Lawmakers Mixed on Stephen's Accomplishments At HHS

Republican Representative Peter Batula of Merrimack has nothing but praise for the outgoing HHS Commissioner.
“I want to say it has been a pleasure to work with John Stephen. He is in my opinion one of the hardest workers in government today and one of the most sincere and dedicated individuals.”
John Stephen in turn credits his staff for taking on more responsibilities with limited resources.
In his resignation letter, he boasted about how they helped him give back $143 million to the state’s general fund.
He did that partly by not filling the more than 250 vacant positions.
He emphasized that working with less meant his department had to use team work to find new ways of solving problems.
As an example, he describes how one of those teams worked to fill the gap in the North Country after the area’s only psychiatric unit closed last month.
“So we put this task force together. We then included the hospitals we’re working with 7 hospitals in that region and also with other hospitals we then brought that plan… I wanted to make sure we had enough time to put a good detailed plan together for the budget. The legislature approved that plan and put the resources in the budget to implement the plan and now we’re starting to work on transition.”
But despite limited resources, Stephen says his department kept a keen focus on priorities.
“The most important issue is to be able to meet needs and demands of citizens in our state that have special needs and population that we’re charged by law with assisting and servicing and also not to forget public health.”
But Richard Cohen says he thinks John Stephen did little to meet the needs of New Hampshire’s citizens.
Cohen directs the Disabilities Rights Center.
“He attempted to almost decimate the Katie Becket program – which was a program to provide funding and services to kids with disabilities to enable them to live at home rather than go to institutions. He made it more difficult to get into nursing homes. There was an attempt to eliminate children and seniors off community mental health programs. He consolidated peer support centers and therefore weakened peer support in mental health. And I think there were few accomplishments that demonstrate that he was trying to serve populations with disabilities or other populations served by health and human services.”
But Merrimack Republican Peter Batula disagrees with Cohen’s assessment.
Batula points out that Stephen helped promote the Recovering Lives program, which aims to help people with drug and alcohol dependencies.
And as for seniors - Batula said that Stephen pushed for funding programs that help the elderly live in their own homes rather than county nursing homes..
“I think we’ve made real progress, but only in beginning stages and the new commissioner will be involved we will deliver as much care to homes as we can and while we do that we’ll still be filling nursing homes.”
Other lawmakers and health care experts agree on the value of giving seniors the option to stay at home if they can.
But critics of Stephen’s plan say the state hasn’t provided enough funds for the homecare program.
And as a result seniors are not getting consistent care.
Democratic Senator Kathy Sgambati, from Tilton, was the former acting head of HHS.
She resigned in 2004 rather than work under the then newly appointed Commissioner Stephen.
Sgambati agrees that home-based care for seniors is a positive trend.
But she adds that under the state’s current system homecare providers aren’t reimbursed enough to cover costs for Medicaid clients.
As a result, she says, homecare workers are underpaid and the jobs have high turnover.
“The issue for some who are vulnerable is that changing caregivers within a couple of months translates not only to disrupting the care pattern but it’s a quality of care issue a trust issue when your vulnerable to know that you’ll have continual help and constancy to who that help is and some choice about it.”
Stephen did agree to some wage increases for those workers.
But homecare providers say it was far below the amount needed to cover costs.
Commissioner Stephen would like to free up some funds by cutting Medicaid spending in other areas.
For example, he’s been pushing a plan that would send Medicaid patients needing specific surgeries to providers who charge less.
Stephen said it would save about $8 million dollars.
“The best example is the tonsillectomy ……and- in one area the state Medicaid is paying 2100 and in another area it’s paying 500 and the federal government is going to pay the bill and the state is going to pay the bill and we’re not bringing competitive strategies into the program. That doesn’t help the taxpayer.”
Rob Nordgren has been running Child Health Services in Manchester for seven years – and knows about the Medicaid reimbursements.
The nonprofit agency provides dental, mental health and other health services to low-income children.
Nordgren warns that Stephen’s plan to outsource surgeries and increase competition won’t work.
“There are certainly appropriate areas where some competition and transparency around pricing, I think but at same time whole notion of a competitive marketplace doesn’t really exist in some parts of our healthcare system and it certainly isn’t going to save the state any money to go down that road.”
Apparently the House Fiscal Committee had it’s own problems with the Commissioner’s plan.
Lawmakers this week tabled the proposal .
And Nordgren says he thinks there will be other significant changes to some of Stephen’s programs when the next commissioner takes the helm.
“A lot of ideas around Medicaid reform are going to be a work in progress and legislators and the governor’s office are going to have to do a lot of work to adjust these programs going forward.”
And while Stephen, Sgambati and Nordgren disagree on the state’s Medicaid policies, all agreed that Medicaid costs and reforms will top the list of challenges for the next commissioner.
For NHPR News, I’m Dianne Finch