Editor’s Note: This story was first published New Hampshire Bulletin.
Lawmakers must decide this year whether to continue spending millions each year to provide Medicaid health coverage to an estimated 50,000 to 90,000 additional low-income people through their Medicaid expansion program. The New Hampshire Fiscal Policy Institute, which lawmakers have long looked to for nonpartisan fiscal analysis, released a report this week with several arguments for doing so.
According to the analysis, continued Medicaid expansion has done more than just improve recipients’ health through increased cancer screening, increased dental treatment and increased pregnancy care.
It has allowed beneficiaries to get the health care they need to stay in the workforce, a plus for them and for state employers desperate for workers.
Medicaid expansion has given state hospitals millions of dollars to cover health care costs for uninsured people who would otherwise be unable to pay. According to the analysis, this reduced the state’s health care costs for inmates.
And the state bears only 10% of the cost, with the rest covered by the federal government. Between 2015 and 2022, the state will inject $210 million into the program, much of it paid for by insurance companies. This is a fraction of the federal government’s contribution of $3.22 billion.
The question is whether the data will persuade lawmakers to continue with a program that raised doubts before it was enacted in 2014.
Here are five findings from the institute’s analysis:
The number of uninsured Granite Staters declined by 42.3% in the five years following the start of Medicaid expansion compared to five years earlier.
New insureds live in rural parts of the state, and nearly half are under the age of 45. About 74% of recipients are white, and people of color are the most likely to be Medicaid expansion beneficiaries relative to the entire population, the analysis found.
Like traditional Medicaid recipients, they are low-income. But they do not meet Medicaid’s other eligibility rules, which require that someone with a physical or developmental disability or be under the age of 19, pregnant or caring for children or other family members.
About 154,000 Granite Staters were eligible for traditional Medicaid in December, according to the state’s Department of Insurance. New Hampshire’s expanded Medicaid population is less than half of the traditionally estimated 52,000 people.
Eligibility for Granite Advantage, the state’s expanded Medicaid program, only considers age and income.
Beneficiaries must be between 19 and 65 and earn less than 138% of the federal poverty level. In 2022, this equates to $18,754 per year for an individual and $38,295 for a family of four.
The expanded Medicaid population swelled to more than 90,000 during the pandemic as job losses and public health concerns kept people at home. This number is expected to decline as the state reviews the post-pandemic employment and financial status of beneficiaries.
Compared to the state’s population, a disproportionate number of beneficiaries identified as Hispanic, 5%, or black or African American, 2.1%, according to the analysis. A higher percentage of beneficiaries live in more rural areas of the state; Coos County has the highest percentage at 16.5%, followed by Sullivan County at 13.8%.
Granite Advantage beneficiaries often work in low-wage or seasonal jobs that do not provide steady employment or health benefits. And they can enroll and leave the program when work becomes available.
The analysis found that’s especially true in low-wage industries such as retail, housing and food service, among the state’s largest employment sectors.
It seems like.
The analysis pointed to research showing that parents who enroll in expanded Medicaid are more likely to enroll their children in Medicaid. Parents covered by Medicaid are also more likely to make sure their child has an annual wellness visit, which is important for monitoring the child’s physical and mental health and keeping them up to date on vaccines.
There are additional indirect health benefits, the analysis found, when adults are able to work and do not have the financial burden of health insurance. This includes continued access to housing and food.
The analysis includes research by the Kaiser Family Foundation on the impact of expanded Medicaid. It found an association between Medicaid expansion and lower mortality rates, including mortality during pregnancy or childbirth and some cancers as well as heart and liver disease.
States with expanded Medicaid saw larger declines in infant mortality rates than states without it, the analysis said. But it noted that the research has not been conclusive.
The New Hampshire Fiscal Policy Institute found conclusive evidence, however, that tens of thousands of Granite Staters on expanded Medicaid used it for treatment last fiscal year.
More than 30,000 people received mental health treatment and/or medications. About 12,000 used their benefits for a hospital stay, and more than 10,000 sought treatment for substance use disorder. About 30,000 sought care for COVID-19, and about 64,000 people accessed their coverage at pharmacies.
When hospitals treat patients without insurance, they use their own revenue and funds from the state to cover the cost.
The analysis found that state hospitals have seen those non-reimbursed costs go down since the introduction of expanded Medicaid.
It cited findings from the New Hampshire Hospital Association that showed the average cost of untreated care fell from $157 million during 2012-2014 to $65.1 million in 2017-2019. Those savings allow hospitals to stay open and avoid reducing services, the analysis found. In turn, this helps maintain health care options for all.
Yes, the state has spent over $200 million since 2015 on expanded Medicaid. But because the federal government picks up 90% of the program’s cost, it has seen a drop in not only the amount it sends to hospitals for uncompensated care, but also the amount it spends on other services. This includes health care for prisoners, the analysis said.
Traditional Medicaid covered just under 7% of the medical care provided to inmates by community providers. Expanded Medicaid’s more generous compensation could save the Department of Corrections $10.2 million between 2015 and 2021, according to the analysis.
State officials emphasize that the general fund, which pays for nearly all state services, does not pay for Medicaid expansion. This is technically true.
In 2022, insurance companies would pay a significant portion of expanded Medicaid costs, about $31 million. The state pulled more than $10 million from its Alcohol Abuse, Prevention and Treatment Fund and $8.7 million from Liquor Commission funding to cover some of the cost. Most of the remaining money came from the previous year’s surplus or money that was returned to the program.