Hospitals to feds: Please intervene to fix N.H.'s broken Medicaid system
The following are excerpts from a letter written by officials from the 10 New Hampshire hospitals suing the state over Medicaid reimbursements to Cindy Mann, deputy administrator of the federal Centers for Medicare & Medicaid Services.The letter was signed by the trustees of Dartmouth-Hitchcock Medical Center in Lebanon, Elliot Health System and Catholic Medical Center in Manchester, Wentworth-Douglass Hospital in Dover, Exeter Health Resources, Southern New Hampshire Health System and St. Joseph Hospital in Nashua, Laconia-based LRGHealthcare, Cheshire Medical Center in Keene and Frisbie Memorial Hospital in Rochester.Collectively, we are the stewards of health-care missions to serve the poor and needy within our communities. We are committed to these missions. They motivate our public service. They provide fundamental guiding principles for our decisions. They are, however, in jeopardy.Our ability to care for the sick regardless of their ability to pay is substantially compromised because New Hampshire has abdicated its responsibilities as a partner with the federal government in the operation of a functional Medicaid program. New Hampshire is among the Medicaid programs with the lowest reimbursement for services provided in the country, and has made circumstances worse with recent actions that have forced the implementation of unprecedented limitations on access to care.The New Hampshire program has been pushed past the breaking point and federal intervention is now necessary to stop any further deterioration of the Medicaid delivery system.New Hampshire lacks functional processes or procedures to assess the impacts on access to care which result from its fiscal decisions. This omission violates the federal Medicaid Act. New Hampshire has enacted a state law, which purports to permit Medicaid funding decisions without analysis of impacts to access. Again, this law conflicts with the Medicaid Act. Efforts to benchmark New Hampshire against peers have not succeeded for want of funding and staff.The state is simply "flying blind" on how its decisions are affecting access to care.New Hampshire has cut Medicaid funding to our 10 hospitals by more than $130 million in this fiscal year. These cuts were made with no policy debate, no analysis of their impact on the entire delivery system, and no consideration of how they would affect the poor and needy. They were done for one simple reason: to balance the state budget and shift the state's fiscal problem to our hospitals.As fiduciaries for the financial viability of our respective hospitals and health systems, we have been forced to take actions we abhor in response to the state's fiscal irresponsibility. We have laid off medical and support staff, closed programs, and reduced or eliminated funding to community health partners.Most significantly, and most regrettably, many hospitals have started the process of eliminating or restricting access for Medicaid patients. Some systems have already implemented these eliminations and restrictions. New Hampshire's failure to be a partner with us in this joint federal/state program leaves us few options. We have taken these actions not because we want to but because we have to.The New Hampshire Medicaid program is broken. Medicaid patients are facing a new reality that they may not get the care they need when they need it. The entire healthcare delivery system is under considerable stress, which impacts the quality of and access to care for all New Hampshire citizens.Beyond our role as trustees and fiduciaries, we are community and business leaders who recognize that the failure of the Medicaid program will have potentially catastrophic impacts in our communities. We cannot sit and watch the further deterioration of this critical program without action.As the federal administrator responsible for New Hampshire's compliance, we are asking you to intervene and help us stop the disintegration of the Medicaid program. New Hampshire is not listening to us. We need your help to fix this ailing program.