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ACA insurance contract set for vote

State House Bureau

July 01. 2014 8:03PM

CONCORD — The state Insurance Department wants to extend a contract with a Boston consulting firm to help the agency implement new regulations and oversight of health care policies for the NH Health Protection Program.

The act approved this year expands Medicaid eligibility under the Affordable Care Act, by using private health insurance purchased through the state and federal marketplace to pay health care providers.

The department, which continues to regulate and review commercial carriers and the policies they offer on the electronic marketplace, would also have to review the private coverage for Medicaid requirements.

The new Medicaid recipients will have to move from the managed care Medicaid program to private insurers beginning in 2015, if the state waiver is approved by federal health regulators.

The Medicaid guidelines will require the department to alter its Qualified Health Plan (QHP) certification process, the department said.

The request, which goes before the Executive Council at its meeting beginning at 10 a.m. Wednesday in the State House, is to extend the contract with the Public Consulting Group, Inc. from Dec. 31, 2014 to Dec. 31, 2015, and increase the price from $530,000 to $2 million.

“Public Consulting Group is uniquely positioned to provide the services as It has been instrumental in creating and implementing new workflows, production standards and tools to support the certification and regulation of Qualified Health Plans for the NHID,” said Insurance Commissioner Roger Sevigny in a letter to Executive Councilors.

He said the company will help to design and implement the program, work with stakeholders and monitor the program once it is up and running.

The insurance department, Health and Human Services and the federal Center for Medicaid Services will have to work together to ensure continuity of care for all persons covered under the qualified Health Plans as they move between different types of coverage, Sevigny said.

The contract will be paid for with federal funds.

Greg Moore of American For Prosperity NH and Medicaid expansion opponent said it would make more sense to wait until the state has received the federal wavier to use private commercial insurance before extending the contract.

“It would make a lot more sense to wait until we hear if there are waivers in place, particularly when a state is asking for a waiver of a type that hasn’t been granted before, and is an open question whether it will be approved,” Moore said. “If the waivers aren’t granted, Commissioner Sevigny will have wasted a ton of taxpayer money for absolutely nothing.”

After more than a year of disagreement, lawmakers finally agreed on a Medicaid expansion plan earlier this year.

Registration for one part of the plan began July 1, while state officials wait to hear whether CMS approves amendments to the state Medicaid plan before implementing the rest of the program.

About 50,000 low-income, working adults are expected to be eligible for Medicaid coverage under the program.

The federal government pays 100 percent of the costs during the first three years of expansion and then gradually reduces its share to 90 percent after seven years.

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