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N.H. Delays Rollout of Medicaid Work Requirements After Thousands Fail to Comply

By Steven Porter  
   July 09, 2019

Less than one-third of those subject to the new rules had demonstrated compliance by the deadline, stoking concerns the policy could decimate coverage.

On what had been the deadline for certain beneficiaries in New Hampshire to demonstrate that they complied last month with the state's new Medicaid work requirements, officials temporarily suspended their rollout of the new rules Monday, acknowledging concerns over the number of people who may lose coverage.

In a letter to state legislative leaders and Gov. Chris Sununu, New Hampshire Department of Health and Human Services Commissioner Jeffrey A. Meyers outlined his rationale for the delay, which was authorized by a bill Sununu signed into law late last month. The new state law also expanded exemptions to the work requirements.

Despite a broad public awareness campaign that included 11 public information sessions, radio and social media ads, more than 50,000 phone calls, and four separate letters to the state's Medicaid beneficiaries, officials have had a tough time communicating with those to whom the new rules apply, Meyers wrote. They still don't know whether nearly 16,900 affected beneficiaries complied with the work rules in June, which was the first month in which the requirements took effect. That's more than double the number of non-exempt beneficiaries who demonstrated compliance with the new rules.

Officials have begun door-to-door canvassing in an effort to track people down, targeting neighborhoods with high Medicaid enrollment but low response rates, as the New Hampshire Union Leader's Mark Hayward reported. Workers will reportedly knock on every door, not just those where Medicaid beneficiaries are believed to reside.

"No other state has taken the efforts, and I think the pains if you will, of making sure we are engaging with this population as aggressively as we can," Sununu said during a press conference Monday, as the Union Leader reported. "Making sure we get this right is absolutely paramount."

Related: Seema Verma Says Medicaid Work Requirements Are Good Policy, Not 'Subversive'

Related: Medicaid Work Requirements Could Cost Hospitals $3.7B

Sununu, a Republican, has joined the Trump administration in vocally supporting Medicaid work requirements. Proponents say the policies help beneficiaries climb out of poverty, while opponents contend they are an effort to cull the Medicaid rolls that expanded in many states under the Affordable Care Act.

The decision to delay New Hampshire's new work requirements comes as the Trump administration prepares to defend their approval in federal court. Some of the same groups that successfully persuaded a federal judge to block Medicaid work requirements in Kentucky and Arkansas are asking the same judge to block New Hampshire's requirements as well. A hearing is scheduled for July 23. (An appeal of the decision affecting Kentucky and Arkansas is pending before the U.S. Circuit Court for the District of Columbia.)

Dawn McKinney, policy director for New Hampshire Legal Assistance, which is one of the groups seeking to have the requirements tossed out, said Monday that she appreciates the delayed rollout but doesn't believe door-to-door canvassing or any other effort will render the requirements workable, as Holly Ramer reported for the Associated Press.

"I don't think we can outreach our way out of this situation," McKinney reportedly said. "We hope our state leaders will come to the realization that there isn't a way to do this where it will work or be legal."

About 40,800 people in New Hampshire have coverage under the state's Medicaid expansion, as the Union Leader reported. Nearly 16,000 of them were exempt in June from the new work rules, but only about 8,000 non-exempt beneficiaries complied with the reporting requirements by the previous deadline, which leaves nearly 16,900 non-exempt beneficiaries who failed to demonstrate their compliance with the policy.

The four-month delay means work requirements for non-exempt beneficiaries are slated to take effect this October, with a reporting deadline thereafter.

Related: 3 Dos and Don'ts of Medicaid Work Requirements

Related: Medicaid Work Requirements Could Erode ACA Coverage Gains

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


Officials have been unable to confirm whether two-thirds of non-exempt beneficiaries who gained coverage through Medicaid expansion—that's nearly 16,900 people—complied with the requirements last month.

Officials have already undertaken significant outreach efforts to inform beneficiaries about the new rules and collect the required information, but they're ramping those efforts up even further with door-to-door canvassing.

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