Revision: Jan. 28, 2016, midnight
\t \t\tHB 1696-FN - AS INTRODUCED
2016 SESSION
\t16-2594
\t01/09
HOUSE BILL\t1696-FN
AN ACT\trequesting a modification of the New Hampshire health protection program.
SPONSORS:\tRep. Lachance, Hills. 8; Rep. Leishman, Hills. 24; Rep. Hagan, Rock. 4; Rep. Richardson, Coos 4; Rep. S. Schmidt, Carr. 6; Rep. Umberger, Carr. 2; Rep. Elliott, Rock. 8; Sen. Bradley, Dist 3; Sen. Boutin, Dist 16; Sen. Stiles, Dist 24
COMMITTEE:\tHealth, Human Services and Elderly Affairs
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ANALYSIS
\tThis bill requires the commissioner of the department of health and human services to submit waivers or state plan amendments to modify the New Hampshire health protection program. The bill also includes funding for such program by charging premiums for the services, using moneys from the insurance premium tax, and changing the priorities of the uncompensated care and Medicaid fund.
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Explanation:\tMatter added to current law appears in bold italics.
\t\tMatter removed from current law appears [in brackets and struckthrough.]
\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
\t16-2594
\t01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT\trequesting a modification of the New Hampshire health protection program.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 New Paragraphs; New Hampshire Health Protection Plan. Amend RSA 126-A:5 by inserting after paragraph XXIX the following new paragraphs:
\t\tXXX.(a)(1) Newly eligible adults who are unemployed shall be eligible to receive benefits under RSA 126-A:5 XXIV-XXV, if the commissioner finds that the individual is engaging in at least 30 hours of one or a combination of the following activities:
\t\t\t\t\t(A) Unsubsidized employment.
\t\t\t\t\t(B) Subsidized private sector employment.
\t\t\t\t\t(C) Subsidized public sector employment.
\t\t\t\t\t(D) Work experience, including work associated with the refurbishing of publicly assisted housing, if sufficient private sector employment is not available.
\t\t\t\t\t(E) On-the-job training.
\t\t\t\t\t(F) Job search and job readiness assistance.
\t\t\t\t\t(G) Community service programs.
\t\t\t\t\t(H) Vocational educational training not to exceed 12 months with respect to any individual.
\t\t\t\t\t(I) Job skills training directly related to employment.
\t\t\t\t\t(J) Education directly related to employment, in the case of a recipient who has not received a high school diploma or a certificate of high school equivalency.
\t\t\t\t\t(K) Satisfactory attendance at secondary school or in a course of study leading to a certificate of general equivalence, in the case of a recipient who has not completed secondary school or received such a certificate.
\t\t\t\t\t(L) The provision of child care services to an individual who is participating in a community service program.
\t\t\t\t(2) The requirements under subparagraph (1) shall be consistent with the federal Temporary Assistance for Needy Families Program, 42 U.S.C. section 607(d).
\t\t\t\t(3) Disqualifications for Benefits-Grounds for disqualification for benefits under this subparagraph shall be consistent with the federal Temporary Assistance for Needy Families Program, 42 U.S.C. section 607(e).
\t\t\t\t(4) This subparagraph shall only apply to those considered childless, abled-bodied adults as defined in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act of 1935, as amended, 42 U.S.C. section 1396a(a)(10)(A)(i).
\t\t\t\t(5) If any provision of this subparagraph, or the application thereof to any person or circumstance, is held invalid, such determination shall not affect the provisions or applications of this subparagraph which can be given effect without the invalid provision or application, and to that end the provisions of this subparagraph are severable.
\t\t\t(b) In order to receive benefits under RSA 126-A:5, XXIV-XXV, newly eligible adults from 101 – 138 percent of the federal poverty level (FPL) shall, except for the medically frail, be required to make premium payments of $25 per month made payable to their respective qualified health plan (QHP) if such payments do not exceed 2 percent of household income. Newly eligible adults below 100 percent of FPL shall, except for the medically frail, be required to make a premium payment of $10 per month made payable to their respective QHP. The respective QHP may retain the percentage of premiums necessary to fund administrative costs related to collection.
\t\t\t\t(1) Coverage shall begin on the first day of the month in which the first premium is paid.
\t\t\t\t(2) After a 60 day grace period, beneficiaries who fail to pay premium payments shall no longer be eligible for benefits under RSA 126-A:5, XXIV-XXV and shall not be eligible to reapply for 6 months.
\t\t\t(c) Newly eligible adults who visit the emergency room for non-emergency purposes shall be required to make a co-payment of $8 for the first visit and $25 for each and every inappropriate visit thereafter.
\t\t\t(d) The commissioner shall seek any new waiver or state plan amendments to implement the provisions of this paragraph. Any such waivers or amendments necessary shall be in place by January 1, 2017. Prior to submitting the waiver or state plan amendments to the Centers for Medicare and Medicaid Services (CMS), the commissioner shall present the waiver or state plan amendments to the fiscal committee of the general court for approval. The program shall not be reauthorized until such waivers or state plan amendments have been approved by CMS.
\t\tXXXI. To fund the benefits contained in RSA 126-A:5, XXIV-XXV, consistent with the schedule outlined in 42 U.S.C. section 1396d(y)(1), the following funding sources shall be applied in the following order:
\t\t\t(a) Premium payments collected under RSA 126-A:5, XXX(b).
\t\t\t(b) The insurance premium tax deposited pursuant to RSA 400-A:32, III(b) in the New Hampshire health protection trust fund, established in RSA 126-A:5-b.
\t\t\t(c) Uncompensated care and Medicaid fund revenues for priorities established under RSA 167:64, I(a)(3).
\t2 Insurance Premium Tax; New Hampshire Health Protection Program. Amend RSA 400-A:32, III to read as follows:
\t\tIII.(a) Except as provided in subparagraph (b), the taxes imposed in paragraphs I and II of this section shall be promptly forwarded by the commissioner to the state treasurer for deposit to the general fund.
\t\t\t(b) Taxes imposed attributable to premiums written for medical and other medical related services for the newly eligible Medicaid population as provided for under RSA 126-A:5, XXIV-XXVI shall be deposited into the New Hampshire health protection trust fund, established in RSA 126-A:5-b. The commissioner shall notify the state treasurer of sums for deposit into the New Hampshire health protection trust fund no later than 30 days after receipt of said taxes.
\t3 Uncompensated Care and Medicaid Fund; Priorities. RSA 167:64, I(a)(3) is repealed and reenacted to read as follows:
\t\t\t\t(3) Subject to subparagraph (a)(3)(D), expenditure of revenues deposited to the
uncompensated care and Medicaid fund shall be made for the following purposes in the following order of priority:
\t\t\t\t\t(A) To support provider payments as budgeted in each year of the biennium.
\t\t\t\t\t(B) To fund the state share of costs attributable to the newly eligible Medicaid population as provided for under RSA 126-A:5, XXIV-XXVI, if funding under RSA 126-A:5, XXXI(a)(1)(A) and (B) are insufficient.
\t\t\t\t\t(C) To make disproportionate share hospital payments to New Hampshire hospitals with and without critical access designation in the following order of priority:
\t\t\t\t\t\t(i) To support 75 percent of the uncompensated care costs of New Hampshire’s hospitals with critical access designation consistent with the requirements of 42 U.S.C. section 1396r-4(g) and any relevant federal regulations promulgated thereunder to be shared among such hospitals in proportion to the amount of uncompensated care provided;
\t\t\t\t\t\t(ii) To make disproportionate share hospital payments to support 50 percent of the uncompensated care costs of New Hampshire’s hospitals without critical access hospital designation in fiscal year 2017, and 55 percent of uncompensated care costs of New Hampshire’s hospitals without critical access hospital designation in fiscal year 2018 thereafter consistent with the requirements of 42 U.S.C. section 1396r-4(g) and any relevant federal regulations promulgated thereunder in proportion to the amount of uncompensated care provided.
\t\t\t\t\t(D) To make a disproportionate share hospital payment to each hospital that meets the criteria set forth for “deemed disproportionate share hospitals” as that term is defined under 42 U.S.C. section 1396r-4 up to an amount as budgeted in each year of the biennium.
\t\t\t\t\t(E) Notwithstanding any provision of law to the contrary, in any fiscal year, the amount of uncompensated care reimbursed to non-critical access hospitals shall be reduced in both state contribution and federal match by any shortfall in net Medicaid enhancement tax revenues.
\t4 Contingency; New Hampshire Health Protection Program Extended. If the modification of the proposed waiver as contained in section 1 of this act is approved by December 30, 2016, as certified to the secretary of state and the director of legislative services, the New Hampshire health protection program shall be extended to December 31, 2020 and sections 5-8 of this act shall take effect upon the date of certification. If the modification of the waiver is not approved by December 30, 2016, sections 5-8 shall not take effect.
\t5 Department of Health and Human Services; Premium Assistance Program. Amend RSA 126-A:5, XXV(a) to read as follows:
\t\tXXV.(a) Consistent with the time frames in this paragraph, there is hereby established the marketplace premium assistance program. This will be a premium assistance program for newly eligible adults and their eligible spouse and dependents, if applicable, until December 31, [2016] 2020 and shall be administered by the department of health and human services. In order to receive medical assistance from the program, newly eligible adults who are ineligible for the HIPP program shall choose from any qualified health plans (QHPs) offered on the federally-facilitated exchange if cost effective; provided, however, that any newly eligible adult who had coverage under an alternative benefit plan (ABP) offered by a managed care organization (MCO) under paragraph XIX during the voluntary bridge to marketplace premium assistance program established under RSA 126-A:5, XXIV shall be automatically enrolled at the beginning of open enrollment in a comparable QHP by that same MCO if one is available, unless such newly eligible adult subsequently chooses a different QHP during the enrollment period. If a comparable QHP is not offered by the newly eligible adult's MCO then the newly eligible adult may choose from any QHPs, if cost effective. Provider payments shall be in an amount which shall be no less than before the effective date of this paragraph.
\t6 Department of Health and Human Services; Premium Assistance Program. Amend RSA 126-A:5, XXV(c) to read as follows:
\t\t\t(c) If the waiver to implement the marketplace premium assistance program is approved on or before March 31, 2015 then, coverage under the voluntary bridge to marketplace premium assistance program established in RSA 126-A:5, XXIV shall terminate on December 31, 2015. Enrollment in the marketplace premium assistance program shall begin on October 15, 2015 and coverage shall begin on January 1, 2016. Coverage shall end on December 31, [2016] 2020. The cost of the medical assistance provided under the marketplace premium assistance program shall be paid solely from federal funds as provided under 42 U.S.C. section 1396d(y).
\t7 New Hampshire Health Protection Program. Amend 2014, 3:10, I to read as follows:
\t\tI. If at any time the federal match rate applied to medical assistance for newly eligible adults under RSA 126-A:5, [XXIII] XXIV-XXV between July 1, 2014 – December 31, 2016 is less than 100 percent, less than 95 percent in 2017, less than 94 percent in 2018, less than 93 percent in 2019, and less than 90 percent in 2020 of the amount as set forth in 42 U.S.C. section 1396d(y)(1), then RSA 126-A:5[, XXIII,] XXIV[,] and XXV shall immediately be repealed upon notification by the commissioner of the department of health and human services to the secretary of state and the director of legislative services.
\t8 New Hampshire Health Protection Plan Extended. Amend 2014, 3:13, I-a to read as follows:
\t\tI-a. Section 12, paragraphs II-VII of this act shall take effect December 31, [2016] 2020.
\t9 Applicability. Sections 5-8 of this act shall take effect as provided in section 4 of this act.
\t\tI. RSA 126-A:5, XXXI(b) and section 2 of this act shall take effect July 1, 2017.
\t\tII. The remainder of this act shall take effect upon its passage.
\t\t\t\t\t\t\t\t\t\t\t16-2594
\t\t\t\t\t\t\t\t\t\t\tRevised 1/27/16
HB 1696-FN- FISCAL NOTE
AN ACT\trequesting a modification of the New Hampshire health protection program.
FISCAL IMPACT:
The Department of Health and Human Services, Insurance Department, Department of Corrections, and New Hampshire Municipal Association state this bill, as introduced, will increase state restricted revenue and expenditures, and may decrease state general fund expenditures and local expenditures by indeterminable amounts in FY 2017 through FY 2021. There will be no impact on county expenditures, or on county or local revenue.
METHODOLOGY:
The Department of Health and Human Services states this bill makes various changes to the NH Health Protection Program (NHHPP), including extending the program's repeal date from December 31, 2016 to December 31, 2020. In addition, the bill funds the NHHPP's extension via the following three methods: (1) assessing a monthly premium on individuals enrolled in the NHHPP, (2) dedicating revenue generated from the insurance premium tax levied on health plans purchased under the NHHPP, and (3) revising the formula for distribution of revenues generated by the Medicaid Enhancement Tax (MET). The Department notes that beginning January 1, 2017, the Federal Medical Assistance Percentage (FMAP), or the portion of NHHPP costs covered by the federal government, will drop from 100% to 95%. The FMAP will further drop to 94% effective January 1, 2018, 93% effective January 1, 2019, and 90% effective January 1, 2020, where it will remain under current federal law. The share of costs not covered by the federal government will be covered by the state, via the funding methods identified above. The bill retains the NHHPP's current method of providing healthcare to eligible individuals by purchasing Qualified Health Plans (QHP) available on the healthcare exchange established by the federal Affordable Care Act (ACA). In instances in which QHPs fail to offer certain services mandated by federal Medicaid requirements, the Department will provide wrap services to enrollees. Individuals who self-attest to being medically frail will continue to be provided services by the Medicaid program via contracted Managed Care Organizations. The Department has provided the following cost projections, which do not include administrative costs related to the program's implementation. (Note that the costs for FY 2017 are for the last six months of the fiscal year only, as the NHHPP is currently scheduled to expire December 31, 2016, and so the bill's fiscal impact will begin on January 1, 2017.)
QHP Coverage | SFY 2017 | SFY 2018 | SFY 2019 | SFY 2020 |
Eligible Individuals | 43,968 | 44,898 | 45,828 | 46,758 |
Per Member Per Year (PMPY) Cost | $7,974 (full year) | $8,612 | $9,301 | $10,045 |
FMAP Rate (adjusted based on CY) | 95% | 94% | 93% | 90% |
Total Funds | $175,294,415 | $386,644,743 | $426,225,833 | $469,665,371 |
Federal Share | $166,529,694 | $365,379,282 | $398,521,154 | $429,743,814 |
General Fund Share | $8,764,721 | $21,265,461 | $27,704,679 | $39,921,557 |
Medically Frail | SFY 2017 | SFY 2018 | SFY 2019 | SFY 2020 |
Eligible Individuals | 3,532 | 3,602 | 3,672 | 3,742 |
PMPY Cost | $17,079 (full year) | $18,445 | $19,921 | $21,515 |
FMAP Rate (adjusted based on CY) | 95% | 94% | 93% | 90% |
Total Funds | $30,163,870 | $66,445,137 | $73,155,341 | $80,513,801 |
Federal Share | $28,655,677 | $62,790,655 | $68,400,244 | $73,670,128 |
General Fund Share | $1,508,193 | $3,654,482 | $4,755,097 | $6,843,673 |
Wrap Services | SFY 2017 | SFY 2018 | SFY 2019 | SFY 2020 |
FMAP Rate (adjusted based on CY) | 95% | 94% | 93% | 90% |
Total Funds | $2,850,017 | $5,820,035 | $5,940,035 | $6,060,036 |
Federal Share | $2,707,516 | $5,499,933 | $5,553,933 | $5,544,933 |
General Fund Share | $142,501 | $320,102 | $386,102 | $515,103 |
TOTAL SUMMARY | ||||
| SFY 2017 | SFY 2018 | SFY 2019 | SFY 2020 |
Total Eligible Individuals | 47,500 | 48,500 | 49,500 | 50,500 |
PMPY Cost | $8,771 (full year) | $9,462 | $10,208 | $11,015 |
Total Funds | $208,308,303 | $458,909,915 | $505,321,210 | $556,239,208 |
Net Federal Share | $197,892,888 | $433,669,870 | $472,475,331 | $508,958,875 |
Net General Fund Share | $10,415,415 | $25,240,045 | $32,845,879 | $47,280,333 |
The Office of Legislative Budget Assistant states that under the terms of the bill, the state share of NHHPP costs is to be funded via the following sources in the following order: (1) revenue generated from premiums assessed on enrollees, (2) revenue generated from the insurance premium tax levied upon QHPs purchased under the NHHPP, and (3) MET revenue, which is used to fund any state costs remaining after revenue generated by (1) and (2) has been exhausted. With respect to funding source (1), the bill requires QHPs to collect premiums from NHHPP enrollees in the amounts of $25 per month from those between 100% and 138% of the federal poverty level (except for those who are medically frail or for whom such premiums would exceed 2% of household income) and $10 per month from those below 100% of the federal poverty level (except for those who are medically frail). The bill includes a provision allowing QHPs to retain the share of premium revenue related to the administrative costs of collecting the premiums, with the remainder deposited into the NHHPP trust fund. The Office is awaiting information from the Department of Health and Human Services relative to the fiscal impact of this provision. With respect to funding source (2), the paragraph that follows provides the Insurance Department's estimate of insurance premium tax revenue generated by QHPs purchased under the NHHPP. With respect to funding source (3), the Office notes the bill amends RSA 167:64, I(a)(3), to provide that MET revenue, after first being used to fund budgeted provider payments, shall be used to fund any state share of NHHPP costs remaining after funding sources (1) and (2) have been exhausted. MET revenue remaining after the NHHPP has been fully funded will be distributed to hospitals in the form of disproportionate share payments. As the Office is awaiting information from the Department of Health and Human Services relative to the amount of premium revenue that will be generated by funding source (1), it is unable to estimate the amount of MET revenue that will be necessary to fund the remaining state share of NHHPP costs.
The Insurance Department states that, as noted above, the bill restricts the share of insurance premium tax revenue attributable to QHPs purchased under the NHHPP, and uses it to pay for program expenditures. The Department projects that the amount of premium tax revenue attributable to the bill will be $0 in FY 2017, $9.2 million in FY 2018, $4.9 million in FY 2019, and $5.1 million in FY 2020. (Because of timing associated with the way the insurance premium tax is assessed and collected, FY 2017 revenue will be $0 and FY 2018 revenue will reflect two years' worth of payments.) Under current law, all insurance premium tax revenue is deposited into the general fund. Although this bill restricts a portion of insurance premium tax revenue to the NHHPP, the restricted portion is that raised from taxes levied on QHPs. Because these QHPs would not be purchased in the absence of the bill, unrestricted general fund revenue will remain the same under the bill as it would under current law.
The Department of Corrections states that to date, the NHHPP has resulted in decreased general fund expenditures related to inmate medical costs, because medical expenses for eligible inmates are funded via the NHHPP rather than by general funds. Although the Department is unable to predict the extent of any future general fund savings, it presents the following data for informational purposes, and notes that the NHHPP was first implemented in FY 2015:
| FY 2013 | FY 2014 | FY 2015 | FY 2016 |
Dollar value of inpatient stays paid for by Medicaid | $627,950 | $547,385 | $1,820,623 | $667,192 |
The New Hampshire Municipal Association states that, since the NHHPP has resulted in reduced welfare costs for some municipalities since its implementation, the program's extension may continue to result in decreased municipal expenditures.
The Department of Administrative Services and the New Hampshire Association of Counties state this bill will have no fiscal impact.