New Hampshire Moves Slowly Into Medicaid Managed Care, but Still Hits Some Bumps

Few states have proceeded into Medicaid managed care with as much caution as New Hampshire. At the start, going into managed care was optional at applied only to certain groups with specialized needs, such as nursing home patients.

Schedules for other patients have been revised repeatedly, and many patients who would have been in Medicaid managed care already won’t enroll until July 1, 2015.

But the timeline presented Thursday at Governor Maggie Hassan’s Commission on Medicaid Care Management made it clear that time and options are running short. Last month, a New Hampshire legislative committee heard that delays have cost the state $9.6 million thus far, which the Department of Health and Human Services had to find elsewhere.

New Hampshire’s plan to contract with private companies—2 have been selected and a third may be on board soon—is not unlike what states around the country have done to slow the rise in spending on Medicaid. And, as expected, families and clients that use services have expressed fears that efforts to manage costs will amount to barriers to care. In New Hampshire, some families say that’s already happening. Cathy Spinney, whose child is affected by Medicaid services, told the Concord Monitor that parents are having to navigate bureaucracy for services that have been received without incident in the past. “Families have had it,” she said.

As in other states, the call for managed care has come with promises to better “coordinate” care among many providers. In many states, especially those that moved rapidly into managed care in bad budget years, the coordination part often fell flat out of the gate, and clients reported disruptions. In Ohio, reports rose of long-time nurses or aides going without pay, with some quitting.

It was during these reports last year that New Hampshire slowed down its schedule to shift some of its most vulnerable clients into managed care: nursing facilities, which were set for September, will not enroll until July 1, 2016, more than a year from now, according to the Monitor.

The big date will be July 1, 2015, when New Hampshire plans to require that those who receive both Medicaid and Medicare—those so-called dual eligible—must enroll in managed care. These clients are some of the highest consumers of healthcare but also historically could benefit the most from better coordination of services.

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