Health, Human Services and Elderly Affairs panel advances framework for SB 134 Medicaid work requirements

Concord — The House Health, Human Services and Elderly Affairs committee reviewed proposed language for SB 134 in a work session that would shift New Hampshire from seeking a waiver to adopting a federal-aligned plan for Medicaid work requirements, and agreed to send both a bare-bones amendment and a merged, more detailed amendment to the full committee on Nov. 12.

The committee’s chair opened the session by saying the amendment package was revised after talks among the department, the bill’s prime sponsor and the governor’s office so the state could submit a plan and avoid a gap in coverage while staying aligned with federal changes. Representative Cofield, the bill sponsor, described amendment 3051h as the core, "must pass" text and 3054h as an optional, more detailed layer that adds definitions and procedural protections.

Committee members and department officials focused on three operational issues: how applicants and current recipients will prove compliance with work requirements, what exemptions will be allowed, and how the department will verify information. The merged amendment under consideration would require applicants to demonstrate compliance for a look-back period (states may choose one to three months under federal guidance), prohibit self-attestation at time of application, allow the department to use ex parte records (reports from other agencies or payroll sources) for verification, and set quarterly verification plus routine redeterminations every six months.

Henry Littman, identified in the meeting as the state Medicaid director, said the proposed language aligns with federal limits but raised operational concerns: the department must speed up long-term care eligibility determinations and increase the frequency of eligibility work or risk falling behind. John Williams, the Department of Health and Human Services legislative affairs director, worked with staff on drafting and review, the meeting record shows.

On documentary evidence the draft sets out that verification ‘‘shall not accept self-attestation’’ at initial application and that the department may use payroll records, unemployment records and other documentary sources. The department told the committee it can pull data from employment security and that the Centers for Medicare & Medicaid Services has developed an app states can use to let applicants import payroll data; the department estimated roughly 60–80% of applicants could provide documentation through such tools, while committee members projected up to about 40% might face difficulty.

Members debated policy trade-offs. Some legislators argued a three-month look-back better guards program integrity and reduces opportunities to ‘‘game’’ the system; others said the longer look-back could unfairly bar people with sudden medical emergencies (for example, an older adult who has a stroke and did not know three months earlier they would need Medicaid). The draft includes a medical‑frailty exemption, but the text requires documentation for frailty and ties severability clauses to federal statute and regulation, which members noted could still create short-term implementation delays if medical records are slow to arrive.

Representative Freundant asked whether the burden is on applicants; the Medicaid director said the department will use ex parte data when available but that applicants must provide information if the department lacks a source. Committee members asked for practical clarifications: how often monthly documentation must be supplied (the draft anticipates monthly reporting with the department also harvesting data quarterly) and how current recipients will be noticed and given time to comply (members were told recipients would receive advance notice and a 30‑day period to address compliance before action).

On scope of qualifying activities, the department said approved activities are broader than paid employment and can include a combination of work, education and volunteering. The department also noted reporting provisions in 3054h provide more specificity than the bare-bones amendment and asked the committee to be ready to adjust the statute if operational challenges arise.

By informal straw poll, the committee signaled broad support for advancing amendment 3051h and majority support for amendment 3054h as revised; members directed Office of Legislative Services to draft a merged amendment that would incorporate core 3051h language into 3054h and to have both the bare-bones and merged amendments available at the Nov. 12 full committee meeting. The chair closed the session and confirmed the Nov. 12 timeline.

What happens next: OLS will prepare a merged amendment incorporating the agreed language and the committee will consider both that merged amendment and the original 3051h at the Nov. 12 full committee meeting. The session record shows the department and sponsor discussed implementation tools (including a CMS app and ex parte data pulls) and operational risks that will likely be the focus of continued committee review.