Deborah Fornier, Medicaid director for the state of New Hampshire, told lawmakers on the Idaho Legislature’s working group on health coverage this morning that in her state, Medicaid was expanded in 2014 to cover all eligible adults, along with a requirement that the state apply for a federal waiver effective in 2016. It did so, and now New Hampshire has shifted the entire Medicaid expansion population from its standard Medicaid managed-care program to a program in which the state pays the premiums for those individuals to purchase commercial insurance through the federal insurance exchange that operates in their state.

That meant 48,000 people were shifted over. “We in essence doubled the number of people in the federal marketplace in New Hampshire,” Fournier said. The state’s Legislature has now extended the program for two more years, through 2018. New Hampshire had expected to see 60,000 people be covered by its Medicaid expansion, but numbers came in lower.

Under questioning from Idaho lawmakers, Fournier said New Hampshire’s Medicaid program has been all managed-care since December of 2013. Under the new waiver program, she said, the vast majority of those patients are now back to fee-for-service plans. “It really depends on whatever the commercial carrier is involved in,” she said. “We don’t dictate to the carriers.”

Idaho has been looking to bring more managed-care elements, including a patient-centered medical home model, to health care delivery in the state in an effort to drive down health care costs.