Health and Human Services Commissioner John Stephen will present his plan to overhaul the state's Medicaid program when he meets with lawmakers Wednesday/today.
Few specifics are known about his proposal.
But broad outlines include decreasing the state's nursing home population, families picking up a greater share of nursing home costs, and creating health savings accounts for some Medicaid recipients.
Until the election of John Lynch, this plan was on the fast track...but as New Hampshire Public Radio's Dan Gorenstein reports, the change in leadership has slowed the process, and brought a degree of greater scrutiny.
HHS Commissioner John Stephen spent his summer all across the state, gathering suggestions for how to change the state's Medicaid program.
Medicaid is New Hampshire's most expensive program...officials estimate it will cost the state nearly 800 million dollars in 2005 alone, and future costs will go even higher.
To make matters worse, beginning next year the state will lose 50 million dollars a year in federal Medicaid money.
In response, Commissioner Stephen and Governor Benson scrambled to informally present a plan to Washington to retool Medicaid.
Now with the election of John Lynch, Stephen must sell his proposal to the new governor.
Stephen says the two met Monday.
TAPE: I thought we had a very good meeting, and I am really looking forward to making my presentation to the Legislature.
When Lynch campaigned for governor, he repeatedly slammed the proposal as Governor Benson's secret plan.
Lynch says going forward; his top priority is to bring the proposal out into the open.
6:40 I want to make sure there is a full opportunity for public input, feedback, discussion, and participation before we move forward, if we do move forward on any aspect.
Lawmakers on the joint Fiscal Committee will play a key role in how the plan moves forward.
Republican Representative Neal Kurk chairs the committee, and has clashed with Commissioner Stephen over this issue already.
Kurk has required Stephen to get legislative approval before HHS finalizes a deal with Washington.
Currently, Washington and the state share Medicaid costs 50/50.
Kurk's first concerns is that no deal should leave the state with an ever increasing share of the Medicaid bill.
That said, Kurk is not downright opposed to Stephen's proposal.
He says it never received a fair hearing during the campaign.
2:58 it was not something turned out by Scrooge, it was something that was turned out by thoughtful caring people, people who are balancing what all of us in our individual lives and in our public lives have to do. How do we provide services in a way that can be afforded by the taxpayers of this state. That balance goes on all the time. it's the essence of what we do in Concord.
Not all the players are as receptive as Representative Kurk.
Christopher Boothby, president of the New Hampshire County Association for one, is not comfortable with the plan.
Boothby says it would allow the state to determine who enters nursing homes, and who stays at home to get care – an approach he says that won't go over too well with lawmakers.
But more pressing for Boothby is how counties will fair financially.
In New Hampshire, the counties are responsible for running the nursing homes.
And for a long time, the state has not lived up to its agreement to help pay its share.
County taxpayers have had to pick up the difference, and Boothby says right now that amounts to millions of dollars.
:37 we're looking at trading an entirely new system without solving a 37 million dollar annual deficit in long term care funding, it's incredible to me that any legislator would consider a new plan without addressing the existing problems that are right in front of us.
One of the factors driving the push for Medicaid reform is a Washington crack down on a scheme that allowed New Hampshire to divert federal Medicaid money to the general fund.
Ned Helms, director of the New Hampshire Institute of Health Policy and Practice questions why Medicaid providers and recipients should lose any funding, if they never got it in the first place.
1:24 if the money that came from Medicaid, never went to recipients, why is that we have to cut from current recipients, that hundred million dollars, that's a legitimate question to ask and I think that takes a little bit of time to look at.
On paper at least, the joint legislative Fiscal Committee is expected to vote later this month on whether HHS should continue working with Washington on a Medicaid deal.
But with all the calls for more public input, it is likely that many lawmakers will look to slow down the process and give it more time.
For NHPR News, I'm DG
