CONCORD, N.H. (AP) -- Democratic Gov. Maggie Hassan urged the Senate on Tuesday to reverse course and expand Medicaid to an estimated 58,000 poor New Hampshire adults.
The Senate votes Thursday on its version of the state budget for the two years beginning July 1. The Senate budget would study Medicaid expansion under the federal Affordable Care Act unlike the House's spending plan, which would expand Medicaid.
Hassan and the House included funding to implement the expansion so New Hampshire health care providers would share an estimated $2.5 billion over seven years at an estimated $85 million state cost.
Democrats control the House, while Republicans control the Senate. The issue is the biggest hurdle to reaching compromise on a budget by the end of the month. House Republican leaders held a news conference Tuesday to support their Senate colleagues' budget.
Hassan said it appears she needs legislative approval to expand Medicaid. She declined to say if she would veto the state budget if it blocks expansion.
New Hampshire's Medicaid program now covers low-income children, parents with nondisabled children under 18, pregnant women, senior citizens and people with disabilities. The expansion would add anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult.
New Hampshire could refuse or postpone a decision, but there are benefits for states that choose to expand Medicaid now. The U.S. government will pick up the entire cost in the first three years and 90 percent over the long haul. Hassan said delaying expansion could cost New Hampshire up to $340 million next year.
"The federal government has historically fulfilled its commitment to the Medicaid program," Hassan said at a Statehouse news conference.
Republican leaders are wary of federal promises to keep up the commitment.
The state's decision on expanding Medicaid is affecting efforts to implement a managed care system for existing Medicaid clients. That has been stalled because hospitals, mental health clinics and other providers refused to participate because of low state reimbursement levels for treating those patients.
The federal government assumes hospitals and other medical providers will face less charity care for the uninsured once the overhaul is fully in place and is reducing states' ability to tap funding used to help offset those costs.
The current budget, written by Republicans, cut state hospital aid to help pay for charity care for all but a handful of critical access hospitals. The 10 largest hospitals then sued over Medicaid rates, which complicated efforts to negotiate over managed care.
Hassan's budget would restore some of the aid but only if the hospitals pay taxes on their revenues at much higher amounts than the Senate believes is realistic. The state parcels out the hospital tax revenue to pay medical providers, for general state spending and to aid hospitals.
The Senate budget also would restore some aid to the hospitals and use some non-hospital tax revenues to boost the amount. In return, hospitals would have to agree to participate in managed care by July 1 to benefit. The Department of Health and Human Services also has adjusted key rates to entice hospitals to participate.
The three companies attempting to establish managed care networks signed contracts with the state believing Medicaid would be expanded under the federal law and increase their client base by thousands of people.
On Tuesday, Hospital Association President Steve Ahnen said hospitals probably will participate in the Medicaid managed care network even if the state doesn't expand Medicaid to cover uninsured adults. Ahnen mentioned the Senate's budget as one reason for the decision.