Lawmakers balk at Medicaid direct certification despite push by anti-hunger advocates

Senate lawmakers Wednesday voted 13-11 against a floor amendment to the budget that would have required the state to enroll in Medicaid direct certification as a pilot program, a move that disappointed advocates. As a compromise to Senate Republicans, the direct certification amendment would have applied only to municipalities in which Supplemental Nutrition Assistance Program (SNAP) participation is at 11 percent or greater based upon federal fiscal year 2021 data.

Medicaid direct certification is a federal program that would automatically sign up eligible students for free and reduced-price lunch based upon their family’s Medicaid enrollment. As of now, families must first submit paper applications to be enrolled.

Sen. Becky Whitley, a Hopkinton Democrat who introduced the amendment, described the 10 towns included in the pilot program as “the top 10 neediest towns in the state.” They are notably all located in red districts and largely in rural New Hampshire. Five of the 10 towns are located in Coos County, identified in a report by the UNH Carsey school as one of the counties with the highest free and reduced-price lunch eligibility rates in the state. Sen. Denise Ricciardi, a Bedford Republican whose district also covers Winchester, one of the 10 towns in the proposed pilot program, was the only state senator of those impacted municipalities who voted yes to the amendment. 

As chair of a special committee on education legislation, passing Medicaid direct certification has been a years-long goal for Manchester Board of School Committee member Sean Parr — a goal that may now be unattainable until the next legislative session. The special committee, formed just two years ago, took on direct certification as one of its first projects. 

“We’ve been trying hard to advocate for Manchester’s priorities,” he said. “To really be present at meetings of the Legislature at the state level.” 

In his school district, Parr assumes at least 5 to 10 percent of eligible students are not enrolled in free and reduced-price lunch. The school district contains some of the highest numbers of students from immigrant and minority backgrounds, who historically face barriers accessing resources like free and reduced lunch. 

“Almost 50 percent of our students are non-white students and there are sometimes language barriers,” Parr said. 

According to the National Center for Education Statistics, 7.5 percent of Manchester students come from families who do not fluently speak English, 3.1 percent greater than the national average. 

“Of course we do put things out in multiple languages,” Parr said. “But it still can be difficult to really reach all the families we serve.

Parr also cited difficulties for single-parent households, which make up 33 percent of families in the district, according to the most recent NCES data. 

“A lot of parents are working second jobs, there are a lot of single-parent households, and that kind of cognitive load is just really hard,” he said. 

The effort to enroll the state in the Medicaid direct certification program has been a long road for advocates. Gov. Chris Sununu failed to apply for the program in 2022, citing a lack of legislative approval and time constraints. This spring, House Bill 601 and Senate Bill 242, which would have directed the state to enroll in Medicaid direct certification, were both eventually tabled. 

Some were hopeful after the House approved adding Medicaid direct certification into the budget. Then, the Senate passed an amendment last month that removed it from the budget and instead created a study committee to analyze potential spending. The floor amendment proposed on Wednesday was voted down due to similar concerns regarding cost.

These costs are not as a result of the program itself, which utilizes federal funds, but as a result of the state’s adequacy funding formula, which uses free and reduced-price lunch enrollment as a proxy for poverty. 

“The state pays schools based on the number of enrolled free and reduced children both in their adequacy formula and the extraordinary needs grants,” said Laura Milliken of New Hampshire Hunger Solutions. “And that makes doing Medicaid certification potentially expensive.”

While New Hampshire Hunger solutions estimated a cost of $18 million to $30 million, which aligns with the $30 million Sununu set aside for the program in his budget, Senate President Jeb Bradley expressed concern that it could cost upwards of $100 million. 

“I think while we all want to make sure that we’re doing everything that we can to ensure that kids have access to free and reduced lunch, we also have to consider the overall price tag,” he said. 

However, his estimates include the passage of a bill that was shelved several weeks before the Senate Finance Committee meeting and cannot be reconsidered until the next legislative session. House Bill 572, which did not pass the Senate, proposed raising the eligibility for free and reduced-price lunch to 300 percent above the federal poverty level. 

For Milliken, the program is worth the additional cost. 

“We know that children who eat meals in school, you know, do better in school in terms of behavior in terms of academic performance, and in terms of their both short- and long-term health,” she said. 

She expressed frustration with the Senate’s inability to pass direct certification. 

“I think it’s a tragedy for the children who are not able to eat meals in school, and I think it’s a tragedy for the school districts who are not able to fully help students succeed,” Milliken said.