Medicaid changes impact on community health centers

WELCOME TO NEW HAMPSHIRE’S BUSINESS I’M FRED KOCHER. HERE’S A QUOTE FROM MY GUEST. WITH THE PASSAGE OF NEW HAMPSHIRE’S 2026 2027 STATE BUDGET AND THE FEDERAL BUDGET RECONCILIATION BILL, NEW REQUIREMENTS AND COSTS ARE COMING TO MEDICAID PROGRAMS THAT COULD IMPACT THOUSANDS OF COMMUNITY HEALTH CENTER PATIENTS. WE ARE ALREADY SEEING THE RESULTS OF THESE SWEEPING CHANGES IN SITE CLOSURES. AND THAT’S A QUOTE BY TESS CANAAN, WHO IS PRESIDENT AND CEO OF THE BI-STATE PRIMARY CARE ASSOCIATION IN NEW HAMPSHIRE AND VERMONT AS IT APPEARED IN HER OPINION PIECE IN THE CONCORD MONITOR, OCTOBER 8TH. TESS IS ALSO AN RN AND A CLINICAL NURSE SPECIALIST WHO IS A FORMER CONSULTANT TO THE HEALTH CARE FINANCING ADMINISTRATION, AND SHE JOINS ME IN THE STUDIO TO EXPLAIN WHAT SHE SAYS WILL BE A LOSS OF MEDICAID COVERAGE FOR 20,000 IN NEW HAMPSHIRE. WELCOME, TESS. THANK YOU. IT’S NICE TO BE BACK. HOW MANY COMMUNITY HEALTH CENTERS DO WE HAVE IN NEW HAMPSHIRE AND HOW MANY IN VERMONT? YEAH, SO IT’S A GREAT QUESTION. SO, BI-STATE, AS AN ORGANIZATION IS A CHARITABLE ORGANIZATION THAT WORKS TO PROMOTE ACCESS TO HEALTH CARE. WE HAVE 21 COMMUNITY HEALTH CENTERS IN VERMONT AND NEW HAMPSHIRE SEEING 330 PATIENTS. WHAT ARE YOU SEEING RIGHT NOW WITH THE CHANGES IN MEDICAID COVERAGE, THE AFFORDABLE CARE ACT, SUBSIDIES GOING AWAY, THE FIRST OF THE YEAR, MEDICARE ADVANTAGE PLANS, LEAVING AT LEAST NEW HAMPSHIRE. RIGHT. AND JUST THE HIGH COST OF DOING BUSINESS. WHAT’S HAPPENING TO THESE CENTERS RIGHT NOW? YEAH. SO THANK YOU. SO JUST FOR YOUR VIEWERS, THE COMMUNITY HEALTH CENTERS ARE A VERY UNIQUE MODEL OF PRIMARY CARE. THEY DO MEDICAL, MENTAL AND BEHAVIORAL HEALTH, ORAL HEALTH, SUBSTANCE USE DISORDER. LOW COST MEDICATIONS, AND THEN ALSO ENABLING SERVICES, TRANSPORTATION, TRANSLATION. AND THEY SEE PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. THEY’RE IN MEDICALLY HIGH NEED AREAS. THEY ALSO HAVE A PATIENT BOARD OF DIRECTORS THAT ARE PATIENTS OF THE HEALTH CENTERS. AND SO THE TWO POLICY ISSUES THAT I’M SEEING THAT ARE GOING TO BE THE MOST. AFFECTED IN NEW HAMPSHIRE IS THE CHANGE TO MEDICAID. SO IN THE BILL THAT WAS PASSED IN JULY, THEY TOOK OUT $950 BILLION OF SPENDING, WHICH THE CBO SAYS 10 MILLION PEOPLE WILL LOSE THEIR COVERAGE. SO PULLING THAT INTO NEW HAMPSHIRE, WE ESTIMATE THE ESTIMATIONS ARE SOMEWHERE BETWEEN 14 AND 40,000. WE CHOSE 20,000 AS FROM A MARKER. SO WE ANTICIPATE THAT THERE WILL BE PEOPLE THAT WILL LOSE THEIR COVERAGE FOR MEDICAID. AND YOU SAY THERE ARE SOME BARRIERS TO HEALTH COVERAGE. AND LET’S PUT THAT UP ON THE SCREEN. WORK REQUIREMENTS, FREQUENT ELIGIBILITY REQUIREMENTS, COST SHARING FOR INDIVIDUALS ON MEDICAID EXPANSION AND MONTHLY PREMIUMS FOR CHIP ENROLLEES. THOSE ARE JUST SOME OF THE BARRIERS, RIGHT? RIGHT. YEAH, ABSOLUTELY. SO BESIDES THE MEDICAID, THERE’S THE MARKETPLACE. AND THAT’S IN THE PUBLIC PRESS NOW, BECAUSE THAT IS PART OF THE GOVERNMENT SHUTDOWN. AND SO IN THE MARKETPLACE, THE PREMIUMS THAT THE INSURANCE COMPANIES PAID TO PAID FOR INSURANCE SO THAT YOUR PREMIUM WOULD BE LESS IS GOING TO END IN DECEMBER. SO THERE ARE 70,000 PEOPLE IN NEW HAMPSHIRE THAT GET THAT ARE ON THE MARKETPLACE. THEY GO AND SHOP ON THE MARKETPLACE FOR THEIR INSURANCE. 50,000 OF THEM ARE GETTING A PREMIUM ASSISTANCE. SO AS OF DECEMBER, 50,000 PEOPLE IN NEW HAMPSHIRE WILL BE LOSING THAT PREMIUM ASSISTANCE, WHICH WILL MAKE THE PURCHASE OF INSURANCE UNAFFORDABLE FOR MANY. AND YOU HAVE TWO CENTERS IN NEW HAMPSHIRE THAT HAVE CLOSED OR ARE CLOSING. RIGHT. AMMONOOSUC COMMUNITY HEALTH CENTER SERVICES IN FRANCONIA AND THE HEALTH CARE CENTER IN CANAAN, RIGHT. DO YOU SEE ANY MORE AT THAT RISK? YEAH. SO THE HEALTH CENTERS IN NEW HAMPSHIRE HAVE 80 SITES. THOSE ARE TWO OF THE SITES, THAT OF THE 80 THAT ARE CLOSING. AND IT’S BECAUSE THEY ARE HAVING LESS REVENUE COMING IN FROM MEDICAID, AND THEY WILL BE SEEING LESS REVENUE COMING IN FROM THE MARKETPLACE, FROM COMMERCIAL INSURANCE. SO AS A BUSINESS MODEL, WE HAVE ONE OF OUR HEALTH CENTERS THAT TWO THIRDS OF THEIR PATIENTS ARE EITHER ON MEDICAID OR ON THE MARKETPLACE. SO IF YOU HAVE CHANGES IN THOSE REVENUE STREAMS COMING IN AS SMALL BUSINESSES, THEN THE EFFECT OF THAT WILL BE LESS RESOURCES AND MORE UNINSURED AND MORE UNCOMPENSATED. AS YOU SAID, EVEN IF THEY’RE NOT INSURED, THEY HAVE TO SEE THESE PATIENTS ANYHOW. THEY WILL STILL BE THEIR PATIENTS. WHAT DOES THE WHAT DO THE STATES OF NEW HAMPSHIRE WANT NEED TO DO RIGHT NOW TO DEAL WITH WHAT YOU JUST DESCRIBED? RIGHT. I THINK ANY TYPE OF PUBLIC POLICY CAN BE REVISITED. I THINK THE CHANGES THAT ARE HAPPENING TO THE MEDICAID PROGRAM IN NEW HAMPSHIRE WOULD GO A FAR STEP TO BE ABLE TO HELP THE MEDICAID ENROLLEES. I ALSO THINK THAT THINKING ABOUT UNCOMPENSATED CARE AND WHAT THE RESOURCES ARE TO BE ABLE TO CONTINUE THIS INFRASTRUCTURE OF THESE HEALTH CENTERS IN VERMONT AND NEW HAMPSHIRE. LEAVE IT THERE. TED KENNEDY, WHO IS PRESIDENT AND CEO OF THE BI-STATE PRIMARY CARE ASSOCIATION IN NEW HAMPSHIRE AND VERMONT. THANK YOU. THANK YOU FRED. NICE TO HAVE YOU HERE. AND A TOUGH SUBJECT. IF YOU MISSED PART OF THIS BRIEFING ON THE COMMUNITY HEALTH CENTERS, YOU CAN G