Committee Summary for House Finance Division III (02/21/2025)

Bill/Time	Type	Title	Sponsor
Unclear 00:02:40.879 - 12:00:31 PM	General Working Session	Unclear

Unclear: State Representative Moren Money, Merrimack Information Only00:02:40.879 - 12:00:31 PM; Representative Money opened the session, noting the absence of the chairman and explaining the purpose of the meeting as a budget work session for the Division of Medicaid Services. They emphasized that the recommendations made in the division are sent to the full Finance Committee, and stressed the importance of maintaining a balanced budget as per RSA 99:8-b and House Rule 48. They also highlighted the availability of resources on the Department of Administrative Services and General Court websites, and encouraged members to take notes on potential amendments or proposals for future sessions. They set a deadline for amendments to House Bills 1 and 2 by March 26th.
Unclear: Representative Tarki Information Only00:06:31.919 - 12:04:22 PM; Representative Tarki expressed concerns about Medicaid policy changes mentioned by the governor, which were not included in the official documentation. They discussed receiving a five-bullet point document from Chairman Edwards that lacked official letterhead and clarity on its origin. They referenced RSA 9.9:2-a, which mandates the transmission of budget-related policy changes by February 15th, pointing out that these changes were not in the draft of House Bill 2. They expressed frustration over the lack of transparency and the delay in receiving official documentation, highlighting their discomfort in discussing significant policy changes affecting Granite Staters without proper information.
Unclear: Representative Mooney Information Only00:09:39.760 - 12:07:30 PM; Representative Mooney acknowledged Representative Tarki's concerns and confirmed that the five-point document related to Medicaid would be posted online within the hour. They clarified that the document was a working document for potential amendments to House Bill 2 and emphasized the ongoing nature of the budget process. They reiterated the importance of the Medicaid services budget and thanked the members for their preparation and engagement.
Unclear: Nathan White, Chief Financial Officer, Department of Health and Human Services Information Only00:15:48.880 - 12:13:39 PM; Nathan White introduced the session on Medicaid services and addressed the earlier conversation regarding policy changes. He mentioned that they would discuss policy changes detailed in the document in question, along with financial impacts and federal regulations. He recommended focusing on the PowerPoint presentation as the document of record and outlined the sections of the governor's operating budget and the DHHS budget briefing book that they would cover.
Unclear: Henry Litman, State's Medicaid Director Information Only00:17:23.839 - 12:15:14 PM; Henry Litman provided an overview of the Medicaid Program, highlighting the differences between the agency and the governor's budget, which included about $60 million in reductions. He explained that the Granite Advantage Healthcare program is off-budget with $10 million in reductions. He mentioned federal policy changes that could impact the budget and offered to make themselves available for further questions. He then started discussing specific slides from the presentation.
Unclear: Representative Priest Information Only00:19:24.760 - 12:17:15 PM; Representative Priest sought clarification on the $70 million difference between the agency and the governor's budget over the biennium, confirming it was indeed $70 million. They also asked about the off-budget status of Granite Advantage and received an explanation that it was a legislative decision.
Unclear: Representative Daniels Information Only00:40:16.920 - 12:38:07 PM; Representative Daniels asked for clarification on the differences between being on Medicaid and in the Granite Advantage Program, learning that both are Medicaid programs with the same benefits but different federal matches. They also sought to understand the total Medicaid population versus those in Granite Advantage.
Unclear: Representative Walner Information Only00:41:02.119 - 12:38:53 PM; Representative Walner asked about the numbers of children, nursing home residents, and Granite Advantage enrollees affected by the Medicaid unwind, and was informed that such data would be available later in the presentation.
Unclear: Representative Stringham Information Only00:20:11.159 - 12:18:02 PM; Representative Stringham asked about the comparison framework for budget differences and whether the Medicaid Program's enrollment impacts commercial insurance premiums. They were informed that the Medicaid Program's enrollment can positively affect reducing premiums in the commercial market.
Unclear: Representative Novano Information Only00:22:32.840 - 12:20:23 PM; Representative Novano sought clarification on whether the one in seven enrollment statistic included expanded Medicaid coverage, learning that it encompassed the entirety of the Medicaid Program.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only00:31:58.799 - 12:29:49 PM; David Choury discussed the changes in expedited renewals due to the end of the federal Public Health Emergency, explaining that the expart rate would decrease by about 2,000 individuals a month, with about half not staying open. He highlighted that Medicaid has continuous enrollment, allowing people to reapply if needed.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:02:33.000 - 1:00:24 PM; David Choury discussed the impact of changing the claiming methodology in the Medicaid Program, stating that it would be favorable to schools. He explained that the true costs of services like physical therapy in schools might be higher than what Medicaid currently reimburses, and the new methodology would help close this gap.
Unclear: Unnamed Speaker Information Only01:03:18.640 - 1:01:09 PM; The speaker, likely a committee member, asked about the net impact of changing the claiming methodology on costs. They also asked for a break due to the intense nature of the topic and to ensure everyone's comfort.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:04:03.920 - 1:01:54 PM; David Choury continued discussing the adult dental program, explaining that the state had a settlement with an MCO company that provided 100% of the state share for a period. He mentioned that the program has grown with over 90 dentists participating and has used mobile dental services to extend access, particularly on weekends in areas with a shortage of providers.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:04:49.319 - 1:02:40 PM; David Choury provided further details on the adult dental program, explaining the budgeted dollars were based on actual experience and included federal matching funds. He highlighted the partnership with Delta Dental and their efforts to grow the dental network and improve service to people in need.
Unclear: Unnamed Speaker (Representative Stringham) Information Only01:06:25.359 - 1:04:16 PM; Representative Stringham inquired about the budgeted expenditures for the adult dental program, noting a significant decrease from the actual expenditures in 2024 to the projected figures. They asked for an explanation regarding this 30-40% decrease in services.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:07:11.400 - 1:05:02 PM; David Choury responded to the inquiry about the budgeted expenditures, stating that the year-to-date expenditures were more consistent with subsequent years' budgets. He also mentioned that the state implemented a minimum dental loss ratio to ensure refunds if spending was below a certain threshold.
Unclear: Unnamed Speaker (Representative Tarki) Information Only01:07:58.480 - 1:05:49 PM; Representative Tarki shared anecdotal evidence from constituents about the difficulty in finding providers for the adult dental program. They asked about the number of providers needed to meet the demand and how the program could be extended.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:08:45.158 - 1:06:36 PM; David Choury responded to Representative Tarki's inquiry, stating that the department would consult with the dental director to provide a precise answer about the number of providers needed. He mentioned efforts to increase the provider network and the use of mobile sites to accommodate last-minute appointments.
Unclear: Unnamed Speaker (Representative Nil Vano) Information Only01:09:31.479 - 1:07:22 PM; Representative Nil Vano asked if the adult dental program included preventative care. David Choury confirmed that it does include preventative care as well as emergency care, with specific exclusions like gum surgery but coverage for dentures for certain populations.
Unclear: Unnamed Speaker (Representative Stringham) Information Only01:11:08.320 - 1:08:59 PM; Representative Stringham requested feedback on whether the rates for Medicaid dental services were adequate for providers. David Choury mentioned that the rate increases in HB 2 of 2023 made New Hampshire's rates competitive, approximating 72% of the commercial market.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:12:43.080 - 1:10:34 PM; David Choury discussed the funding for the adult dental program, mentioning the use of Centene settlement funds and the need to address future funding as these funds would run out. He projected a small balance of these funds at the end of the biennium.
Unclear: Unnamed Speaker (Representative Priest) Information Only01:13:41.520 - 1:11:32 PM; Representative Priest asked about the unused funds from the Centene settlement and how they would be applied. David Choury provided projections for the end of state fiscal years 25 and 26, stating that these funds would depend on utilization.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:14:28.520 - 1:12:19 PM; David Choury discussed the children's health insurance program, mentioning a transfer into the account and the impact of the federal Public Health Emergency and continuous enrollment requirements. He noted that the budget included revenue from premiums, which would be shown as a revenue rather than netted into expenses.
Unclear: Unnamed Speaker (Representative Walner) Information Only01:19:54.880 - 1:17:45 PM; Representative Walner asked for details on how premiums for the children's health insurance program would be collected, referencing their past experience with the Healthy Kids Corporation. They expressed concerns about families struggling to pay premiums and the need for policies to handle non-payment.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:20:41.840 - 1:18:32 PM; David Choury responded to Representative Walner's concerns about premium collection, stating that Medicaid remains continuously open for reapplication if coverage is lost. He discussed potential methods for premium collection and the need to develop policies for non-payment scenarios.
Unclear: Unnamed Speaker (Representative Tarki) Information Only01:25:23.719 - 1:23:14 PM; Representative Tarki presented a hypothetical scenario of a single mother with two children at 25% of the poverty level and questioned the impact of a $283 monthly premium on her ability to afford healthcare and the potential increased costs for the state if she lost coverage during a medical emergency.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:26:59.520 - 1:24:50 PM; David Choury responded to Representative Tarki's scenario, clarifying that the state's budget estimate did not assume 100% premium collection and acknowledged that some costs might be passed on to other areas if coverage was lost.
Unclear: Unnamed Speaker (Representative Stringham) Information Only01:29:19.280 - 1:27:10 PM; Representative Stringham asked about mechanisms for handling patients without health insurance and the potential offset of savings from premiums by increased use of uncompensated care funds. They inquired about economic modeling for these secondary effects.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:30:05.719 - 1:27:56 PM; David Choury responded to Representative Stringham's questions, stating that they could consult with other states on their experiences with premium cost-sharing. He mentioned the state's efforts to balance budget requirements with access to care.
Unclear: Unnamed Speaker (Representative Nil Vano) Information Only01:31:40.119 - 1:29:31 PM; Representative Nil Vano asked about demographic trends in New Hampshire, specifically regarding birth rates and their impact on Medicaid budgeting. David Choury noted that New Hampshire's birth rate had stabilized and discussed the state's economic status compared to neighboring states.
Unclear: David Choury, Deputy Director for Medicaid Program Information Only01:37:16.679 - 1:35:07 PM; David Choury discussed the Medicaid schools program, noting a decline in utilization due to the complexity of compliance and the potential benefit of a grant to support the program. He mentioned that the program's budget was for an increase and included 100% federal funds.
Unclear: Unnamed Speaker (Representative Walner) Information Only01:39:36.840 - 1:37:27 PM; Representative Walner asked how school districts accounted for their portion of Medicaid services. David Choury explained that schools bill Medicaid for services like physical therapy, with Medicaid covering half the cost and the school district covering the other half.
Unclear: Kate Fry, Vice President of Advocacy, New Futures Information Only03:44:51.279 - 3:42:42 PM; Kate Fry emphasized the need for more information regarding the changes being discussed. She suggested the use of a crosswalk and another point in time for providers and those affected to provide feedback. She acknowledged the newness of the information and thanked the committee and department for their presentation.
Unclear: Don McKenny, New Hampshire Legal Assistance Information Only03:45:36.479 - 3:43:27 PM; Don McKenny supported the idea of a public opportunity for comment and requested more information about the costs to implement suggested changes, specifically regarding premiums and co-pays. He noted that he had seen implementation costs for work requirements but not for premiums and co-pays, which he believed would be significant and should be factored into the proposals discussed in the working document.