Column: N.H. Medicaid Funding Falls Far Short

For the Valley News
Published: 3/6/2017 9:00:16 PM
Modified: 3/6/2017 9:00:21 PM

The Valley News recently wrote an in-depth article about the care provided at two area nursing homes — one in New Hampshire, the other in Vermont — following their sale.

 As the trade association for most of New Hampshire’s nursing homes, we were pleased to see quality improvement highlighted for Hanover Terrace.

 New Hampshire has been recognized by the federal government for having the nation’s second-best nursing home care, based upon the rate of deficiencies found during rigorous surveys. Whether this high quality is sustainable, however, is largely a function of the state’s reimbursement for the roughly 4,200 nursing home patients in New Hampshire who are on Medicaid.

 At last measure, 45 percent of the residents of Grafton County’s four nursing homes were on Medicaid.  That figure can be much higher elsewhere — it’s 70 percent in Sullivan County. 


Medicaid payments fall far short of paying care costs. Indeed, New Hampshire has the nation’s third-highest shortfall between Medicaid payments and nursing home costs. One need not be a demographer to see how unsustainable this shameful disconnect is.

  Over eight years nursing home care funding will have grown by less than half (7.2 percent) of the most recent wage increase (15 percent) the state gave its own caregivers, nurses at state prisons. 


To provide an example, Woodlawn Care Center, run by the Martin family in Newport, has been recognized by federal government ratings as a top facility — even achieving a 5-star quality rating and deficiency-free surveys. 


But Woodlawn, like any facility that cares for the Medicaid poor, also has its costs — mostly wages for caregivers and support staff. Efficiently run, Woodlawn is comparatively “lucky” that the state’s Medicaid payments, at $161.77 per patient day, “only” fall 25.2 percent short of its costs.  That leaves it with a projected shortfall between payments and costs of $621,394.  Perhaps one-third of that gap will be closed by the federal match upon a fee that all facilities pay.


Imagine any other business setting — let alone a health care setting — where you would expect top quality despite costs not being met.  Government regulation of nursing homes, perhaps as rigorous as the regulation of anything short of nuclear power plants, takes no account of government underfunding. Nor would providers argue it should — regardless of resources, providers are, ultimately, accountable for the care.

A family like the Martin family, where the oldest son shovels snow on snow days, has their reputation and life savings tied up in the care that they provide. 


When Medicaid underfunding is too unbearable, facilities simply close — as recently happened with the 45-year-old William P. Clough Extended Care Center in New London. It is worth asking how many other facilities the state is willing to see close in the face of a coming “age wave.” 

Gov. Chris Sununu’s proposed budget would freeze nursing home funding for two years, even as it relies upon more revenue from a fee facilities pay. 


What is jarring about New Hampshire’s unwillingness to adequately fund care for its most elderly and disabled citizens is that this disregard contradicts what voters want.  According to a post-election poll, a plurality of voters (43 percent) ranked Medicaid funding for long-term care even ahead of education as a top priority for legislators to focus on.  Over three-quarters (76 percent) were in favor of the state fully reimbursing care costs for long-term care. 

Gov. Sununu and legislators will have much to improve upon in the budget deliberations that lie ahead.  They must also be wary of adding another layer of care-chiseling cost by turning the Medicaid long-term care program over to private managed care insurers — an idea 73 percent of voters oppose. 


Too often the challenges of caring for our aging population can be hidden. The Valley News deserves credit for bringing them to light. It is a conversation we must have as a just society.


Brendan Williams is president/CEO of the New Hampshire Health Care Association.

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