CMS Gives New Hampshire Nod for Custom Medicaid Expansion

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New Hampshire's waiver features premium assistance to shop on the exchange and includes a work-referral requirement. CMS resisted linking a waiver to work-related requirements more than a year ago when granting Pennsylvania's waiver.

On Friday, New Hampshire became the sixth state to gain approval from CMS for its own form of Medicaid expansion under the Affordable Care Act (ACA).

The approval comes as the state is slowly converting its Medicaid programs to managed care, although that process has experienced delays amid concerns over quality and service interruptions for more vulnerable clients.

Democratic Governor Maggie Hassan last year signed a bill that allowed Medicaid expansion and created a temporary program that let beneficiaries join its Medicaid managed care system. Without the waiver, those who joined the managed care rolls would have been phased out of the program. As of March 3, 2015, 36,404 state residents had enrolled in this transitional program and an estimated 50,000 may be eligible.


Under the waiver, however, these individuals will use Medicaid funds for premium assistance to purchase private insurance through the exchange, instead of paying for services directly. With the waiver in place, eligible New Hampshire residents will be eligible for premium assistance as of January 1. The New Hampshire program also has a mandatory work-referral program for able-bodies adults. In the past, CMS resisted linking waivers with work-related requirements, notably when granting Pennsylvania's waiver. However, governors in several Southern states have raised work-related requirements in waiver requests.

“Because of our bipartisan health care expansion plan, more than 36,000 hard-working Granite Staters now have peace of mind and financial security that comes with quality, affordable health insurance,” Hassan told the Manchester Union Leader. “The premium assistance waiver will allow these people to choose among private insurance plans offered on the health insurance marketplace.”

New Hampshire’s program, while called a premium assistance waiver, has some similarities to the Arkansas private option, which was the first such waiver granted by CMS to entice a state that otherwise would not have expanded Medicaid to allow consumers earning between 100% and 138% of the federal poverty level to gain access to health coverage. Since that time, versions of the option have been opted in Republican controlled of states with divided government.

The waiver approved for Pennsylvania came during the final months of the administration of former Governor Tom Corbett. The new governor, Democrat Tom Wolf, is expected to pursue conventional Medicaid expansion and set up a state exchange.

As more consumers access health coverage under the ACA, the stakes increase for the outcome of King v. Burwell, the case argued last week before the US Supreme Court. The case will determine if consumers living in states without their own exchanges will be able to access tax credits called for in the ACA. A ruling is expected in June.

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