Patient Health First: New Hampshire Increases Medicaid Rates, Expands Coverage for Primary Care and Preventive Services

Concord, NH – Today, Governor Chris Sununu announced significant enhancements to Medicaid to expand primary care services and preventive treatments to improve residents' health, patient experience, and the financial outlook of the program. Earlier today, the Governor and Executive Council approved contracts with three managed care organizations (MCOs) to begin covering preventive treatments in primary care for persons enrolled in Medicaid, effective September 1, 2024.

"Prevention is the best medicine," said Governor Chris Sununu. "By significantly raising rates and expanding Medicaid coverage for preventative services " especially during the state and country's ongoing mental health crisis – this new structure helps keep Granite Staters healthy while lowering costs across the health care system. Once again, New Hampshire is leading from the front."

Under the new arrangement, hospitals will see Medicaid rate increases totaling $76 Million – more than doubling the base rate for inpatient services, with a 120% increase to critical access hospitals and 133% increase to Prospective Payment System (PPS) Hospitals. Additionally, rates for outpatient services have been increased, inclusive of enhancing direct payments supporting such services.

\New patient-first services reimbursable by the New Hampshire Medicaid Program include health risk assessments, preventive screenings, preventive mental health screening and counseling, comprehensive medication reviews, and coverage for care coordination performed in primary care offices.

The current inpatient base rate to Critical Access Hospitals is $3,345. That increases to $7,351, effective September 1.

The current inpatient base rate to PPS Hospitals is $3,011. That increases to $7,001, effective September 1.

How does this model net a better result?

This new arrangement is a massive financial win for those providing services that meet the needs of patients across the Granite State. Under this structure, the hospital systems are projected to receive $363.2 Million in inpatient and outpatient hospital service reimbursement and directed payments.

By increasing rates, this redesign takes advantage of improved federal matching funds, securing an additional $129.6 Million increase to the system. This structure incentivizes and rewards hospitals who provide an array of comprehensive, critical services.

What's new to New Hampshire?

A health risk assessment is a method used by primary care providers to evaluate a patient's individual situation and risks to develop personalized health plans that are tailored to their specific needs, preferences, and risk factors. Primary care practices will now receive payment from Medicaid for care coordination to connect patients with the resources and treatments that they need.

Under the enhancements announced today, services covered by Medicaid now include:

• Preventative screenings in primary care offices for early signs of depression, anxiety, substance use disorders, alcohol misuse, obesity, and other risky conditions
• Counseling services by primary care providers for tobacco cessation and substance use disorders
• Comprehensive medication reviews
• Preventative services related to maternal and child health, including outpatient lactation support, doula services, and donor breast milk
• Opportunities for federal incentives to increase blood lead screenings for one- and two-year olds

"New Hampshire is among the healthiest states in the country," says DHHS Chief Medical Officer Dr. Jonathan Ballard, "The contracts approved today create an opportunity for an even healthier state, as we focus our efforts on expanding coverage for preventive services and improving primary care."

"Medicaid's focus on preventive services and primary care for children and adults with low incomes will help increase access to these services for those who will benefit from them the most," says New Hampshire Medicaid Director Henry Lipman. "We thank Governor Sununu and the Executive Council for this significant investment to improve the health of the Granite State for many years to come."

The rollout of these new services supports the goals in the DHHS Roadmap 2024-2025 to "promote thriving communities." To read the full Roadmap, please visit the DHHS website.