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As director of health law and policy for UNH’s , , supports New Hampshire’s Department of Health and Human Services in a range of areas, including Medicaid. The former director of Medicaid for New Hampshire, she shares some insights on the public health insurance program.

What is Medicaid?

Deborah Fournier: Medicaid is a critical source of health insurance for some vulnerable people:Ìýchildren, expectant moms, senior citizens, people with disabilities and adults with low incomes.ÌýThese are folks who wouldn't be able to get most of their healthcare from anyplace else.

New Hampshire’s Medicaid budget is roughly $2.5 billion per year, with federal funds making up the slight majority of that and the rest funded by the state. Medicaid provides coverage for essential healthcare services everyone needs:Ìýtreatment for ear infections, broken legs, asthma attacks, prenatal care. It includes doctor’s appointments and prescription medicines.

About 187,000 Granite Staters are covered by Medicaid, including almost 90,000 low-income kids.ÌýIn fact, the largest Medicaid eligibility group in New Hampshire is children.ÌýMedicaid provides coverage for 25% of the state’s children.

What are the current issues around Medicaid?

At the federal level, Congress is proposing $880 billion worth of cuts to Medicaid. For context, that’s roughly what the federal government spends on Medicaid across the country for one year — although to be clear, all of those cuts wouldn’t happen in a single year.

We don’t know how those cuts would be implemented, but it’s likely that states will end up paying more than they are currently paying for the same coverage. So states will have to make a choice: Generate more revenue or cut people off Medicaid.

What about the proposed work requirements as a condition for coverage for certain adults?Ìý

Here in New Hampshire we have experience with work requirements: We implemented them in 2019. But we ended up suspending them within a few months, because the reporting requirements were so complex and detailed that many Medicaid members couldn’t comply and about 20,000 low-income people would have lost their coverage. And that’s despite the state spending more than $4 million communicating those requirements to members.Ìý

Medicaid is a health insurance program, not an employment or financial independence program. When it began in 1965, the groups who received it — infants and children, pregnant women, people living with disabilities and older adults — were generally not employed and thus didn’t have access to employer-sponsored health insurance.

Further, data from multiple studies suggests that Medicaid recipients who can work are working. The rub is that you can have a minimum wage job working 40 hours a week, 52 weeks a year, and your gross income is still below the federal poverty level. So it's something of a misnomer to suggest that people need to work so that they are no longer eligible for Medicaid. Unfortunately, we have enough low-wage jobs that people can work full time and still be in need of this program.

Most of us aren’t on Medicaid. Why should we care about these proposed changes?

For those of us who hope to grow old, Medicaid matters because it is a dominant source of coverage for long-term care services in New Hampshire and in the country.ÌýWithout it, senior citizens and people with disabilities would be forced to bear the cost of these critical services — skilled nursing facilities, home and community-based care services that maintain mobility and independence — on their own.ÌýCoverage for this care is not available through traditional health insurance. Not even from Medicare.

But bigger picture, when states have to start making choices about who they cover and who are they cutting off, it adds up to more people being uninsured — but they’re still using the healthcare system. That means more uncompensated care, which means more financial strain on our healthcare providers, who we know are already struggling.

It’s better for the entire healthcare ecosystem if people are covered with insurance. And it’s better for people to get the health care that they need, so they can live their lives. Policy that keeps everyone covered is best.