Medicaid Expansion Deal in Play?

Some of the most powerful people in the legislative and executive branches were milling about in the hallway of the Legislative Office Building. There was Terie Norelli, the House Speaker. Gene Chandler, the House Republican Leader. Sylvia Larsen, the Senate Minority Leader. Pamela Walsh, Chief of Staff to Gov. Maggie Hassan. Senate Majority Leader Jeb Bradley. Among other key players. Was something big in the works?

Welcome to the committee of conference process on House Bill 1 – the $10.7 billion state budget. There's stop-and-go. There are long recesses. There are sidebar conversations. As this biennial dance ensued Tuesday, there was talk about a possible compromise including Medicaid expansion.

The House and the governor want it. The Senate opposed it, with Senate President Peter Bragdon concerned about federal strings attached (he wants New Hampshire to study it first, while supporters say that would have the state potentially lose out on millions). Now there are signs that this elephant in Rooms 210-211 of the LOB might be addressed and resolved.

Norelli issued a statement Tuesay afternoon, saying that during the Committee of Conference on the budget, Chairwoman Mary Jane Wallner and Rep. Cindy Rosenwald presented a New Hampshire Model for Medicaid Expansion.

"After intensive study both inside and outside the legislature, we are certain that moving forward with Medicaid Expansion is the right choice for New Hampshire," Norelli said. "I believe this proposal addresses concerns expressed by the Senate and moves the discussion forward.

"Throughout the Committee of Conference on the Budget, the House has come to the table to discuss, debate and apply thoughtful consideration to the Senate’s version of the budget," she added. "We look forward to hearing their thoughts and engaging in a constructive dialogue about our proposal as we work towards a completed budget before Thursday’s deadline."

Here's a quick summary of the House proposal:

Proposal Expansion of Medicaid to Maximize Federal Dollars

HB 2 Commission to Study and Implement Medicaid Expansion by January 1, 2014 consistent with and authorized by section 1902(a)(10)(A)(i)(VIII) and section 1902 (e)(14) of the Social Security Act as amended by the Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152 (the “Act”).
 
Timeline:

• Commission shall begin work no later than 7 days after enactment of the budget and develop a plan that DHHS can present to Fiscal Committee for a vote at its August 2013 meeting.
• If Fiscal does not approve a plan by September 1, 2013, DHHS may submit a state plan amendment to CMS expanding eligibility through December 31, 2016.

Charge for Commission:

Assist department of health and human services to develop Medicaid Expansion proposal that:

• maximizes use of promised federal dollars
• assigns newly eligible to private plans through employer sponsored premium assistance program or New Hampshire Care Management program

Plan must be consistent with the Act
Plan must be implemented by January 1, 2014
 
Commission appropriated $200,000 which funds may be relied upon by the Commission or DHHS to secure experts without further approval.
 
Members
 
3 Members appointed by President of the Senate
3 Members appointed by the Speaker of the House
3 Members appointed by the Governor

The Committee of Conference on the budget has a noon Thursday sign off deadline for the Senate and 4 p.m. Thursday for the House.