House Finance Division III presses DHHS on five-point Medicaid policy package, transparency of House Bill 2 materials

House Finance Division III convened a budget work session Feb. 21 to review the Department of Health and Human Services' Medicaid budget and a five-point set of proposed policy changes that staff described as potential amendments to House Bill 2.

The session, chaired by State Representative Maureen Mooney, focused early on members' concerns about transparency after several lawmakers said they had only recently received a five-point document describing policy changes. "I am really uncomfortable that we are gonna be discussing significant policy changes that are gonna affect tens of thousands of Granite Staters and their health care coverage without official documentation on the changes that are coming," Representative Telerski said.

DHHS officials responded that the department had prepared a more detailed PowerPoint and the governor's operating budget materials and would post the five-point document and today's presentation online. "We have before you a couple of different documents. The first is the PowerPoint presentation, and we will be going through the policy changes that are described in the document that was being discussed before," said Nathan White, chief financial officer for DHHS.

Agency staff described the five points as working proposals reflected, in part, in the governor's recommended budget and operating adjustments. The items discussed during the session included: returning to regular (pre-pandemic) eligibility redeterminations (the end of certain federal flexibilities used during the public health emergency); a proposal to add premiums or cost-sharing for the Children's Health Insurance Program (CHIP); pharmacy and prescription cost-sharing adjustments including a $4 pharmacy copay scenario; policy language to prioritize lower-net-cost drugs (generic vs. brand) already reflected in the HB 2 draft; and a premium structure for the Granite Advantage program (the state's Medicaid expansion population).

Henry Littman, the state's Medicaid director, flagged that some of the measures already reflected within the governor's operating budget but acknowledged uncertainty about final HB 2 text and timing. "I would probably recommend using this as the document of record and maybe set aside that other PowerPoint or that other bullet document for the time being," Littman said, referring to the department's PowerPoint.

Members repeatedly sought clarity about when the full HB 2 trailer bill would be available. Staff said the Office of Legislative Services was preparing language and that DHHS planned to post today's materials and the five-point outline shortly after the meeting. Committee members also asked that the department and budget staff produce crosswalks showing where proposed policy changes map to the governor's budget totals and to identify fiscal implementation costs.

Why it matters: The five policies being discussed could affect coverage, program costs and provider payments across tens of thousands of New Hampshire residents. Lawmakers emphasized that if elements will be enforced through HB 2 or other statutory language, the legislature and the public should have time to review final text before votes.

The committee did not take votes during the work session. DHHS officials said they would supply additional supporting documents, fiscal notes and website postings for committee members and requested stakeholders.

Ending: Division III scheduled further budget work sessions later in the week to continue review of related divisions, and DHHS said it will post presentation materials and the five-point outline online for committee review.