NH Legislators to Make Important Decision on Medicaid Expansion

With the inception of the Affordable Care Act (aka Obamacare), states had the option to expand eligibility for the public Medicaid health insurance program that serves low-income individuals and families. The federal government would pay 90 percent of the expanded program costs. Individual states were to cover the rest.

Medicaid “Expansion” was accomplished by raising the income limit for applicants to qualify for Medicaid. Those eligible for Medicaid pay no health insurance premiums and the cost of their health care is paid by the state and federal government.

In 2014, the New Hampshire Legislature voted to expand eligibility for Medicaid on a trial basis for two years. It has since voted twice to continue the program and must decide whether to do so again this legislative session.

More than 80 organizations have formed a coalition urging legislators to pass SB 263 to permanently reauthorize Medicaid expansion in New Hampshire. Without reauthorization, benefits are set to end on December 31, 2023 for an estimated 50,000 to 60,000 people.

Increasing access to health care coverage for children and their families is a priority of the New Hampshire Children’s Health Foundation.

Many Granite Staters benefit from expanded Medicaid

According to a recently released report by the New Hampshire Fiscal Policy Institute, in the last fiscal year alone, more than 100,000 Granite Staters had access to health care through Medicaid Expansion at some point, bringing $502 million in federal dollars into the state.

Medicaid Expansion has been particularly important for Granite Staters in need of mental health care, substance use disorder services, emergency room visits, and pharmacy services, the report notes. Nearly 30,000 Granite Staters accessed mental health medication treatments at least once through Medicaid Expansion in the last fiscal year, while at least 8,600 unique individuals received some form of substance use disorder care services.

Children benefit indirectly but significantly

While coverage through Medicaid Expansion is for adults aged 19 to 64, children indirectly benefit from Medicaid Expansion, according to the Fiscal Policy Institute report. Adults with low incomes who access Medicaid Expansion are more likely to enroll their children in Medicaid.

As reported by Georgetown Center for Children and Families, parents who have coverage are more likely to access health and mental health services, improving health and development for children. Economic well-being is also improved for families when parents have health care coverage.

Expansions in health coverage to adults spurred greater enrollment for previously-eligible children. The report cites a Health Affairs study which identified Medicaid enrollment increases between 2013 and 2015 for children of parents who received coverage under Medicaid Expansion in their states.

Those increases were approximately twice as large, in percentage terms, than the increases for children with parents who were not newly eligible under Medicaid Expansion due to living in states without it. Other research found an approximately 29 percent increase in the likelihood a child completes an annual child wellness visit, a preventive care service, if that child’s parents are enrolled in Medicaid.

Of the 91,507 New Hampshire Medicaid Expansion enrollees on October 1, 2022, the Fiscal Policy Institute found that 25,931 (28 %) had children under the age of 18 years in their household. Among those enrollees with children, 10,255 had children under five.

Impact at the grass roots level

NAMI New Hampshire is a grassroots organization providing support, education and advocacy for people affected by mental illness and suicide.

As reported in the NH Bulletin, at a recent press conference organized by the coalition promoting continued Medicaid Expansion, NAMI’s executive director Susan Stearns (a board member of the New Hampshire Children’s Health Foundation) noted that, “In 2021, more than 7,000 people in New Hampshire used expanded Medicaid benefits for outpatient substance abuse treatment while more than 26,500 people relied on benefits for mental health medication.”

“We know timely access to care not only improves outcomes but saves lives,” she said.

Amoskeag Health is the nonprofit Federally Qualified Health Center (FQHC) in the Manchester area that provides primary care and behavioral health services. FQHCs qualify for enhanced reimbursement from Medicaid and Medicare to provide care to underserved or low-income populations, offering services on a sliding fee scale.

At the press conference, Amoskeag Health president and chief executive officer Kris McCracken stated that since the expansion of Medicaid the number of the center’s uninsured patients has dropped from 28 percent to less than 22 percent. In that time, the number of patient visits climbed from 43,000 a year to over 75,000.

Read the NH Fiscal Policy Institute’s report The Effects of Medicaid Expansion in New Hampshire >