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Expanding Medicaid: A bottom line assessment

Executive Summary

Date: May 31st, 2013

The question of whether to expand the state’s Medicaid program is one of the major policy choices facing New Hampshire lawmakers this year. The issue has been forced on policymakers, in a sense, by last year’s U.S. Supreme Court ruling that the federal Affordable Care Act (ACA) could not mandate that states expand their Medicaid programs to include new populations. How this question is resolved – expand, don’t expand, or expand in different ways than originally imagined by the ACA – could result in a major redesign for the largest program in state government and affect the healthcare of tens of thousands of New Hampshire residents.

This report provides a primer on existing information on Medicaid expansion to help policymakers make sense of the implications of the Affordable Care Act and state decisions on some of these goals. The paper also highlights a handful of potential courses of action and the impacts on coverage and state finances. Those courses include: no expansion of Medicaid; an expansion to include residents with incomes below 138 percent of the poverty level, as proposed within the Affordable Care Act; and a series of alternative models.

In short, expanding New Hampshire’s Medicaid program would result in an increase in the number of state residents with health insurance coverage. However, the financial implications of an expansion would vary depending on how that expansion is implemented. Moreover, the financial implications for the state change over time as well. In addition, the impact on individuals will vary considerably depending on the path taken by policymakers.

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