Nursing home population reduced under proposed Medicaid changes

CONCORD, N.H. (AP) – Gov. Craig Benson has proposed reducing the state’s nursing home population by 30 percent in the next five years for a savings of $337 million that would go toward developing adult day-care centers and hospices.

The proposals to the state Medicaid program also set up private health accounts for pregnant women and families with children and give the state more control over how disabled people get medical care.

The proposal was outlined in a report sent to Health and Human Services Secretary Tommy Thompson in Washington last month and has not been made public yet. The Concord Monitor obtained a copy of Benson’s report this week.

According to the proposal, the goal is to move people out of nursing homes and into home and community-based care centers. Right now, any elderly person who is deemed sick enough or poor enough is admitted to a state nursing home. Under the changes proposed by Benson and Health and Human Services Commissioner John Stephen, those eligibility requirements would be tougher, though no details are provided.

All nursing home applicants would be screened to determine whether their children or other family members should pay part of the care costs. The assets of family members are currently not considered in assessing nursing home applicants.

That proposal has raised some opposition in other states.

Traditionally, nursing homes have been considered an “entitlement,” much like Social Security or Medicare.

Diane Rowland, executive vice president of the Kaiser Family Foundation and an expert on Medicaid, said the proposals outlined in Benson’s report are “a reversal of the directions we have historically taken.”

The report offers no details about how the proposals will affect New Hampshire’s Medicaid budget, which is shared by the federal government and the state. It projects that the first year of changes could cost the state several million dollars, but that savings could reach $100 million a year within five years.

More than 150,000 of New Hampshire’s poor, disabled and elderly residents are on Medicaid.

“I understand that time is short, so we need to move this forward quickly,” a letter from Benson to Thompson accompanying the report reads.

Several leaders in New Hampshire’s health community said that they were unaware of the details in the proposal or that a request was sent to Washington. Neither Benson nor Health and Human Services Commissioner John Stephen has discussed the proposed changes publicly with the Legislature, which must approve any changes in the way the state pays for Medicaid.

Rep. Neal Kurk, chairman of the Legislative Fiscal Committee, said he had not heard any of the details, but he said Benson was right to review his proposals with officials in Washington before seeking approval from New Hampshire lawmakers.

“It’s my sense that the ideas are pretty preliminary right now, and I wouldn’t expect to be informed,” said. “They need now to fly this by Washington first.”