work requirement on certain Medicaid recipients was a lot of sound and fury of little immediate consequence.
First of all, there’s no chance that federal funding for the overall Medicaid expansion program, which now provides health insurance to 53,000 state residents, will be jeopardized by the ongoing debate over work requirements, according to DHHS Commissioner Jeffrey Meyers.
The work requirement is only one part of the program, and it doesn’t take effect until later in the year. The rest of the program is approved and will launch as planned on Jan. 1, despite a unanimous vote by the Joint Legislative Committee on Administrative Rules on Thursday to oppose changes to the work requirement rules imposed by the federal government.
Republicans and Democrats agreed to the work requirement as part of the bipartisan compromise extending the program, which is 90 percent federally funded, for another five years. The current version of Medicaid expansion, known as the New Hampshire Health Protection Plan, expires on Dec. 31, to be replaced by the Granite Advantage Health Care Program.
The most significant change is that beneficiaries in the Granite Advantage program will get their government-funded health insurance from managed care organizations that contract with the state, just like the other 100,000-plus low-income individuals on traditional Medicaid, and not from plans on the Obamacare exchange, as was the case with NHHPP.
Also new to expanded Medicaid in 2019 is the work requirement for certain able-bodied adults. The federal government threw a wrench into the state’s plan by changing the terms of those work requirements.
Despite the JLCAR vote on Thursday to oppose those changes, Meyers says he is pressing ahead with the program as modified by the federal government, since he has no other choice.
“SB 313 (the state law extending expanded Medicaid for another five years) requires me in my capacity as commissioner to implement the work and community engagement requirement in accordance with the waiver issued by the Centers for Medicare and Medicaid,” he said. “No commissioner can choose which laws they will comply with and which they will not.”
According to Meyers, DHHS is moving forward to start the work and community engagement requirement on March 1, 2019. Under that timeline, the requirement won’t take effect until June, and no one could lose coverage for non-compliance before August 2019.
The number of expanded Medicaid recipients who may be subject to the new work and community service requirements could be as high as 15,000, according to DHHS estimates. Opponents of the work requirement claim that the pool will be rather small, since most Medicaid recipients who can work are already working. But time will tell.
Under state law, agencies like DHHS can implement new rules over the objection of JLCAR within 50 days of the agency’s response to the objection. “DHHS will be filing its response to Thursday’s objection before the next JLCAR meeting,” Meyers said. “It is my hope that the committee will reconsider and approve the interim rule based on our response.”
Meyers believes that he can make a solid case that the work rules issued by CMS are consistent with the bipartisan compromise that led to SB 313 and will not be unfair to expanded Medicaid recipients. Democrats want a work requirement that will not result in anyone losing coverage.
“Senate Democrats made it clear last session that we would not vote for a Medicaid expansion program that kicks anyone off of their coverage,” said Sen. Dan Feltes, D-Concord. “Unfortunately, the Trump administration ignored two years of bipartisan compromise and proposed changes that do just that.”
Republican leaders in the House and Senate agree with Meyers that the changes amount to minor tinkering not significant revision that will endanger coverage on a widespread basis.
The fact that the four Republicans on JLCAR voted with the Democrats to oppose the federal changes to the work requirement was somewhat of a head-scratcher. Feltes made clear two weeks ago that Democrats would challenge the changes at the Dec. 20 JLCAR meeting, so Republicans had plenty of time to get organized.
Republican Sen. John Reagan of Deerfield, who served as chair of JLCAR for the past two years but has moved to the vice chair position under the Democratic majority, said leaders should have made their position clearer.
“It is the lack of input from our leadership resulting in strange votes,” he wrote in an email. “Also we are all subject to the Feltes for governor campaign, which seems in the offing.”