The Medicaid Expansion in New Hampshire

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1 The Medicaid Expansion in New Hampshire New Hampshire House of Representatives Concord, NH October 8, 2013 Deborah Fournier, Esq. Policy Analyst New Hampshire Fiscal Policy Institute

2 The Medicaid Expansion available to states beginning Jan. 1,

3 What is New Hampshire Medicaid? Nearly 50 year-old, joint, state and federal public health insurance program for low-income people. Primarily covers children, senior citizens, expectant mothers, and people with disabilities. NH covers 132,000 people in any given month. Annual total fund expenditure = $1.4B. Each state designs and administers its own program within federal framework. Federal government pays a fixed percentage of the cost, at least always 50 percent, of total cost for members care. 3

Disabled Children 1% Expectant mothers and parents 12% Low-income Medicare

4 Children Make Up Most of the Medicaid Membership New Hampshire Medicaid Membership, by Eligibility Group, FY 2011 Low-Income Children 59% Severely Disabled Children 1% Expectant mothers and parents 12% Low-income Medicare Beneficiary 7% Elderly 6% Mentally Disabled Adults 9% Physically Disabled Adults 6% 4

5 Current Medicaid Eligibility for Low-Income Adults is Limited Eligibility Category Income Limit as Percentage of Federal Poverty Level (FPL) Income Limit in Dollar Terms (2013) Parents 40% $6,204* Disabled 76% $8,732 Seniors 76% $8,732 Children (Ages 1-18) 185% $21,256 Pregnant women 185% $21,256 Working disabled 450% $51,705 Adults without children or a disability Currently ineligibile regardless of income * Family of two 5

6 Medicaid Expansion Framework Extend Medicaid coverage to adults, 19-64, with incomes up to 138 percent FPL ($15,856). No other qualifying condition necessary, i.e., do not need to be a parent, pregnant, disabled, etc. Group Federal Share Newly Eligible Adult 100% (2014,2015,2016) 95% (2017) 94% (2018) 93% (2019) 90% (2020 and beyond) 6

7 Current Medicaid Coverage and Potential Changes Effective January 1, % FPL 300% FPL 200% FPL 100% FPL New Federal Subsidies Through Private Insurers NH Medicaid Up to 300% FPL New Federal Subsidies Through Private Insurers (tax credits and cost sharing assistance on sliding scale up to 400% FPL) Medicaid Expansion Up to 138% FPL Up to Up to 53% FPL 51% FPL Up to 185% FPL BCCP Up to 250% FPL MEAD Up to 0% FPL 71% FPL 0% FPL Ages 0-19 Children Childless Adults Parents Medically Needy Adults Pregnant Women BCCP Up to 450% FPL Disabled 400% FPL 300% FPL 200% FPL 100% FPL - Current Medicaid Covered Groups - New Federal Subsidies Available Under Federal Law

8 Medicaid Expansion - Participation Projections The Lewin Group estimates a range from 47,000 to 67,000 people will ultimately participate by ,000 new enrollees is Lewin s most likely scenario. DHHS summary of ACA Impacts on NH Medicaid as presented to the Commission in July is based on Lewin and projects a newly eligible Medicaid enrollment figure within this range. 8

9 Potential Benefits: Vast Majority of New Medicaid Enrollees Dominated by Uninsured (Lewin Projections) Newly Eligible Previously Insured 33% Currently Eligible Unenrolled 5% Newly Eligible Uninsured 62% 9

10 Potential Benefits: Vast Majority of Participating New Enrollees Have Income Under Federal Poverty Level New Medicaid Enrollees by Income Level (Lewin Projections) 18,761 Income Below 100% FPL 42,559 Income Between % FPL 10

11 Potential Costs: NH DHHS Summary Impacts on NH Medicaid Program New Medicaid Enrollees 60,000 State Share of Price Tag: Federal Share of Price Tag: Offsets Identified: Net State Costs: $18M over 7 yrs $2.4B over 7 yrs ($64M) over 7 yrs ($45M) over 7 yrs 11

12 Medicaid Expansion and NH: Who Will Benefit? Gains in personal income ($2.3B with, $2.07B without), gross state product ($2.8B with and $2.45 without) and provider revenue across the spectrum ($3.5B with and $3.3B without) are expected. NH is expected to gain an average of 5,100 jobs with expansion and 4,400 without it. However, some providers do better than others. Health systems are expected to see a net increase in income of $113M with the Medicaid expansion and $158M without it. That being said, physicians and clinics and prescription drug sectors gain higher revenue ($206M and $181M respectively) with the Medicaid expansion.

13 Medicaid Expansion and NH: Who Will Benefit? Lewin estimates that household health spending will be reduced by $92M for NH households. Lewin estimates that average out-of-pocket health spending by the uninsured at the new Medicaid eligibility income level will decline by 50 percent in Community Health Centers and Community Mental Health Centers will see precipitous drops in uncompensated care, 80 percent and 79 percent, respectively. There is only minimal reduction in private insurance premiums with and without the Medicaid expansion. (.37 percent decrease with expansion,.34 percent decrease without).

14 Medicaid Expansion and New Hampshire ACA significantly boosts NH s economy and revenues, and Medicaid expansion maximizes these economic and fiscal impacts. - Lewin Group PPT presentation, slide 41, January 11,

15 Not Taking the Money Statute did not imagine Medicaid expansion as optional. Marketplace subsidies begin at 100 percent FPL for most residents. Without subsidy someone earning less than $11,490 in 2013, would have to contribute as much as 8 percent of income towards premium plus cost-sharing. Seventy percent of those likely to enroll will be ineligible for the subsidies and cost-sharing protections because their incomes are too low. Because of these factors, many eligible for the Medicaid expansion will likely remain uninsured. Lewin estimates 22,300. NH will also lose out on federal dollars coming into to the state budget and economy, as well as the jobs, increases in personal income and GSP projected by Lewin. 15

16 Medicaid Expansion Participation: Who Will Benefit? Tens of thousands of the eligible NH residents are workers who tend to be in the following industries: restaurant and food service construction elementary and secondary schools grocery store landscaping department and discount stores entertainment medical equipment and medical supply companies and building support services In other words: waitresses, janitors, school bus drivers, teachers aides, store clerks, construction workers, and landscapers are likely to benefit from the Medicaid expansion. 16

17 Medicaid Expansion in NH: What Happens Next? Medicaid Study Commission convened July 8. Eleven-member commission. Nine voting members. State insurance and health commissioners, or their designees, serve as two non-voting members. Commission has a charge to study several topics including potential costs and benefits of expanding Medicaid eligibility in New Hampshire. All findings will be due in a report to the legislature by Oct. 15, 2013.

18 Medicaid Expansion in NH: Concepts the Commission is Considering Premium Assistance Mandatory HIPP for those with employer sponsored insurance Moving some Medicaid Expansion population to the Marketplace Circuit Breakers Data Collection Maximizing federal dollars Waivers The timing and feasibility of some of these are in tension with one another.

19 Recap Tens of thousands more lives covered by Medicaid; Budget neutrality or net savings are possible for the state, especially in a Managed Care setting; state may likely get to budget neutrality in a managed care setting with only the corrections savings. No subsidies in a health benefits exchange for most newly eligible if we don t accept the federal dollars; at least 22,300 left uninsured. If state accepts $2.4B in federal aid it receives all of the maximized economic and fiscal benefits associated with ACA in NH. Commission may conclude its work by October

20 economic opportunity, prosperity, and security for all New Hampshire residents 11 Depot Street, 2 nd floor Concord, NH

Louisiana and the Affordable Care Act (ACA)

Louisiana and the Affordable Care Act (ACA) Steve Spires, Louisiana Budget Project stevespires@lano.org 225.236.1401 www.labudget.org About Louisiana Budget Project Provides independent, nonpartisan research