Long-term care is on the ropes in New Hampshire

It is increasingly impossible to recruit and retain caregivers at all levels of care – whether for in-home care, in facilities or in hospitals


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For those providing long-term care in the nation’s second-oldest state, this is one of the most worrisome times in memory.

New Hampshire reimburses less for Medicaid care than perhaps any other state. For its roughly 4,500 Medicaid clients in nursing homes, the state looks at cost reports, disallows costs it’s unwilling to pay for, and then, even from that total, eliminates another 29.88 percent of costs across-the-board before paying for its clients’ care.

Medicaid payments have only gone up 4.5 percent since 2009, while the consumer price index has gone up by around three times that amount. Medicaid payment for assisted-living facilities is even more arbitrary, at just $49 a day for 24/7 care, meals and housing – below a budget motel rate.

It is increasingly impossible to recruit and retain caregivers at all levels of care – whether for in-home care, in long-term care facilities or in hospitals. Acknowledging this crisis, legislators created a commission to study the issue, which this month concluded Medicaid reimbursement should be sufficient to pay the state’s share-of-cost of living wages.

As the commission noted, “continuity of care is essential to quality care” and “caregiving should be a viable profession.”

The broader business community has also taken note. The Business and Industry Association, generally not fond of new state spending, has put on its five-item 2017 legislative agenda the need to increase reimbursements to Medicaid providers.

That priority, along with the BIA’s support for improved state university investment – which could boost nurse training programs – shows a commendable concern for both the old and young. Indeed, I think they are connected. Adequate support for caregiving could help with New Hampshire’s much-lamented exodus of young adults.

With an estimated $107 million budget surplus, the Legislature and Governor-elect Chris Sununu, should heed these calls to invest additional resources in the Medicaid caregiving workforce. After all, the sacrifice of caregivers, and those they care for, has helped build the state’s surplus.

At the same time, providers are worried about the state landscape, and looking for leadership in Concord, there are serious threats at the federal level.

Congress must resist Medicaid cuts that would uniquely disadvantage New Hampshire. So-called “block grants,” for example, would effectively freeze the federal contribution toward care, which is already depressed by New Hampshire being tied with a handful of other states for the lowest federal Medicaid matching rate. Why should New Hampshire, where the federal government only pays half the cost of Medicaid care, be forever disadvantaged compared to a state like Mississippi, where the federal contribution is 75 cents on the dollar? Surely New Hampshire’s senior citizens, and those with disabilities, are as worthy as those in other states.

Because of its low federal Medicaid matching rate, New Hampshire is also forced to employ provider tax mechanisms that generate additional federal resources. There has been a longstanding effort by some congressional leaders – most recently through the benignly titled Common Sense Savings Act of 2016 – to eliminate such mechanisms.

This effort has been fought by groups ranging from child advocates, hospitals, long-term care providers and even obstetricians. It must be stopped, or funding shortfalls will become even more miserable for New Hampshire’s most-vulnerable citizens.

The next year will be pivotal at the state and federal policymaking levels. Simply put, it will determine whether long-term care has a long-term future in New Hampshire. 

Brendan Williams is president and CEO of the NH Health Care Association.

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