Impacts of Medicaid Expansion The purpose of this report is not to argue the merits of the complex issue surrounding the Medicaid expansion provision of the Affordable Care Act (ACA). However, an expansion of Medicaid to non-disabled adults without children, with incomes at or below 133 percent of the federal poverty guidelines, could have large implications for the demand for alcohol treatment services in New Hampshire, as well as increase the demand for health care services attributable to alcohol. On the service supply side, Medicaid expansion may also offer NH the opportunity to increase alcohol treatment rates in the state at little or no cost to state government. Some Key Considerations:
An estimated 58,247 NH adults may become eligible for Medicaid under the ACA if the state approves the Medicaid expansion. (Figure 9) A high percentage of these adults are in age groups with high rates of alcohol abuse. Studies by The Center for Health Care Strategies (CHCS) and Mathematica Policy Research argue that new Medicaid enrollees are likely to have levels of chronic disease and behavioral health problems (including excessive alcohol; use) that are significantly greater than those experienced in the current non-disabled Medicaid population.21 Studies indicate that individuals with alcohol and substance abuse problems have higher health care costs on average than do non-abusers.22
Failing to build adequate alcohol treatment capacity for the Medicaid expansion population could have a significant impact on state general fund expenditures for the Medicaid program long into the future. Although the expanded Medicaid population may contain higher incidence of alcohol abuse, and have higher overall health care costs than the current Medicaid population, expanding treatment for alcohol disorders to the newly eligible Medicaid population could result in significant savings to state government and the larger NH economy. NH and its Figure 9
An Estimated 58,247 Non-Disabled Adults, Without Children, Would Become Newly Eligible For Medicaid Under the ACA Estimated # of Adults Newly Eligible for Medicaid 55-64
11,211
45-54
14,295
35-44
6,564
9,365
25-34
14,081
20-24
18-19
2,731
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Source: Author’s calculation using data from the 2010 and 2011 March Supplement of the “Current Population Survey”
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