NH prepares to move 30k or more off Medicaid

Aug. 29—State officials believe at least 30,000 people in New Hampshire are getting health insurance under the federal Medicaid program even though they no longer qualify for it.

New Hampshire can't remove them from the rolls, however, until the federal COVID-19 emergency expires. The emergency is currently scheduled to end Oct. 30, but Biden administration officials have told governors that it will last at least through this December.

Keeping people insured through Medicaid was the bargain states made in exchange for extra Medicaid money to help them cope with the pandemic's economic fallout.

For New Hampshire, the extra money will total $350 million over 24 months through the end of 2021.


The Sununu administration wants to hire a private contractor at a cost of $200,000 a month to assist the state in taking ineligible clients off coverage.

That contract was recently tabled by a bipartisan majority on the Executive Council.

The councilors questioned the need to hire the equivalent of 30 full-time workers to man phones when the Medicaid cutoff looks to be four months away.

"I don't understand the urgency with going forward with this contract now," said Councilor Ted Gatsas, R-Manchester.

Councilor Cinde Warmington, D-Concord, wanted to know why the state wants to pay Maximus Services Inc. of Reston, Va., 10 times what it had been paying the firm since it first won a no-bid contract seven years ago.

"Why a fixed contract at such a high rate?" she asked.

Health and Human Services Commissioner Lori Shibinette said given the health care workforce shortage, the most efficient and cost effective way to get the job done was to pay the company $2 million over the next 10 months.

With the contractor placing the calls, HHS staff will be freed up to process the paperwork to determine how many of those on Medicaid should come off the program, she said.

"We were not able to find our own people," Shibinette said.

"We are trying to do this as quickly as possible and this is the most fiscally responsible way to get people off the Medicaid rolls."

Medicaid is the federal-state health insurance program for low-income families, the disabled and senior citizens.

The state splits the cost of the coverage with the federal government.

Once COVID-19 hit, enrollment soared as the state's unemployment rate shot up from 2.5% to 17% in a matter of a few months.

Over the past 18 months, the Medicaid rolls have grown by nearly 43,000, or about 25%.

There are currently 222,091 people on Medicaid, 16% of the state's population. Children account for 43% of that total.

To date, state officials analyzing cases have found at least 25,213 will be ineligible for Medicaid starting in January.

Since mid-June, those people have been getting pink-colored notices each month about the agency's review and asking them to give any information if they contest this determination.

Another 45,391 clients haven't provided documentation to prove they should remain on the program.

Those clients received a different letter, urging them to provide backup for staying on the program as soon as possible or risk being dropped at the end of 2021.

Shibinette said the state taxpayer cost of keeping 10,000 ineligible clients on the rolls past January is $3.5 million a month.

If the number of ineligibles is 30,000, that's a $10.5 million monthly hit.

"We are talking real money here," Gov. Chris Sununu said.


HHS Associate Commissioner Christine Santaniello said the agency needs enough advance time to ensure qualified Medicaid recipients don't fall through the cracks. "We may have 60 days to just enroll people," Santaniello said.

Zandra Rice Hawkins, executive director of Granite State Progress, a liberal advocacy group, praised state officials for early outreach to these clients, as long as all get detailed information and help with their health care options.

The federal COVID-19 relief law requires states to move these clients, if they are still eligible, into other programs with "equivalent benefit levels."

During a recent webinar, HHS officials said one of the key goals of this project is to find the best coverage for those who shouldn't remain on Medicaid.

"I really hope the intent of this is not simply to reduce the rolls but rather to make sure there's a handoff of continuing care for many of these families," Hawkins said.

For example, many of these families could qualify for health insurance with low premiums through the Affordable Care Act, she said.

"A case can be made hiring this contractor makes sense," Hawkins said, "but would it be just as cost effective to let this process play out naturally, and spend the money to sign up many of these people for other health care coverage?"