State Marketplace Profiles: New Hampshire

Final update made on November 1, 2013 (no further updates will be made)

Establishing the Marketplace

On June 18, 2012, Governor John Lynch (D) signed HB 1297 into law, which prohibits the state from participating in or enabling a state-based health insurance Marketplace. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally-facilitated exchange.”¹ Given this authority, newly-elected Governor Maggie Hassan (D) informed federal officials on February 13, 2013 that New Hampshire would pursue a state-federal partnership exchange. The state will retain control over plan management and consumer assistance functions.²

In 2011, Governor Lynch allowed two bills opposing the implementation of federal health reform to become law without his signature.³⁴ SB 148 prohibited the enforcement of the individual mandate in the Affordable Care Act and HB 601 established the Joint Health Care Reform Oversight Committee to oversee all recommendations for legislation implementing federal health reform and required the Insurance Commissioner to obtain approval from the Committee before implementing any provisions.

While Governor Lynch was initially favorable to the creation of a State-based Marketplace, opposition in the state substantially limited his ability to move forward.⁵ In April 2011 the Insurance Department withdrew a contract for work on Marketplace governance, eligibility, and health plan participation, because of a unanimous rejection by the Executive Council, a body of five elected members who advise and provide a check on the Governor’s power in the state.⁶

Contracting with Plans: The New Hampshire Insurance Department (NHID) has legislative authority to certify Qualified Health Plans (QHPs); however, standards and rules relating to QHPs are subject to approval by the Joint Health Care Reform Oversight Committee. NHID released guidelines for QHP Certification on April 10, 2013.⁷ Anthem Blue Cross and Blue Shield is the only insurer offering coverage in the Marketplace in 2014.⁸ Anthem will offer 11 health plans across three metal levels, one dental plan, and one catastrophic plan. Anthem has contracted with 16 out of 26 hospitals in New Hampshire and one hospital in Massachusetts in accordance with Network Adequacy requirements. Rates in the Marketplace are higher than other states, in part due to New Hampshire containing only one rating area and one insurer within the Marketplace.⁹

Risk Adjustment, Reinsurance, and Risk Corridors: In December 2012, Governor Lynch indicated that New Hampshire was interested in administering its reinsurance program; however, Governor Hassan intends to use federal services to run the state’s program.¹⁰

Consumer Assistance and Outreach: HB 1297 authorized the creation of a 12-member Health Exchange Advisory Board, for which the Governor, Insurance Commissioner, and Health and Human Services Commissioner each nominated four individuals who were all confirmed by the Executive Council. The Advisory Board, which began meeting in November 2012, is tasked with representing the interests of businesses and consumers in the Marketplace.¹¹

Due to opposition from Republicans in the state and the failure of the legislature to appropriate funding, NHID is not able to directly oversee the implementation of consumer assistance programs, and responsibilities have been shifted to the New Hampshire Health Plan (NHHP), the state’s high risk pool.  NHHP was awarded $5.3 million to fund a Marketplace Assister program and to develop and implement an outreach and education campaign.

On September 5, 2013, NHHP released a Request for Proposals (RFP) for the Marketplace Assister program. Marketplace Assisters (MPAs) will provide outreach and direct assistance to consumers seeking to enroll in coverage through the federal Marketplace, healthcare.gov.  MPA proposals were due September 20, 2013 and on October 1^st, NHHP announced six organizations had received funding to serve as Marketplace Assisters.¹² The Marketplace Assister program will be run alongside the federal Navigator program. On August 15, 2013 CMS awarded nearly $580,000 to Planned Parenthood of Northern New England and Bi-State Primary Care Association to serve as Navigators in New Hampshire.¹³ NHID developed the in-person assister training curriculum and NHHP will provide program oversight. Per New Hampshire state law, Navigators and MPAs as well as other assisters may not recommend one plan over another. Insurance brokers and Agents will also play an important role in signing people up for coverage. Brokers, agents, and MPAs are required to register with CMS and the State of New Hampshire.¹⁴

Also on September 5, 2013, NHHP released an RFP for the development and implementation of an outreach and education campaign to raise awareness about the coverage opportunities under the ACA and to create a brand identity for the New Hampshire Marketplace. Components of this campaign include the development of a state-based website and a communications strategy involving television, radio, print, and online advertising; social media platforms; grassroots and small business outreach; and partnerships with community entities such as libraries, schools, and faith-based organizations. NHHP expects to award the contract in early November.¹⁵

Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. New Hampshire compared potential plans and the legislative Joint Health Care Reform Oversight Committee recommended Matthew Thornton Blue (Anthem BCBS) as the benchmark plan.⁹ The state will use the Federal Employee Dental and Vision Plan (FEDVIP) for the pediatric dental and vision supplements.

Marketplace Funding

While the State of New Hampshire Insurance Department received a $1 million federal Exchange Planning grant, little of the money was spent. The passage of HB 601 ordered the return of $666,000 in unused funds effective July 2011 and directed the Insurance Commissioner to decline certain Marketplace planning grant funds in the future. The Department has since requested permission to use the remaining funds; however, the Executive Council declined to authorize the spending in December 2011.¹⁶ In February 2013, the state was awarded a Level One Establishment grant for $894,406 to hire consultants to support plan management operations, including activity management and technical assistance, and to perform preliminary research for consumer assistance functions. In April 2013, New Hampshire received a second Level One Establishment grant totaling $5.3 million to support further planning, development, and design of a Consumer Partnership Marketplace.¹⁷ Despite being awarded this federal funding, the state of New Hampshire rejected the second level one grant funding. Instead, CMS awarded the funds to the New Hampshire Health Plan (NHHP), a quasi-government organization originally created to oversee the high risk pool. NHHP will oversee the consumer outreach and education efforts in the state.

In February 2011, New Hampshire applied for an Early Innovator grant as part of the multi-state New England consortium; however, the state itself was not included as a recipient when the award was granted.¹⁸

Next Steps

On March 7, 2013, New Hampshire received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a Partnership Marketplace.¹⁹ Enrollment in the Marketplace began October 1, 2013.

For more information on New Hampshire’s health insurance Marketplace visit: http://www.nh.gov/insurance/consumers/fedhealthref.htm and healthcare.gov.