The New Hampshire Governor's Commission on Medicaid Care Management is recommending expanding Medicaid eligibility under the Affordable Care Act, "due to its necessity" in transitioning the state's Medicaid program from fee-for-service to managed care.
The commission, convened by Democratic Governor Maggie Hassan, said that expanding Medicaid eligibility would make the new care management system "more efficient and more cost-effective" and would alleviate the problems of fragmented care for low-income patients' uncompensated care for providers.
"Serving a larger group means lower administrative and other program costs per capita. The larger the managed care pool, the better and more efficient and more cost-effective the care system opportunity," wrote the commission, which is chaired by Mary Vallier-Kaplan, former VP of the New Hampshire Endowment for Health, and includes a former health department commissioner and representatives from providers and advocacy groups.
[See also: Questions abound in Arkansas' private Medicaid option]
The commission also said that New Hampshire's new Medicaid managed care program, called a care management system, is largely predicated on eligibility expansion. The state's contracts with three managed care organizations -- Meridian Health Plan, Centene and Boston Medical Center HealthNet's Well Sense -- have the expansion population built into their implementation plans.
"Rejection of the expansion," the commission said, "would jeopardize ongoing MCO participation, put projected savings to the State at risk, and threaten to make care management untenable."
Hassan, a former attorney for Partners Healthcare and the former Democratic state Senate leader, has called for Medicaid expansion and included it in her two year budget proposal.
The New Hampshire Senate, where Republicans have a two-member majority, may be debating the issue over the next few days. Backed by the Senate President, Republican Peter Bragdon, the state Senate finance committee removed expansion from the budget bill, but included a provision creating a commission to study the possibility of expanding Medicaid through private insurance (a la Arkansas' "private option") options for increasing state flexibility and the impact of expansion on providers.
The full Senate will vote on the budget bill June 6, and will likely have to negotiate with leaders from New Hampshire's 400-member House -- where Democrats have a majority -- before the new fiscal year begins July 1.
Medicaid eligibility expansion would bring insurance to approximately 58,000 New Hampshire residents, along with $2.5 billion in federal funding over the next seven years, according to the Governor's estimates.