Senate Bill 134 seeks to require that New Hampshire Medicaid recipients work in order to receive health care through the program. (Photo by Getty Images)
The New Hampshire Senate voted on party lines, 16-8, Thursday to approve a Republican-backed work requirement plan for Medicaid — the latest in a series of proposals that could dramatically alter the Medicaid landscape in the Granite State.
Senate Bill 134 seeks to require that New Hampshire Medicaid recipients work in order to receive health care through the program. Because Medicaid is a program jointly run by the state and federal government, any work requirements would need to be submitted by the state to the federal government. This bill would instruct the New Hampshire Department of Health and Human Services to draft and submit a request — known as a Section 115 demonstration waiver — to the U.S. Centers for Medicare and Medicaid Services. That request would have to be approved by the Joint Legislative Fiscal Committee, a financial committee composed of members of both the state Senate and House.
In addition to providing health care coverage for 183,000 low-income and high-need New Hampshire residents, Medicaid finances the medical costs of over 1 in 5 births and care for about 2 of every 3 nursing home patients in the state, according to CMS. Approximately 65% of Medicaid recipients are currently working, according to DHHS.
Republicans framed the proposal as a way to help Medicaid recipients get out of poverty.
“We are a state that prides itself on work to support our families, independence, and self-sufficiency,” Sen. Howard Pearl, a Loudon Republican, said on the Senate floor Thursday. “Medicaid and other welfare programs should be a bridge for non-aged, non-disabled adults, not a destination.”
He pointed out that other programs like the Supplemental Nutritional Assistance Program — also known as SNAP or food stamps — have work requirements.
Democrats pushed back, arguing that taking away people’s health care when they’re out of work does not help them find work, but rather it makes it more difficult for them to find work.
“When Granite Staters have access to health care, then they are healthy and when they are healthy, we have a healthy workforce,” Sen. Suzanne Prentiss, a West Lebanon Democrat, said. “We have heard this from the hospitals, we have heard this from the businesses, and we’ve heard it from the people themselves.”
Indeed, research compiled by the Brookings Institution suggests that work requirements for programs like SNAP and Medicaid do not increase employment and often strip benefits from people. For Medicaid specifically, the research found that in states with work requirements, many people lost their health care coverage not because they didn’t meet the work requirement, but because they struggled with complex reporting systems these states implemented to enforce the work requirements.
This bill will need to be reviewed by the Senate Finance Committee before the House of Representatives considers it.
New Hampshire has attempted Medicaid work requirements before, but failed upon implementation. The state added Medicaid work requirements through legislation that went into effect in 2019. This required Medicaid recipients to work 100 hours a month to receive coverage. However, just one month into the new system, the state reversed course. Only about 8,000 of the 25,000 people subject to the requirement complied and documented their hours. Before the remaining roughly 17,000 people lost coverage, then-Gov. Chris Sununu, a Republican, halted the requirement. The state had already spent more than $130,000 sending letters and text messages, making phone calls, holding public information sessions, and setting up information tables outside grocery stores and other locations in an effort to inform recipients of the requirements. They also sent state employees to go door-to-door in high-enrollment neighborhoods in Manchester, Nashua, and Laconia.
New Hampshire’s botched work requirements came after Arkansas, the first in the nation to attempt Medicaid work requirements, failed to implement a similar system in 2018. There, the system revoked Medicaid coverage from more than 18,000 people — nearly 1 in 4 of those subject to work requirements — in just seven months. Evidence suggests many of those who lost coverage did so not because they didn’t meet the 80-hour-per-month requirements but because of bureaucratic dysfunction.
This is one of several changes being proposed to Medicaid in New Hampshire.
Republican Gov. Kelly Ayotte is attempting to cut down the costs of the program in a tight budget year for the state. Ayotte’s proposed budget, and the accompanying policy-related “trailer bill,” would charge some recipients premiums, increase pharmacy cost-sharing, and end the already winding down continuous eligibility system.
If Ayotte’s proposals are enacted, Medicaid recipients, with children, who earn 255% of the federal poverty level and those without children who earn between 100% and 138% of the poverty level, would have to make payments of up to 5% of their household income in order to receive coverage. Additionally, the amount Medicaid recipients pay for their prescriptions would rise from $1 or $2 to $4 per prescription (unless that exceeds 5% of household income). Lastly, Ayotte is attempting to end continuous enrollment, a system that began during the COVID-19 pandemic and allowed people to keep their Medicaid coverage even after they no longer met the requirements. (That system already ended, but the state needed time to disenroll recipients.)
At the same time, Medicaid recipients and advocates are bracing for potential cuts at the federal level. Republicans in the U.S. House of Representatives passed a resolution last month that instructed congressional committees to impose a series of cuts to the federal budget. In order to make these cuts happen, experts believe the government would need to slash an estimated $800 billion from Medicaid nationwide.
In New Hampshire, the concern is particularly acute due to a so-called trigger law the state passed in 2018. That law would cut state funding for New Hampshire’s Medicaid expansion program — which is funded jointly by the state and federal government — if federal funding falls below 90% of the cost of the program.