Days after the release of a critical letter from a federal agency, U.S. Sen. Maggie Hassan is defending the Medicaid expansion plan she signed into law as New Hampshire’s governor.
In an interview in Keene Monday morning, Hassan, a Democrat, said the expansion program — and its funding structure — was vetted by outside legal experts before it was signed and that it complies with federal law. And she pushed back at the federal agency, Centers for Medicare and Medicaid Services (CMS), for its criticism of New Hampshire’s arrangement.
“This is a deliberate attempt by the Trump administration to undermine our bipartisan Medicaid expansion program,” Hassan said in response to questions following a tour of the Corning Specialty Materials plant in Keene.
The comments came after the office of the present governor, Republican Chris Sununu, released a July 25 letter sent to him by CMS, which raised concerns that the funding arrangement for the program is illegal. CMS, a subset of the U.S. Department of Health and Human Services, administers major federal insurance programs, including Medicaid. The Medicaid expansion program, established by the Affordable Care Act in 2010, allows states to opt into expanded Medicaid payments as long as the state finances a small portion of its overall fund.
New Hampshire’s expansion program, signed into law in April 2016, relies on donations by insurance companies and hospitals to pay for the state’s portion of that federal government program. Those contributions were key to attracting enough support in the Legislature to pass the bill after Republicans called state-sponsored funding a non-starter.
But the CMS letter, released by Sununu’s office Friday evening, argues that the arrangement is illegal and asks Sununu and the N.H. Legislature to amend the law before any attempt is made to renew the program next year.
Federal Medicaid laws prohibit provider-related donations, barring limited circumstances, the letter states. New Hampshire’s hospitals and insurer donation system has a direct connection between the money donated by providers and the benefits those providers receive — according to the letter, that makes the system in violation of the law.
The letter explicitly asks for legislative change. Barring that, CMS would withhold funds to the program after 2018, effectively ending the program.
“While CMS has concerns that New Hampshire may be out of compliance with federal requirements, we expected that by the end of New Hampshire’s next legislative session, changes will be put in place …” the letter says.
In her comments Monday, Hassan pushed back at the federal department’s findings, calling the letter a “deliberate attempt by the Trump administration to undermine our bipartisan Medicaid expansion program.”
Without addressing the letter’s concerns directly, Hassan said she was aware of the issues as governor when the bill was being worked on, as they had been raised by Republican legislators. She added that as governor, she herself had been approached by CMS — then under the Health and Human Services department of the Obama administration — “as Republicans predicted I would years ago.”
But Hassan said she had defended the legal merits of New Hampshire’s Medicaid expansion to the Obama administration when it raised its concerns, and that she had successfully convinced CMS to continue funding the program. She chalked up her effort as within the standard practice of negotiations.
“There’s always ongoing concerns every time you create something new in Medicaid,” she said. “You always have to deal with the federal government.”
Sununu, for his part, says he “immediately began comprehensive negotiations” after first learning that CMS was looking into the payment structure, in June, he said in a statement.
Sununu, who voted against Medicaid expansion efforts as a state executive councilor in 2013 and 2014, has frequently defended the program in recent years, particularly in the face of attempts in Washington to impose heavy cuts.
But in his statement, he said that legislative changes to New Hampshire’s funding scheme will still need to be made ahead of the start of 2019.
It’s unclear whether those changes will be approved. Medicaid expansion has long been controversial within the Legislature, and doubts had already been raised that state lawmakers would choose to renew the program a third time, before it “sunsets” in December 2018.
But speaking on the way forward, Hassan said Sununu should continue to defend the law.
“I think that our Department of Justice, our outside experts put together very good information about the fact that our bipartisan Medicaid expansion program complies with federal law,” she said.
“I continue to believe it does, and I think governors always have to work with the federal government on their Medicaid programs. I think Governor Sununu needs to continue to do that, and obviously if I can be of assistance, I’m happy to do that too.”