Health and Human Service officials laid out their plan to revamp the state's Medicaid program to lawmakers today.
A key proposal would reduce the number of people in nursing homes where costs are high.
Instead, HHS would pay for less expensive home and community-based care services.
New Hampshire Public Radio's Dan Gorenstein reports.
After months of leaks and campaign rhetoric about the plan to change Medicaid, HHS Commissioner John Stephen finally released his report.
Stephen told lawmakers Medicaid reform is essential.
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4:55 we are confronted with budget shortfall, aging population, federal revenue reductions, rising costs and an inefficient service delivery system.
Stephen and his staff spent nearly 3 hours pushing as hard as they could to sell the joint Fiscal Committee members.
The Commissioner says he wants a green light from the committee in order to negotiate a deal with Washington to change Medicaid.
To make those changes, HHS needs a waiver from the federal government.
A waiver would give the state more flexibility in how it uses Medicaid dollars.
In exchange the federal share of the money is fixed over a five year period.
That limit concerned a few lawmakers.
They worried if Washington's contributions were exhausted, New Hampshire would be left holding the bag.
State Medicaid Director Steve Norton assured the Fiscal Committee, that this waiver is not a cap.
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3:44 we've learned with TN, and a few other states, once you've started to spend more money than you go back to feds, and reopen negotiations with them, and say, for these reasons, population changes, economy tanked, we have to revise our estimations of that target. I wouldn't think of it as a cap.
HHS's proposal relies on what may seem to be a contradiction: increase services, and save money at the same time.
But the authors say over five years, the state can save some $280 million dollars, in large part by decreasing the number of people in nursing homes.
Commissioner Stephen says there are many people who are currently in nursing homes, who could be living at home, and receiving care from service providers in the community.
The Commissioner says his plan assumes there will be a 30% reduction in the number of nursing home beds over a five year period.
8:56 we are not talking about throwing seniors out of a nursing home. We are talking prospective...the door into the nursing home is too easy to get in to today...most of your savings in my opinion is going to come from that change.
In order to move enough people out of nursing homes, Stephen says Washington would have to provide up front funding for more home nurses and other services.
Republican Senator Dick Green applauds the effort to try to increase community based options, as well as look for greater efficiencies.
He says, if that can happen, great, but Green isn't convinced.
4:55 if we can honestly save some money, without shfting the cost down, then we should be doing that. What I have a problem with is saying, we are going ot cut these expenses, and we are not going to cut eligibility, not going to cut any sevices, but we are not going to spend as much money. That to me is an oxymoron. It doesn't make sense.
Senator Green says he fears the state will pay less per person once they are out of a nursing home, but that the total cost of care won't go down, and local officials will have to make up the difference.
That is just one of the considerations Fiscal Committee members will weigh before they are scheduled to vote on the plan on the 23rd.
Commissioner Stephen told lawmakers he won't pursue a waiver without its approval.
For NHPR News, I'm DG
