Positives and Major Flaws with SB 313, NH’s Medicaid Expansion Reauthorization Bill

The following is a copy of Granite State Progress & Education Fund testimony to the State Senate Finance Committee on SB 313, the Medicaid expansion reauthorization bill.

Chairman Gary Daniels
Senate Finance Committee
New Hampshire Senate
Concord, New Hampshire, 03301

February 20, 2018

RE:       SB 313, Reforming New Hampshire’s Medicaid and Premium Assistance Program

Dear Chairman Daniels, Vice Chairman Reagan, and Committee Members,

Thank you for the opportunity to provide testimony regarding SB 313, Reforming New Hampshire’s Medicaid and Premium Assistance Program.  Granite State Progress & Education Fund supports Medicaid expansion reauthorization and the underlying goals of this legislation.

Granite State Progress & Education Fund is a multi-issue advocacy organization working on issues of immediate state and local concern. For the last decade, our organization has engaged in activities to increase access to quality, affordable health care in New Hampshire, and to ensure consumers know about the programs and protections available to them.

Medicaid expansion reauthorization is critical to ensure 50,000 lower income Granite Staters have access to quality, affordable health care.

New Hampshire has come together time and again to craft an innovative, bipartisan solution to draw down federal dollars and expand access to health care coverage in New Hampshire. As Governor Chris Sununu said in his State of the State, we all agree Medicaid expansion should be reauthorized – it’s just a matter of how we do it. As the legislature works to craft a uniquely New Hampshire solution, we call on you to focus on reducing barriers to coverage in order to improve the lives of Granite Staters and keep our state healthy and strong.

Positive aspects of the current version of SB 313, which we support, include:

Reauthorization for 5 years, which is a positive step toward providing stability for Medicaid expansion enrollees;

Establishing behavioral health rates sufficient to ensure access to, and provider capacity for, all behavioral health services including substance use disorder services;

Establishing the Granite Workforce Pilot Program to promote job and work preparation in high labor need areas, such as health care, advanced manufacturing, construction and building trades, information technology, and hospitality; and to create a network of assistance to eliminate barriers to work such as transportation and child care issues;

While the bill establishes a work requirement, which is not ideal, we do appreciate that it provides exceptions for those who participate in community engagement activities such as job training, job search assistance, educational training (GED, college, or vocational), community service, caregiver responsibilities, and substance abuse disorder treatment.

We are similarly pleased to see the current bill includes having MCO’s (Managed Care Organizations) help people enroll in private health insurance when they are ready to transition out of the program. Over the last several months our organization conducted a statewide public education and publicity campaign to inform Granite Staters how to enroll in the private health insurance marketplace before the annual deadline, an effort which involved direct mail, digital content, neighbor to neighbor outreach, and enrollment fairs throughout the state. Medicaid expansion enrollees will not have the benefit of a massive public education drive to educate and inform them about how to get enrolled, and that is why it is critical that we create a system that helps them sign up and reduces potential gaps in coverage.

These are all provisions that will help ensure our program remains strong and stable while taking into consideration the very real situations facing Granite State families, and which we encourage you to keep in place as legislative debate continues.

We also have major concerns with parts of the bill that the committee will need to address:

Continuity of Care – We are pleased to see that the current bill includes prior authorization for treatment and medications when a consumer transitions from the premium assistance program to MCO’s. This is a critical provision to ensure no one loses care during transitions from one program to another. We would further encourage the legislature to consider expanding prior authorization from 90 days to 120 or 180 days. If the MCO’s are doing their job, an individual should not need prior authorization for that long but this is a safeguard we can build in for Medicaid expansion enrollees, and one that will incentivize MCO’s to ensure the new care plan is quickly put into place.

Incentives – The bill mentions incentives and it makes sense to include them to lower health care costs, as long as they are pro-active measures to encourage positive behavior, rather than policies that penalize or increase barriers to coverage. We urge the legislature to make it clear that the legislative intent is to provide incentives like wellness classes or gas cards for individuals who take pro-active steps to lower health care costs, rather than harmful measures like increased cost-sharing that only hurts Granite State families trying to utilize the health care we want to make sure they have available.

For example, if I am a parent working two jobs and have a child with a high fever, I may not have the time to wait and take my child to a primary care physician in the morning. If I work at a job without earned sick leave, I might be risking my employment or my income to stay home multiple days. A family should not be penalized for having to make tough decisions, but they could receive incentives for making less costly choices when possible.

Medicaid Expansion Work Requirement & Barriers to Coverage – Creating and enforcing work requirements has been found to be cost-ineffective and burdensome, and we have included a recent article from Governing that speaks to this reality. As it appears the New Hampshire legislature is committed to this idea, we call on you to craft a program that reduces the barriers that create the need for a program like Medicaid expansion in the first place. The current bill seeks to do this in two ways: it creates work requirement exceptions for those in education or job education, or those with caregiving responsibilities or undergoing substance use disorder treatment; and it establishes the Granite Workforce Pilot Program to eliminate barriers to work such as transportation and child care issues. We urge the legislature to strengthen these provisions by:

Including exemptions for parents of young children. While parents or caretakers for children under 6 years of age are excluded from the work requirement, this exemption should be adjusted up to age 16 – or at least an age at which a young child could be left home alone unsupervised after-school unless child care is provided by the State of New Hampshire.

Expanding Granite Workforce Pilot Program and establishing a two-year pilot program to ensure adequate data. While SB 313 establishes the Granite Workforce Pilot Program to eliminate barriers to work such as transportation and child care issues, the pilot program is only slated for 6 months which is barely enough time to set up a program with an individual let alone implement and evaluate it, and only includes referrals. A pilot program of at least two years and which addresses those barriers directly would provide more data. But more to the point – the work requirement will continue even after the pilot program ends, jeopardizing health care for people who experience those barriers, so as long as the work requirement is in place, New Hampshire should have a wrap-around network. Work requirements without serious barrier reduction efforts only set people up to fail. Lastly, TANF funds can only be directed to childless adults 18 through 24 years of age, so SB 313 currently leaves a huge barrier gap for those older than 24 years of age.

Funding – SB 313 funds the state portion of Medicaid expansion, in part, by adding more funding to the alcohol abuse prevention and treatment fund and then allocating that to the Medicaid expansion program. We cannot expand Medicaid by cutting other key public health programs. The legislature needs to amend the bill to assert that the alcohol fund will not dip below funding levels as of January 1, 2018 for any program or service that would have been funded from the fund originally.

It is the responsibility of Governor Sununu and the legislature to craft a New Hampshire solution that continues access to health care coverage in our state.

We encourage you to listen to the testimony provided here today and to take into consideration these points as you finalize the New Hampshire Granite Advantage Health Care Program. If our organization can be of any assistance, please do not hesitate to contact us.