As expanded benefits end, Granite Staters will have to find alternatives
When the nation’s Covid-19 public-health emergency ends May 11, New Hampshire residents will need to find alternatives to expanded benefits they’ve had for the past three years.
Changes to Medicaid, the Supplemental Nutrition Assistance Program, telehealth and a plethora of other resources helped thousands of Granite Staters, including those out of work due to the pandemic. Medicaid Expansion alone saw an 86 percent enrollment increase from February 2019 to February 2023.
As these programs return to their pre-pandemic requirements and benefit levels, public health officials are working to ensure a smooth transition and continued support.
“The public health emergency may be ending, but New Hampshire’s response to Covid-19 in our communities will continue,” said Patricia Tilley, director of the Division of Public Health Services for the state health department.
Continuous enrollment
The implementation of the federal public health emergency in 2020 allowed programs to be more flexible with who they served and how much assistance they provided.
Before the pandemic, Medicaid recipients were required to go through an annual redetermination process, according to Elinor Wozniakowski, market director for Dartmouth Health at Conifer Solutions, an organization Dartmouth contracts to organize its revenue cycle functions. This entailed submitting documentation on income, health needs and other factors to confirm continued eligibility.
To qualify for Medicaid in New Hampshire, one must be of low income and either pregnant, responsible for a dependent under the age of 18, 65 or older, blind or disabled, according to the U.S. Department of Health and Human Services’ website.
The qualifying income levels are determined along a scale depending on how many people are in a household. For a household of one, the maximum qualifying income in New Hampshire is $19,392, while for a family of four, it’s $39,900.
When the pandemic hit and the federal public health emergency was put in place, the redetermination process was waived through the Medicaid Expansion program, called Granite Advantage. However, as of April 1, this continuous enrollment will end, more than a month before the public health emergency is officially terminated.
Through outreach in the form of letters and educational resources, New Hampshire has worked to let people across the state know of this change.
“The state of New Hampshire has actually done a really good job of communicating their unwind plans for the end of continuous enrollment,” Wozniakowski said.
The state health department began a “pink letter” campaign last year, Wozniakowski said, to inform people that the continuous enrollment would be ending and they needed to complete their redetermination.
With the deadline drawing closer, state health officials have upgraded to a “yellow letter” campaign, which signifies a more urgent call for Medicaid recipients to complete the redetermination process before April 1.
“If folks get a letter in the mail, don’t sit on it, and don’t just put it on the kitchen table and not look at it,” she continued. “Open it up — call, email, connect — to make sure that you have the support that you need to ensure that you have consistent coverage.”
Wozniakowski added that Dartmouth Health is taking action to make sure all its partners, including Cheshire Medical Center in Keene, are informed and are providing information via social media posts, posters and tear cards in registration areas.
Conifer Solutions is also partnering with the Foundation for Healthy Communities, which provides education about healthcare in New Hampshire. With the organization’s help, Conifer Solutions has set up informational tables across the Dartmouth Health system to make sure patient navigators are informing their clients of this change, according to Wozniakowski.
She emphasized that these transitions will happen over the course of the next year, so people won’t go uninsured overnight. Instead, once redeterminations have been submitted, the state will apply an algorithm where eligibility of people who have not used Medicaid services in the past year will be determined first, and more vulnerable populations will be determined later in the year to give them more time to find alternative coverage.
“We just need to stay on top of it and make sure we’re continuing to communicate the state plan and stay in touch with our patients to make sure that there’s no gaps in coverage,” she said.
The Medicaid Covid-19 Group will also end May 11, according to Wozniakowski. This is an insurance option that became available during the pandemic for people whose health insurance did not cover Covid-related services, or who did not have health coverage at all. This option provided diagnostic services, over-the-counter tests, vaccinations and treatments.
Wozniakowski explained that people who used this coverage during the pandemic may be eligible for regular Medicaid or insurance through the Affordable Care Act (ACA) after May 11, and advised them to contact the state health department or a patient navigator to explore coverage options. Patients of Dartmouth Health can reach out to their patient advocates for assistance.
Nutrition resources
Another program that expanded its resources during the pandemic was the Supplemental Nutrition Assistance Program (SNAP), which provides families with financial assistance for better access to food.
Earlier in the public health crisis, households that received SNAP benefits were given “emergency allotments.” But on March 1, SNAP households’ benefits were cut, reverting back to their pre-pandemic allotments, according to the state health department.
Wozniakowski said that with inflation and the current increase in grocery costs, this may pose hardships for families.
However, multiple services could help mitigate these burdens, according to Tilley of the NH Department of Health and Human Services.
One, she noted, is the Women, Infants and Children Nutrition Program (WIC), which provides nutrition support to women of low income who are pregnant or mothers of young children.
The Commodity Supplemental Food Program is also offered to seniors 60 and older through the state health department. This program provides free food and nutrition information and the opportunity to join The Senior Farmers Market Nutrition Program, which gives seniors local, farmgrown produce.
The NH Food Bank is another resource, providing nutritious meals to homeless shelters, food pantries, soup kitchens, senior centers and children’s programs, according to its website.
The food access map, on the Food, Meals and Nutrition page of the NH Department of Health and Human Services’ website, displays nutrition resources across the state.
DHHS is also working to keep Covid treatments accessible as people experience transitions with their coverage.
“We’re going to continue to ensure that the Covid-19 vaccine is available,” Tilley said.
According to the U.S. Health and Human Services’ website, most private insurance plans will continue to cover Covid-19 immunizations in full. Medicaid will also cover these shots through Sept. 30, 2024.
Treatments for Covid-19 infections, including Paxlovid and Lagevrio, will also generally remain covered and available, according to the HHS website. However, after Sept. 30, 2024, coverage of treatments may differ from state to state, the federal health department’s website says.
Aside from the pandemic-prompted changes to Medicaid and SNAP, the Centers for Medicare and Medicaid Services issued around 70 waivers to offer additional flexibility, according to Matthew Houde, vice president of government relations at Dartmouth Health.
Among them, he noted, is flexibility pertaining to access to care via telehealth, which was extended at the end of 2022 for an additional two years. So, at least for now, that will remain in place.
Houde emphasized that part of his role in government relations has been advocating to make some of these flexibilities permanent.
He doesn’t expect this to happen for all 70 waivers, but said permanence for three to five particularly effective ones would be a “game changer.”
“When the pandemic hit, we needed to be nimble and flexible in order to provide care to people,” he said. “For me, it’s about, how do we make sure our providers can continue to provide the care that they have seen so effective during the course of the pandemic, with the flexibilities of the public health emergency coming to an end.”
This article is being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.
