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Medicaid director briefs committee on enrollment, waivers, managed care and high-cost therapies
Summary
State Medicaid director Henry Littman summarized program structure, enrollment trends following the public-health emergency unwind, waivers approved for inpatient behavioral-health and reentry services, and rising pharmacy costs driven by gene and specialty therapies.
Henry Littman, New Hampshire’s Medicaid director, briefed the committee on program structure, enrollment and policy items the legislature can expect during the session.
Littman said Medicaid enrollment rose during the federal pandemic-era continuous-enrollment period to about 251,000 and has since dropped to roughly 184,000, fluctuating between 182,000 and 184,000 in recent months. "We were one of the first states, one of the first four states to be able to begin that process and one of the earlier states to finish it," Littman said of the unwind and re‑verification work.
Littman outlined the state’s managed-care structure: the Granite Advantage Health Care Program (the state’s Medicaid expansion program) and the standard Medicaid program (the Granite Advantage Healthcare Program and related managed care arrangements were reauthorized through 2030). He said ongoing issues that may return as legislation include the disproportionate share program and the Medicaid enhancement tax, and that the department is pursuing measures to help school districts claim more Medicaid match for eligible school services.
Littman described an approved Section 1115 waiver (referred to as the "11 15 waiver" in testimony) that renewed in July 2024 and included higher federal matching for certain inpatient substance-use-disorder and psychiatric services, provided the state invests additional funds in community-based services. A new element he highlighted is a community reentry benefit for sentenced individuals leaving corrections facilities to improve continuity of care for people with mental-health or substance-use disorders; the department began implementing that benefit Jan. 1 at state correctional settings and will move to counties.
On pharmacy costs, Littman said high-cost gene and specialty therapies are increasing program spending: "Last year, 66 potential therapies of that nature were available," he said, and described a recently implemented high-cost pharmacy risk pool intended to share risk with managed-care organizations and align utilization and follow-up practices.
Littman also summarized program operations: Medicaid oversees managed care and supports other divisions’ Medicaid-funded services, and federal match rates vary by population (e.g., expansion populations receive 90% federal match; standard populations around 50%). He offered to provide periodic committee reports and detailed follow-up on fiscal and policy items as bills advance.
No committee votes were taken at the orientation; Littman answered several members’ questions on enrollment, reimbursement rates and pharmacy management.
