CONCORD, N.H. (AP) — New Hampshire should expand its Medicaid program under the Obama administration's health overhaul law because it's the right thing to do for the state's economy, finances and families, Gov. Maggie Hassan told lawmakers Thursday.
New Hampshire's current program covers low-income children, pregnant women, parents with children, elders and people with disabilities. The state is deciding whether to expand eligibility to include anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult, and while it could refuse or postpone a decision, 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.
"As both Democratic and Republican governors around the nation have said, it's a good deal, one that will, among other things, allow us to save money in existing state programs, while increasing state revenues," Hassan said in her budget address to lawmakers.
Hassan, who plans to appoint a commission to advise her on implementing the expansion, noted that the federal government historically has fulfilled its commitments to the Medicaid program. But Republican lawmakers who oppose the expansion point to special education and other areas where promised federal funding has fallen far short. They argue that expanding Medicaid is unaffordable, unnecessary and amounts to an effort by the federal government to hijack state finances.
A report commissioned by the state health department estimates that expanding Medicaid would boost enrollment by about 58,000 people by 2020, and together with the federal law's other provisions, would reduce the number of uninsured residents from roughly 170,000 to 71,000. The report estimates that expansion could cost the state $85 million during that time period, but the state would get $2.5 billion in federal funding.
Proponents of expanding Medicaid note that those who currently lack insurance frequently end up in the emergency room in crisis with conditions that could have been prevented or cured had they received routine care in a doctor's office. According to the New Hampshire Hospital Association, hospitals have seen a 40 percent increase in the amount of uncompensated care they provide since 2008.
"Uncompensated care at our hospitals' emergency rooms increase costs for everyone," Hassan said. "By moving forward with Medicaid expansion, we can reduce that uncompensated care and save the average New Hampshire household an estimated $145 per year."
Ten of the state's largest hospitals sued the state last year in part over the elimination of payments they used to receive from the state to offset what they spend on uninsured patients. Hassan's budget would make more funding available for uncompensated care payments to those hospitals — about $50 million in fiscal year 2014 and $60 million 2015.
Under the expansion, Medicaid would cover both substance abuse treatment and mental health treatment, which Hassan called both smart and right. Aside from the Medicaid expansion, her budget also includes increased spending aimed at what Hassan called one of the state's most pressing public health challenges: restoring the state's mental health system.
The state is nearly half way into a 10-year mental health plan that includes goals ranging from expanding inpatient psychiatric care in hospitals to increasing the number of group home beds to support people in their communities. But those who provide mental health services say the state not only has failed to make progress but has in some cases gone backward. Dozens of people wait for days at a time for inpatient care in emergency rooms, and some leave without care at all, putting themselves and others at risk, Hassan said.
"That's not the kind of state we are," said Hassan, who is proposing a new designated receiving facility to take the pressure off local emergency rooms, adding new acute psychiatric residential treatment beds.
Saying the focus should be on treating people in their communities, Hassan called for adding 75 new community residence beds, housing and support services for 100 additional people and 10 new community treatment teams to help adults and children in crisis.
"While this won't solve all of the challenges facing our mental health system, it is beyond time that we make real and meaningful investments in helping those in desperate need of care," she said.