Independence is everything to Justin Bonnie. The 21-year-old lives with his family in Barrington, works for the Dover Housing Authority, and helped with the after-school program. He is a drummer and his passion is to make music.
What makes that possible is domestic nursing and personal care that he qualifies through the New Hampshire Medicaid program. Bonnie has a genetic condition, RYR1-related myopathy, which can weaken all the muscles in his body and pose a serious risk to breathing.
“I refuse to be in a facility,” he said. “I need to be able to live wherever I am, in my apartment, and wherever I am, and having that freedom and independence is very important to me.”
However, he worries that freedom and independence could be at risk.
Last month, Republicans in the U.S. House of Representatives passed a budget plan that required significant cuts to Medicaid, a state- and federally funded safety net healthcare program. This will force New Hampshire to roll back key parts of the Medicaid program. This could cover over 180,000 children, the elderly, people with disabilities and low-income adults.
This is because Republicans at Concord are weighing changes to New Hampshire's Medicaid program, including job requirements for some patients and a new monthly premium.
Bonnie and others who rely on Medicaid health insurance in New Hampshire say they are chasing the news with concern – and are blessed with potentially life-changing changes.
The nurse he hired through Medicaid was a lifeline. Before that, his mother had to spend the night in his room.
Once, he couldn't wake her up, so he had to call his grandparents in the middle of the night. However, he is even more concerned about his friend, who is disabled and lives alone, without the support of the same family.
“This program, Medicaid, is essential for basic survival,” he said.
Medicaid support for disabilities, worrying patients who are dependent on mental health
According to an analysis by the New Hampshire Institute for Fiscal Policy, if Congress advances Medicaid cuts, the state could potentially lose hundreds of millions of dollars a year. That will encourage state legislators to come up with that money elsewhere or cut back on who Medicaid covers in New Hampshire.
The expansion of Medicaid in New Hampshire under the Affordable Care Act of 2014 to low-income adults could also be at risk. Under state law, the program is known locally as granite advantage, but will automatically close if federal funds drop.
State Senate Democrats recently tried to remove that automatic repetition by amending another bill on Medicaid. Senate Republicans blocked the amendment and determined it was not closely related to the underlying law.
Asked last month if she was worried that she could threaten New Hampshire's Medicaid expansion program, Ayot said it was too early to speculate.
“I can't deal with my hypothesis,” she said. “So we don't know what's going to happen. And we'll deal with anything that happens when it happens.”
But just as politicians discuss the future of Medicaid, it makes people like Jennifer Belmont Earl of Barrington wonder what it means to their families.
“I don't like a lot of the rhetoric that comes with Medicaid cuts. I think people who have to use Medicaid don't deserve it, so I don't deserve healthcare,” she said.
Barrington residents have two children with autism, ages 5 and 8. Medicaid was consulted by experts at Boston Children's Hospital and Dartmouth Hitchcock Medical Center for regular speech and occupational therapy. She said it helped them learn to communicate better.
“We were extremely fortunate because Medicaid has covered many different child-driven therapies that really helped our children become more independent,” she said.
Belmont Earl said that even private insurance would be a huge burden to pay these services from pockets. She has heard from families whose insurance stops paying speech therapy at a certain age, or only covers certain types of treatment.
For Karen Prive, 53, of Franklin, Medicaid has opened the door to better mental health care. Prior to that, even if she had Medicare (a separate federal program for the elderly and people with disabilities), she could still pay hundreds of dollars a month and see therapists and psychiatrists for depression and PTSD.
“The help I was getting wasn't enough,” she said. “I was hospitalized a lot.”
Now she's watching a team of providers at her local mental health center. That made a huge difference. She is rarely hospitalized.
But the frightening worries about what funding cuts mean for nonprofit mental health centers like her have earned most of the revenue from Medicaid.
“Many providers don't accept Medicare,” she said. “I'm scared to lose my mental health care if I'm not in a community mental health care center.”
Work requirements and monthly insurance premiums are also available
New Hampshire policymakers are also considering changes to Medicaid at the state level. Last week, the state Senate initially approved a bill that would add work requirements to Medicaid.
Ayotte also suggests charging premiums for some Medicaid beneficiaries as a way to reduce costs for the state. (New Hampshire currently does not charge monthly Medicaid premiums, but 17 other states have child coverage premiums or fees.)
The governor's plan applies to households with children making at least 255% of federal poverty levels (approximately $68,000 for a family of three).
Neither Ayotte's office nor the state Department of Health and Human Services answered questions about how many people pay with premiums, even though federal laws limit the 5% of their income.
State officials estimate that premiums will save around $27 million over the next two years, along with increased pharmacy tuition fees. Ayotte says it will make the state's Medicaid program more sustainable and maintain children's qualifications at current levels. This is more generous than most states.
“We meet our financial needs in New Hampshire, maintain our eligibility where we are and maintain budgets for essential services,” she said.
But Nashua's Erin Morehouse worries that the premium could be affordable for her. After being fired from her job as a public health researcher in November, she works part-time at Target for $17 an hour while searching for another job.
Medicaid can afford the medication she needs for asthma and serious allergies, she said. But if she had to pay 5% of her monthly income for Medicaid, she would probably have to go without health insurance.
“I think I just realize that I couldn't do a little bit of (drug) and that I can stretch as much as I can,” she said.
These articles are shared by partners at Granite State News Collaborative. For more information, please visit collaborativenh.org.
