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A Waiver-less Medicaid Expansion

August 15, 2013 Common Cents

Designing a “New Hampshire approach” to extending health insurance to more Granite Staters via Medicaid includes options that do not require special waivers from the federal government.

One option is to ramp up an existing program called the Health Insurance Premium Payment (HIPP) program. HIPP allows people who qualify for Medicaid but who have coverage from their employers to keep that private coverage, with Medicaid paying their premiums. This is less expensive than covering all of a worker’s medical needs via Medicaid, and New Hampshire already has the authority to run this program so long as it is voluntary.

Given that New Hampshire has a higher proportion of its people covered with employer-sponsored insurance than other states, this is a way to ensure that the new Medicaid funds coming from the federal government go largely to the low-income workers in N.H. who remain uninsured.

The N.H. Department of Health and Human Services estimates that encouraging the use of HIPP could maintain the private coverage of roughly 13,000 newly-eligible Medicaid beneficiaries.  This would effectively prevent most of the potential migration from private to public coverage, called “crowd out,” which critics of Medicaid expansion fear.

Furthermore, this route does not delay the state’s ability to extend Medicaid to low-income families starting on Jan. 1, 2014 and allows the state to take advantage of the 100 percent federal funding through 2016.

If New Hampshire wants to go beyond a voluntary program and make enrollment in private market coverage mandatory, like Arkansas is attempting to do, New Hampshire would have to seek special permission from the Centers on Medicare and Medicaid Services – namely a waiver.  The process is time consuming and could delay the state’s ability take full advantage of the 100 percent federal match.

However, even without a waiver, the state can work with the private managed care companies to create insurance products for the new Health Insurance Marketplaces that would provide a bridge to private-market coverage for beneficiaries whose incomes grow beyond the Medicaid eligibility level. This way, workers are assured they will remain in the same network of providers, minimizing the cost and disruption of outgrowing Medicaid.

New Hampshire can leverage private-market solutions while maximizing the federal aid by using HIPP without going through the rigmarole of a waiver process.  It can accept the federal funds now while taking time to create new pathways to the private market for those beneficiaries who will need it most.

 

 

 

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