Long-term care insurance touted by HHS chief

New Hampshire should consider helping to offer affordable long-term care insurance to younger and middle-aged residents, according to Health and Human Services Commissioner John Stephen.

Stephen said his advisory council is exploring how to encourage young citizens to buy long-term care insurance, which would reduce the burden on state government when the baby boomer generation reaches retirement age.

“We have got to come up with incentives to get people to have coverage for themselves and also to choose less expensive options for care than nursing homes,” Stephen said during an interview last month with The Telegraph editorial board.

After nine months on the job, Stephen is crisscrossing the state trying to seek consensus on how to reform Medicaid, which consumes 70 percent of his agency’s budget.

He has hosted 11 public forums across the state.

Stephen said he plans to recommend changes to Gov. Craig Benson as early as this month and perhaps will have a draft plan ready to submit to the Legislative Fiscal Committee by the end of September.

“That’s the best-case scenario for a timetable, and we may not be able to keep to that,” Stephen cautioned.

Private providers of Medicaid services and recipients of services have packed the hearings to urge Stephen not to make sweeping changes.

Stephen said the status quo is not possible, since spending on seniors is expected to double between now and 2015.

“We’ve got to do things differently,” said Stephen, a former assistant safety commissioner and state prosecutor before he took over leadership of the state’s largest agency.

This review is sparked by the Bush administration’s decision to crack down on states leveraging the federal Medicaid program to maximize federal grants.

U.S. Health and Human Services Secretary Tommy Thompson told Benson and Stephen it would not approve the state’s request for $300 million over the current two-year budget cycle unless it committed to make changes in the future.

Benson came back to Concord and spoke favorably about the concept of a “block grant,” which would earmark a fixed amount of federal revenue for the state in exchange for allowing New Hampshire flexibility to design its own services for the poor, senior citizens and the disabled.

But Stephen said Benson has said little about block grants since that time and, contrary to the claims of his critics, Stephen said he is not supporting that controversial option.

“It’s not true. He didn’t make a deal whatsoever. The only deal is to build a system that will work for New Hampshire without any new costs on the federal government,” he said.

Thompson echoed Stephen’s viewpoint during an interview with The Telegraph last month.

‘A judgment call’

Stephen said he also would pursue a requirement before the Legislature next year that all doctors and nurses disclose gifts that are given to them by pharmaceutical companies as a way to encourage them to do business.

A few months ago, Stephen and Benson threatened to take a national pharmacy to court to get it to open its books, but they have since backed off on that idea.

“We have got to begin to really scrutinize the (prescription drug) spending,” Stephen said.

Another major Medicaid expense is the care for 200 patients at the New Hampshire Hospital that totals $50 million a year.

Stephen said he disagrees with community mental health directors who contend the state should close the hospital and use the savings to improve services at the local level.

“There are always going to be some you make sure that they get constant supervision,” Stephen said.

“It’s a judgment call as to who is better placed in a community.”

The population living in the state hospital should be reduced, but it will always serve as a “safety net” for the most serious patients who pose a danger to the public if they are released.

“They (center directors) will rail at the dollars spent at the state hospital, yet if there is a tough situation or case, they are the first to say, ‘Well, we’ll have the state hospital deal with it,’” Stephen said.

Among other reforms under consideration by Stephen are:

• Look-back period for nursing homes: Stephen said he seriously will explore changing the period from three to five years that senior citizens can transfer their financial assets to others to qualify as a Medicaid patient for a nursing home. The federal standard is five years, while New Hampshire permits a three-year financial review.

• Selective contracting for hospital services: Stephen said it’s a small enough state that Medicaid could substantially save money by selecting the hospital that offers the most affordable cost for procedures.

• Wholesale purchases of medical equipment: Stephen said the state would save significantly were it able to purchase equipment from middlemen rather than buying it at the pharmacy level.

• Transportation brokerage: The state could save by setting up a brokerage or dispatcher service to arrange for transportation for all those in Medicaid programs, Stephen said.


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