New Years Day 2019 marked the launch of Granite Advantage Health Care Program. The program officially replaces the New Hampshire Health Protection Program (NHHPP)/Premium Assistance Program (PAP) as the states Medicaid expansion plan.

Since New Hampshire expanded its Medicaid coverage in 2014, over 120,000 people have moved through the program, with 53,000 currently enrolled.

Granite Advantage was signed into law in 2018, and marks a five-year extension of the Medicaid expansion program.

I’m old enough to know what it was like before we had Medicaid expansion, said Sen. Tom Sherman (D- District 24), an advocate for Granite Advantage. This provides coverage for comprehensive services. Its the single most important aspect of our fight with substance abuse and mental health

A controversial component of the new plan is that it requires able-bodied adults aged 19 to 64 to complete 100 hours a month of community engagement, also known as a work requirement. If 100 hours is not met the individual risks being locked out of benefits.

In addition to working, recipients can meet their 100 hour requirement with job training, volunteering or substance use disorder treatment among other approved activities.

New Hampshire will join five other states with work requirements for Medicaid recipients. The requirements are granted by a federal waiver as a way for states to modify the Medicaid expansion programs created by the Affordable Care Act (ACA).

Although there is no data yet to support the effectiveness of tying work requirements to benefits, advocates see them as a way to promote independence and hopefully allow people to find employment which will provide employer-based insurance.

I can understand where supporters are coming from, said Sherman. It is important that people on assistance are working towards being self sufficient, although data shows most people are moving through – not sitting on Medicaid benefits.

Opponents point to the additional burden placed on state infrastructure and low income workers, many of whom may have unstable hours, unpredictable child care and transportation issues.

We had fear and concerns from the beginning that the way its drafted could lead to loss of coverage said Jake Berry, vice president of policy for New Futures, a New Hampshire non-partisan health advocacy group. Well be watching to see what happens.

Another major change in Granite Advantage is the way care will be delivered. The new plan will use a Managed Care Organization (MCO) to deliver services versus private insurance companies.

When our state went with private pay some of us said it would be more expensive and it was, said Sherman, who recalled the state considered an MCO originally in 2014 but opted to purchase private insurance plans. The switch is anticipated to save taxpayers approximately $200 million.

MCOs have been shown to curb the high cost of health care by building networks of providers and facilities contracted at a specific rate. The plans utilize a total care approach which is better for helping patients manage chronic conditions and adapt healthier life styles, among other elements.

New Futures is working along with the state to make sure all enrollees are aware of the new changes. Medicaid expansion is absolutely essential we need to make sure we make it work for as many people as possible, said Berry.

The state will hold seven public forums across New Hampshire in January,

The forum on the Seacoast will be held in Portsmouth, Tuesday, Jan. 29, 2019, 3 p.m. -4:30 p.m., Portsmouth Public Library, 175 Parrot Ave.

Were not talking about socialized medicine or government run health care were talking about health coverage, said Sherman, who noted insured individuals live longer and contribute more. We all benefit from a healthy population whether its lost wages, lost work, people depend on their health for financial stability.

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Work requirements now included in new state Medicaid plan –