Reform Update: New Hampshire on track to expand Medicaid this year

New Hampshire appears on track to be the last state before the year ends to expand Medicaid as part of the Patient Protection and Affordable Care Act. Meanwhile, action on the issue may be delayed in at least two other states until next year.

Committees of the New Hampshire House and Senate today are conducting public hearings as part of a special session on whether or not to expand the program to adults with incomes up to 138% of the federal poverty level. The committees are scheduled to vote on a recommendation Thursday.

Separately, legislative leaders and Democratic Gov. Maggie Hassan have been having closed-door discussions since late October to come up with a bipartisan agreement on expansion. Democrats, who support the Medicaid expansion, control the state House, while Republicans, who have resisted the expansion, narrowly control the Senate.

As the legislative negotiations continue, Jim Roche, president of the state's Business and Industry Association, expressed hope the Medicaid expansion would take place as long as it won't lead to additional cost-shifting to the business community. “Regular, preventive care costs less, will lead to less utilization of healthcare services and ultimately lower health insurance costs for businesses and individuals,” he said in a written statement.

Missouri may see some movement early next year, when the legislature meets starting Jan. 8. On Oct. 28, Missouri's House Interim Committee on Medicaid Transformation held a hearing to get public input on the Medicaid expansion. The Republican-led house and senate decided to create the committee instead of including expansion in the 2013 budget as Democrat Gov. Jay Nixon proposed.

Some Missouri legislators are examining alternative coverage expansion models, particularly the Arkansas model that recently was approved by the CMS, said Dr. Karen Edison, director of the Center for Health Policy at the University of Missouri. Under that plan, Arkansas will use federal Medicaid funds to buy private coverage for adults earning up to 138% of poverty in the state insurance exchange.

In Pennsylvania, Republican Gov. Tom Corbett has sent a coverage expansion proposal to the Obama administration that resembles the Arkansas model after the GOP-controlled Pennsylvania legislature rejected a Medicaid expansion.

John Michael Hall, senior director of Medicaid policy for the National Association of States United for Aging and Disabilities, said it's unlikely Corbett would consider a straightforward expansion of Medicaid given his strong opposition to the Affordable Care Act.

To date, 25 states and the District of Columbia have approved the Medicaid expansion.

Tens of thousands of low-income people are struggling to get Medicaid due to problems with the federal insurance exchange website.

Reports indicate that the federal government can't transfer Medicaid applications to state Medicaid programs. The snafu is hurting those in the 36 states relying on the national exchange site.

The news isn't all bad as at least 440,000 people have signed up for Medicaid in 10 states in the six weeks since open enrollment began, according to Avalere Health, a market analysis firm. Some states are reporting more interest in signing up for Medicaid than for private insurance.

Many uninsured military veterans are eligible for expanded Medicaid. The Urban Institute found that 40% of uninsured veterans earn less than 138% of the federal poverty level—about $15,000 for an individual—and would qualify for expanded Medicaid if their state opted to expand the program.