New Hampshire Union Leader December 27, 2018
Dec.
27--CONCORD -- Continuing the expansion of Medicaid health insurance to
more than 50,000 low-income New Hampshire residents was supposed to
be last year's legislative battle. But as 2019 dawns, the program now known as
Granite Advantage Health Care is again atop the legislative agenda.
In one of her first
acts as a state senator, former state Rep. Cindy Rosenwald, D-Nashua, will
soon introduce legislation dealing with work requirements for Medicaid
beneficiaries. The bill has been "filed confidentially" according to
a state Senate spokesman, and its language is not yet ready for
public release.
One bill that has
been filed publicly by newly elected Concord state Rep. Rebecca
McWilliams would remove the work requirement from the Granite Advantage
program.
At issue is the
question of whether able-bodied adults not involved in caring for a dependent
child should be required to work or engage in community service or job training
for at least 100 hours a month to qualify for the federally funded health
insurance.
That work requirement
was a key part of the deal struck between Republicans and Democrats in
2018 to extend the program, seen as essential in the fight against opioid
addiction, for at least another five years. It was scheduled to sunset
on Dec. 31.
The federal government,
through the Centers for Medicaid and Medicare, approved the work
requirement last week, but with some changes to the rules governing
eligibility.
That set off a
firestorm in Concord, where Democrats accused the Trump
administration of tinkering with a carefully crafted compromise in the hope of
dumping eligible recipients off their health insurance.
Fears of confusion
The changes will be
"expensive to administer and cause confusion, chaos and loss of coverage
for thousands of people," according to Dawn McKinney, policy director
at N.H. Legal Assistance, which advocates for low-income families.
Rosenwald's bill
will "codify New Hampshire-specific rules in state law,"
according to a statement from the Senate Democrats, in an attempt to push
back on the federal changes.
Republicans at
the State House say the federal changes are minor and consistent with
principles both parties agreed to in passing Senate Bill 313, the expanded
Medicaid reauthorization. They want the state to accept the federal rules and
move on, warning that any state challenge to the changes puts the federal
approval at risk.
Department of
Health and Human Services Commissioner Jeffrey Meyers also thinks the
federal changes can be accommodated without violating the spirit of the SB 313
compromise.
Republican leaders
in the State House in the days before Christmas suggested
that Democrats never really liked the work requirement and were
trying to use the rules process to upend it.
"This was
negotiated in good faith, and compromises were reached on both sides,"
said House Minority Leader Dick Hinch, R-Merrimack. "Clearly, this is
an organized effort by Democrats to bypass the bipartisan agreements
made just this year."
The key question
is, how onerous are the federal changes? Both sides are far apart on that
analysis, and the details are incredibly complex.
Vote applauded
McKinney applauded
the Dec. 20 vote by the Joint Legislative Committee on
Administrative Rules to object to the federal changes.
"The rejected
rule would subject some people who rely on Medicaid for their health coverage
to harsh work reporting requirements," she said. "Objecting to the
proposed work requirement rule was a responsible decision, given the potential
ramifications."
According to
McKinney, almost 17,000 people have lost their Medicaid coverage
in Arkansas since September, due to that state's work requirement.
"Kentucky has
been mired in litigation over this issue for months with no resolution in
sight," she said. "New Hampshire Legal Assistance is working hard
with our partners in other organizations to make sure the same thing doesn't
happen here."
According to DHHS
figures, about 45 percent of the population on expanded Medicaid is already
working full- or part-time, and another group will qualify for one of several
exemptions from the requirement, leaving as many as 15,000 recipients facing
the work or community service mandate.
Despite warning
alarms sounded by Republicans, McKinney, Meyers and others maintain the
state's pushback on the federal rule change will not jeopardize Medicaid
coverage scheduled to take effect on Jan. 1.
"Our state
leaders have time now to develop a common-sense, bipartisan New
Hampshire solution," says McKinney. "Hard-working New
Hampshire families don't need any more red tape. They need health care coverage
so they can stay healthy and continue to provide for their families."
___
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