NH Public Policy
New Hampshire Center for Public Policy Studies

New Hampshire's Changing Medicaid Program: Enrollment and Expenditures

Executive Summary

Author: Steve Norton

Date: August 31st, 2017

Although the US Congress has made little progress in their quest to repeal, replace, and/or reform the Affordable Care Act (ACA), there is interest in changing current law in ways that will impact New Hampshire. Factions within both the House and Senate have argued for the end of federal participation in recent expansions in Medicaid coverage. Also, Congressional proposals created per capita block grants for Medicaid, designed to slow federal expenditure growth.

This piece attempts to put the Medicaid program within the context of other health insurance coverage, and provide an assessment of how coverage changes could impact the current financing of the state’s Medicaid program. We review longitudinal data on caseload and claims from the Department of Health and Human Services, along with expenditure data from the Centers for Medicare and Medicaid Services (CMS) to shed light on current caseloads as well as the potential implications.

The findings are not surprising. The ACA resulted in significant increases in Medicaid coverage (33% increase). The vast majority (75%) of this uptick was a function of the expansion of Medicaid to adults (known as the NH Health Protection Plan), specifically those individuals between the ages of 19 and 64.
These coverage expansions have predictably resulted in notable rises in expenditures, in the form of payments to managed care companies.

Between 2013 and 2015, total Medicaid expenditures grew by 43%, with federal dollars (extra $407 million over the period), more so than state dollars (added $109 million over the period), shouldering most of the burden. In state fiscal year (SFY) 2016, the NHHPP resulted in $386 million in payments to provide coverage to enrollees of the program.