DRCNH Home > News > 12-7-2004 Medicaid

December 7, 2004
by Daniel Barrick, Concord Monitor

Doug Hall, one of the most respected policy analysts in the state, said yesterday that officials at the Department of Health and Human Services have failed to provide him with data about New Hampshire's Medicaid program despite repeated requests.

The lack of public information makes an intelligent understanding of the department's recent proposal to overhaul Medicaid all but impossible, Hall said.

"My experience implies that the department has no interest in answering public questions or responding to public suggestions regarding its Medicaid reform plans," he said. ". . . What degree of confidence can the public put in the department to be planning on the basis of good data, reasonable assumptions and honest projections?"

Hall, co-executive director of the New Hampshire Center for Public Policy Studies, spoke at the first of three public forums the department scheduled to discuss GraniteCare, its plan to revise Medicaid. His sentiments were echoed by many people yesterday, including doctors, Medicaid recipients and advocates for the poor, elderly and disabled. They said Health and Human Services Commissioner John Stephen still had a long way to go before answering even the most basic questions about his proposal. Others said what few details were available left them feeling uneasy.

"When do we see more numbers?" asked Amy Messer, an attorney with the Disabilities Rights Center. "We need more information in order to give you full feedback."

Stephen acknowledged as much yesterday, saying that he wasn't ready to release any financial data about the plan but wanted to hash out broad principles first. Stephen unveiled his proposal to a legislative committee last month. But yesterday's hearing in Concord was the first time Stephen or other department officials have responded to public scrutiny about the plan.

GraniteCare proposes several sweeping changes to Medicaid, the joint federal-state health insurer for the poor and disabled. The proposals include reducing the number of the state's nursing home beds by a third, while increasing the amount of money spent on home- and community-based care; setting up personal savings accounts for poor families and pregnant women; and making it easier for the state to scrutinize the financial background of nursing home applicants.

There's still a long way to go before any of Stephen's proposals take effect. He must first work out financial details with health officials in Washington. Then the Legislature must agree to incorporate those proposals in the state budget. And Gov.-elect John Lynch, who has raised questions about GraniteCare, must approve that budget.

Hall, a former lawmaker who is often asked to present his reports to the Legislature, said he had unsuccessfully requested statistics from the department about the past three years of New Hampshire's Medicaid program. He said his research had turned up a handful of errors in the department's calculations of increases in Medicaid spending in the next few years and left him uncertain about the validity of GraniteCare's assumptions.

"Thus far, they've not put out anything to make me have any confidence that they know what they're doing," Hall said in an interview last night. "It's really critical that all of this be vetted publicly, and so far that hasn't happened."

People who work with those with developmental and mental disabilities also raised doubts about GraniteCare. Bruce Pacht, executive director of United Developmental Services in Lebanon, said Stephen hadn't done enough to solicit ideas from those who work in the field.

"You don't transform social policy by having a group of isolated people who develop ideas and send them down to everyone," he said.

Several people questioned the changes that GraniteCare would make to children's health care. Stephen has proposed giving private accounts, known as "health services accounts," to poor families and pregnant women. These accounts would provide their users with a specific amount of money to be spent on medical care for a year. Money left over could be used on non-health related expenses, but the patient would be responsible for costs above the account cap.

Dr. Suzanne Boulter, speaking for the New Hampshire Pediatric Society, said there was little information available about health service accounts.

She said they typically have higher administrative costs, require expensive computer systems to track, don't improve people's health and lead people to skip follow-up care.

"Our children deserve better than to be guinea pigs in an experiment with health services accounts that has no track record in the public sector," she said.

Stephen said several times that he wasn't ready to provide any specific information, but he did stress his enthusiasm for the idea.

"The health services accounts are still very much being worked out, so I can't tell you a lot, except that I'm really excited by the prospects of this particular issue,"he said.

At other times, Stephen described GraniteCare as "exciting,""transformative" and "empowering." He said reducing the amount of money the state spends on Medicaid was one factor in his plan, but the bigger priority was making people take more responsibility for their own health care.

"The question is, 'How can we change behavior?'" Stephen said.

Additional hearings on GraniteCare are scheduled today in Berlin and Thursday in Nashua.

(The Associated Press contributed to this report.)