The CMS is denying a New Hampshire waiver request that would impose a work requirement on the state's Medicaid beneficiaries, create new standards for verifying U.S. citizenship and penalize beneficiaries if they use the ER in non-emergency situations.
In August, the state requested that those considered eligible either work, train for a job, be actively searching for work or other work-related activities for at least 30 hours per week.
In a letter to the state, the CMS said it was unwilling to approve any of the requests as they “could undermine access, efficiency, and quality of care provided to Medicaid beneficiaries and do not support the objectives of the Medicaid program (PDF).
The denial, which follows rejections of similar proposals submitted by Ohio and Arizona, indicates that the CMS will not incorporate more conservative ideas into state Medicaid expansion programs.
New Hampshire, a state where Republicans currently control both legislative chambers, also sought to require newly-eligible adults to verify that they are U.S. citizens by providing two forms of identification, and verify that they are residents of New Hampshire by providing a state-issued driver's license or a non-driver's license picture identification card.
Finally, the state sought a policy that would require beneficiaries who visit the emergency room for non-emergency purposes to pay a copayment of $8 for the first visit and $25 for each subsequent visit. The CMS denied this request but left the door open for the state to reapply if the program covered non-emergency services provided in the ER.
Patient advocates criticized the waiver application overall but were especially troubled by the proof of ID request.
That proposal, "would cause massive delays in coverage for many Medicaid beneficiaries,” Georgetown Center for Children and Families said in a comment. The current process that verifies identification through data matches is quick and accurate, the center added.
The work requirement request, which the CMS has yet to approve for any state, was also widely derided.
“Linking Medicaid eligibility to employment has no connection to the purposes of the Medicaid program,” Community Catalyst, a consumer advocacy group, said in a comment.
A spokesperson for the state's Department of Health did not respond to a request for comment.
As of August 2016, New Hampshire has enrolled 185,767 individuals in Medicaid and CHIP — a net increase of 46.18% since 2013, according to federal data.
The fate of further tweaks to the Medicaid program in New Hampshire is tied to the upcoming elections. Republican Gov. Chris Sununu, who previously opposed expansion, is in a tight race with Democrat Colin Van Ostern. They're vying to succeed Democratic Gov. Maggie Hassan, who steered expansion through the Legislature in 2014 and is now running for U.S. Senate.