How New Hampshire’s Medicaid Work Experiment Could Impact Community Health Centers

More than 2500 fewer patients may visit New Hampshire community health centers annually due to the restrictive Medicaid work and reporting requirements the state launched in January, according to an analysis by researchers at the George Washington University Milken Institute School of Public Health (Milken Institute SPH). Their analysis, published today on GWHPMMatters, includes their estimate that the requirements may result in nearly 11,000 fewer visits to the state’s community health centers, cut Medicaid revenues by up to $2.8 million, and cause up to 28 full-time staff to be lost.

“New Hampshire’s work experiment is aimed at adults whose eligibility arises from the Affordable Care Act’s (ACA’s) Medicaid expansion. Its terms are among the most restrictive among the work experiments approved to date,” said the study’s senior author, Sara Rosenbaum, JD. She is the Milken Institute SPH’s Harold and Jane Hirsh Professor of Health Law and Policy and a widely respected authority on Medicaid. “The requirement extends through age 64, longer than other demonstrations, reaching well into the age at which the health of older low income Americans shows serious deterioration.”

Milken Institute SPH researchers have been tracking the accumulating evidence about the effects of these work requirements since the Trump administration announced over a year ago that it would grant permission to states to require many Medicaid recipients to work, volunteer or train for a job as a condition of coverage.

“New Hampshire’s work experiment requires beneficiaries to demonstrate 100 hours of work per month on a year-round basis, compared to 80 hours in many other states,” said Jessica Sharac, a Milken Institute SPH research scientist and the study’s first author. “The state gives Medicaid recipients only one month to cure any month in which their work hours fall below this 100-hour threshold. Certain activities such as job training, vocational education, and job search would qualify, but the Department of Health and Human Services’ 1115 approval does not include funding to expand job or educational supports.”

The new analysis builds on an analysis recently published by the Commonwealth Fund by Milken Institute SPH researchers Leighton Ku, PhD, MPH and Erin Brantley, PhD(c) of the potential impact of New Hampshire’s work experiment. They estimate that between 30 percent and 45 percent of all adults subject to the requirement – 15,000 to 23,000 beneficiaries – would lose Medicaid within one year.

Rosenbaum, Sharac, and their colleague Peter Shin, PhD, MPH, director of the Geiger Gibson Program in Community Health Policy at the Milken Institute SPH, combined these Medicaid loss estimates with updated data from community health centers derived from the 2017 Uniform Data System information reported to the Department of Health and Human Services by all health centers. This enabled the Milken Institute SPH team to estimate the impacts on health center revenue, staffing, and patient care capacity in New Hampshire, as they previously did for Arkansas and Kentucky using patient loss data for those states.

In their report, Sharac, Shin and Rosenbaum explain why they believe that the impact estimates and consequences presented in their analysis may actually be an underestimate. “In the most rural and isolated New Hampshire communities where health centers are the only source of primary care, the impact is likely to be more severe, since these communities lack alternatives,” Rosenbaum said. “As our previous impact assessments have demonstrated in other work experiment states, Medicaid losses also carry implications for all community residents who depend on health centers and other safety net health care providers for the type of care that maintains health and promotes the ability to work.”

What Could New Hampshire’s Medicaid Work Experiment Mean for Community Health Centers?” by Shin, Sharac and Rosenbaum, is available below.