HHS Looks at Grim Prospects

TAPE: From May to June, the....Medicaid caseload went up .9%

That’s state Medicaid Director Katie Dunn.

Dunn spoke at a meeting with top Department officials and social service providers from across the state.

The new budget anticipates Medicaid caseloads will grow 1% between this July and next.

That amounts to 113,082 total cases.

But based on the caseload as of June 30th, just the 39th person who signs up will put the state’s Medicaid budget in the red.

HHS Associate Commissioner Nancy Rollins.

TAPE: there will most likely not be enough money. And while we’ll continue to demonstrate we do the best we can... I think there will be some tough decisions that the Legislature will have to make going forward.

Already some providers have had to lay staff off to help deal with the lean budget.

But Susan Young who represents in-home healthcare services says tight budgets are causing more than simply layoffs.

As Director of the Homecare Association of New Hampshire, she works with 44 different organizations.

TAPE: we are seeing a lot of agencies that are limiting or walking away from the Medicaid services, even though they want to take care of those folks as part of their mission, they can’t afford it.

Young says if people on Medicaid can’t get in-home care; it’s all the more likely that when they need medical attention, they’ll end making costly ER visits.

But beyond that, she says people’s day to day quality of life is suffering.

TAPE: if they aren’t receiving the support and care...their physical condition declines, they are less able to get around, their personal hygiene may not be as good. And what really is a stress they can be isolated if they are at home and nobody is coming in either.

Rising caseloads, declining services, exhausted budgets and social service providers who aren’t sure what’s coming next are facts of life at HHS now.

The pressures are prompting the Department to look hard at its various services.

Which ones work, which ones don’t work so well.

The undertaking is part of an overall effort to prioritize services.

After that, Associate Commissioner Nancy Rollins says HHS plans to hold regional meetings with the providers along with state and local politicians to have hard conversations.

TAPE: this is the amount of money that has been in the area, this is the client population, these are the demographics, we are not going to hit people over the head, but it’s up to regional areas to think out what’s the right approach to have these dollars flow and serve the people they’ve got.

In the meeting in Concord Tuesday morning, Commissioner Nick Toumpas told the providers that he expects a thorough review of all programs in the next 12 months.

Then take that data and begin to sort out which programs are worth preserving and which need to be cut.

State Senator Jackie Cilley raised her hand.

TAPE: it’s my understanding from talking to stakeholders in my district, that there are providers who are really teetering. You’ve painted a picture of a two year, one year planning, one year implementation, is there a contingency plan in place, if those stakeholders aren’t available? I fully recognize, when we go through this there will be fewer providers that are a part of it.

To some extent, Commissioner Toumpas is talking about survival of the fittest providers in the state.

Ned Helms, former H.H.S. Commissioner, says it’s time for people to think differently.

TAPE: those agencies are going to have to start to talk creatively, not about what exists today but what needs to exist tomorrow. And I think Nick has laid out a very thoughtful pattern.

No matter how thoughtful Toumpas’s direction may be for the Department, it’s clear in the short-term fewer services will be available and that means hardship for some of the state’s most needy.

For NHPR News, I’m DG.