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Companies, advocates and legal groups clash as committee hears proposal to add work requirements to Medicaid expansion
Summary
Senate Bill 134 would direct DHHS to pursue a waiver requiring community engagement for certain able‑bodied adults on the Medicaid expansion program. Proponents argued work promotes independence; opponents said prior experiences (Arkansas) show coverage losses and high administrative costs.
A contentious hearing on a proposal to require work or community engagement for certain non‑elderly, non‑disabled adults receiving Medicaid expansion drew a large turnout and sharply divergent testimony.
Sponsor Senator Howard Pearl told the Senate Health & Human Services Committee that the bill aims to help adults move off public benefits into paid work, citing research about lifetime earnings associated with employment. He offered a committee amendment requiring any waiver be submitted to the legislative fiscal committee for review before federal submission.
John Stephen, a former DHHS commissioner, testified in favor and said work is integral to escaping poverty and that New Hampshire has experience operating effective work‑oriented programs (TANF) that reduced caseloads. He urged careful program design to avoid administrative pitfalls and suggested the committee leverage prior waiver work.
Opponents were numerous and included New Hampshire Legal Assistance, community mental‑health centers, disability advocates (Autistic Self Advocacy Network), NAMI New Hampshire, New Futures, and cancer survivors and patient advocates. Legal Assistance warned that previous state attempts and litigation show risk of widespread coverage loss — citing Arkansas and prior New Hampshire work‑waiver litigation — and argued the measure is premature while federal policy is unsettled. NAMI and disability advocates said the majority of Medicaid beneficiaries already work and that work requirements impose reporting burdens that could cause people to lose coverage in error, harming people with mental illness or disabilities. A cancer patient said illness prevents reliable employment and urged maintaining coverage without additional administrative barriers.
DHHS told the committee the federal landscape is uncertain and that building a robust waiver would require administrative investment. Department staff provided a broad preliminary general‑fund estimate (about $2.5 million) for infrastructure and evaluation costs and warned that prior waiver efforts required significant setup. They also said any waiver would need federal approval and that a rigorously designed exemption set would be essential.
Ending
The committee heard both philosophical and practical arguments: proponents framed work as a pathway out of poverty while opponents emphasized evidence that previous implementations produced coverage losses and administrative expense. Senators asked DHHS for more detailed implementation and fiscal analysis before proceeding.
