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Senate GOP unveils Medicaid expansion plan

New Hampshire Union Leader

February 17. 2018 6:58PM

CONCORD - Senate Republican leaders released late Friday a long-awaited plan for revamping Medicaid expansion.

The plan would claim 5 percent of state liquor-sale profits to serve as a taxpayer match for the New Hampshire Granite Care Advantage Health Care Program.

As expected, the proposal includes a work requirement for all Medicaid recipients, moves clients from private insurance to managed-care coverage and would extend the life of the program five years, to the end of 2023.

Senate President Chuck Morse, R-Salem, said the Trump administration has been briefed on the proposal but has yet to decide whether it complies with the federal Affordable Care Act.

"This is a completely new, redeveloped and reenergized program that maintains many of the New Hampshire-specific goals we've included in previous programs, but incorporates new ideas and strategies for improving overall health and providing key health care resources like substance-abuse treatment programs and opportunities for personal growth, including a multi-faceted work requirement aimed at improving the quality of life for those in the expanded population," Morse said in a statement.

Senate Majority Leader Jeb Bradley, R-Wolfeboro, said moving clients to managed care would save federal taxpayers $200 million a year.

The plan is to use recaptured savings to support grants from an existing, 3.4 percent of gross liquor profits currently spent on substance-abuse treatment and not only for those on Medicaid.

"We believe we can make the case with the federal government that the savings will be more than enough to support existing grants out of the alcohol fund going forward," Bradley said.

Private insurance plans in the individual market experienced rate increases as high as 52 percent this year due to higher-than-expected costs they incurred to cover the Medicaid population.

To lower costs, this plan would include screenings for behavioral health and substance abuse, he said.

"Those exempt from the 25-hour-per-week work requirement would include the disabled and the medically frail," he said.

Others could seek from the state a "good cause" exemption for such reasons as the death of a family member or a "life-changing event" such as divorce or domestic violence.

"We think it's very realistic; it's not meant to be punitive at all and there are numerous ways to satisfy it other than work, including education and job training," Bradley said.

State Rep. Cindy Rosenwald, D-Nashua, served on the Medicaid commission and said she'll be looking to offer changes to expand those work exemptions to include single-mothers with children between the ages of 6 and 12 years old.

"I think we all can agree that giving these folks a pathway to a job is the best thing for them and the state's economy," Rosenwald said.

"We need to understand that some of these people have real barriers to being able to do that."

Greg Moore, state director of Americans for Prosperity, said some of these changes are laudable but they don't alter his group's opposition to Medicaid expansion.

"Our opposition, which has been consistent and ongoing, hasn't changed," Moore said. "This still leaves an entitlement program, which in the future is not sustainable for the state, and could leave taxpayers holding the bag for even higher costs as Congress looks to get out from under a failed Obamacare model."

Senate Democrats proposed amending the state Constitution to require that 5 percent of the gross liquor profits be spent on substance-abuse treatment and recovery.

All Senate Republicans voted Thursday to kill that proposed amendment and it died on 14-10 vote.

Senate Democratic Leader Jeff Woodburn of Whitefield said he'll ensure the legislation continues coverage for the 50,000 clients.

"After several months of work, we must continue to work together in a bipartisan way, build from the unanimous recommendations of the Medicaid commission, ensure we don't arbitrarily kick anyone off of health insurance, and actually help break down barriers to work," Woodburn said in a statement.

Bradley said it was encouraging that House and Senate Democratic leaders Friday did not oppose the plan outright.

"We remain optimistic that we can build bipartisan support for this proposal," Bradley added.

A public hearing on SB 313 is set for Tuesday afternoon in Representatives Hall.

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