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New Hampshire Gets Its Medicaid Work Requirement

For the first time, the federal government has approved a work requirement for able-bodied adults in New Hampshire's expanded Medicaid program -- a key condition for state lawmakers who recently voted to extend the program for another five years.

By Dave Solomon

For the first time, the federal government has approved a work requirement for able-bodied adults in New Hampshire's expanded Medicaid program -- a key condition for state lawmakers who recently voted to extend the program for another five years.

New Hampshire becomes the fifth state with an approved work requirement, in addition to Kentucky, Illinois, Arkansas and Maine.

The head of the Centers for Medicare and Medicaid Services (CMS) confirmed in a May 7 letter that New Hampshire, as of Jan. 1, 2019, will be able to require all beneficiaries of expanded Medicaid health insurance from ages 19 to 64 to participate in 100 hours per month of "community engagement activities, such as employment, education, job skills training or community service as a condition of Medicaid eligibility."

There are exemptions for pregnant women, medically frail and certain parents or caretakers of dependents.

"Today's announcement by CMS authorizing New Hampshire's Medicaid work requirements is a transformative step toward a more thriving workforce," said Gov. Chris Sununu in announcing the decision.

"Work requirements help lift able-bodied individuals out of poverty by empowering them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs," he said. "They help people gain the skills necessary for long-term independence and success. We are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole."

The expansion of Medicaid, providing health insurance to approximately 50,000 low-income New Hampshire residents, cleared the House in a voice vote last week after representatives voted 303-29 to adopt amendments to the Senate-passed bill.

The House and Senate votes were conditional upon approval of the work requirement by the federal government.

Health and Human Services spokesman Jake Leon said in an email to a Union Leader reporter Monday: "Based on information produced by the department, we have estimated that about 45 percent of the expanded Medicaid population are currently working full- or part-time."

When lawmakers voted to extend expanded Medicaid two years ago, they sought a waiver from Medicaid rules to impose a work requirement, but were denied by CMS under the Obama administration.

New Hampshire went ahead with the two-year expansion to the end of 2018 despite that denial, but refused to do so this time around.

The Trump administration signaled a greater willingness to approve work requirements in the administration of the federally funded program.

"The Center for Medicare and Medicaid Services is approving the community engagement program based on our determination that it is likely to assist in promoting the objectives of the Medicaid program," according to Seema Verma, CMS administrator.

The idea of expanding eligibility for Medicaid was considered a controversial part of the Affordable Care Act, and was a contentious issue when the legislature first adopted the expansion in 2014. It was reauthorized for another two years in 2016, and was set to expire at the end of 2018 if not renewed again.

New Hampshire was among 33 states that expanded Medicaid eligibility with the goal of reaching a portion of the population not qualified for Medicaid at the time, but not earning enough to buy subsidized policies through the online marketplace.

The state already had more than 100,000 households on traditional Medicaid before the expansion.

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(c)2018 The New Hampshire Union Leader (Manchester, N.H.)

Natalie previously covered immigrant communities and environmental justice as a bilingual reporter at CityLab and CityLab Latino. She hails from the Los Angeles area and graduated from UCLA with a B.A. in English literature.
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