HARRIS MEYER July 08, 2019
Facing mounting fears about likely coverage
losses, New Hampshire's Republican Gov. Chris Sununu announced Monday that he
is delaying implementation of the state's Medicaid work requirement program for
120 days.
In addition, Sununu signed a Democratic-sponsored bill that would halt the work
requirement if 500 or more people are disenrolled due to noncompliance, or if
providers report an increase in uncompensated care resulting from beneficiaries
being disenrolled due to noncompliance.
Many of New Hampshire's nearly 50,000 Medicaid
expansion enrollees faced a deadline of July 7 to provide evidence that they
met the monthly requirement in June of working, volunteering or attending
classes or qualified for an exemption. If they fail to report, they have one
month to fix the issue before losing benefits. The first cut-offs would occur
on Aug. 1.
But nearly 18,000 people either had not reported
they had met the community engagement requirement or that they qualified for an
exemption, the state Department of Health and Human Services said. State
officials said many enrollees remained unaware of the reporting and work
requirements despite mailings, phone calls, and a door-knocking campaign.
Patient advocates blamed the complexity of the
reporting process.
Concerns about nonreporting, along with the
chastening experience with a Medicaid work requirement in Arkansas—where more
than 18,000 expansion enrollees were booted out last year due to nonreporting
or noncompliance—prompted New Hampshire Democratic lawmakers to pass a bill in
May establishing a coverage loss cap and adding more exemptions.
New Hampshire is the second state to enact this
type of guardrail against coverage losses resulting from a Medicaid work
requirement. In May, Montana enacted a bill requiring a re-evaluation of
its new Medicaid work requirement if more than 5% of the 96,000 low-income
adults currently enrolled were disenrolled due to noncompliance.
This is the latest setback for the Trump
administration's policy of encouraging states to adopt work requirements, a
centerpiece of its Medicaid policy.
Meanwhile, U.S. District Judge James Boasberg in
Washington is scheduled to hear arguments July 23 in a lawsuit seeking to invalidate the CMS' approval of New
Hampshire's work requirement waiver. In March, Boasberg struck down the agency's approval of similar
waivers in Kentucky and Arkansas on the grounds that the agency did not adequately
consider the potential impact on coverage losses.
New Hampshire's waiver has some of the toughest
provisions of any of the nine state work requirement demonstrations the CMS
approved so far. Its requirement applies to low-income, nondisabled adults ages
19 to 64 who are eligible for the program, including parents of children ages 6
and older.
The waiver requires beneficiaries to report at
least 100 hours per month of work, job training, education or volunteer
activities, compared with 80 hours in other states. They face suspension the
month after failing to report the required level of community-engagement
activities, rather than losing coverage only after repeated months of failure
to comply, as in other states.
The new law reduced the minimum monthly hours of
community engagement activities from 100 to 80.
The New Hampshire Hospital Association, which
had raised concerns about the work requirement's impact on coverage, continuity
of care, and uncompensated care, applauded Sununu's decision to sign the bill.
"The state is taking a proactive step in
ensuring these individuals maintain their insurance coverage, which is vitally
important to the health and well-being of our state," said Steve Ahnen,
the hospital association's CEO.
Joan Alker, executive director of the Center for
Children and Families at Georgetown University, said enactment of the New
Hampshire law is a recognition that work requirements "are fundamentally
flawed as they don't help people get work. Coverage losses from work
requirements are inevitable and that makes families more economically insecure
as a result."
New Hampshire Republican lawmakers, who did not
support the delay or changes in the work requirement, called the bill a
betrayal of the bipartisan political compromise reached in 2017 to extend the
state's Medicaid expansion while establishing the work requirement.
Sununu's office did not respond to requests for
comment.
It's not clear whether the new state law will
affect the federal lawsuit challenging the New Hampshire work requirement
waiver.
Jane Perkins, legal director at the National
Health Law Program, one of the lead attorneys for the plaintiffs challenging
the work requirement, said she didn't know if the lawsuit would be affected
because she hasn't seen the specifics of the legislation.
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