A bill that would change the way long term care is offered to Medicaid patients squeaked through the House today.
The intent of House Bill 691 is to make the most expensive part of Medicaid "long term care" a little more cost effective.
It promotes less pricey home care for the elderly and gives an incentive for people to buy long term care insurance.
Representative Peter Batula, chair of the Health and Human Services Committee, urged his colleagues to pass the bill.
Batula: More important than anything else this bill intends to set New Hampshire on a clear path leading to a continuum of health care services that are community based and where individual choice is recognized.
If trying to help seniors stay at home for long term care had been the only component of the bill, it would probably have passed with greater support.
Instead, only five votes separated the yeas from the nays.
Representative Tom Donovan, a Democrat from Claremont, spoke in favor of the bill.
He admits the divisive issue was a provision to crack down on people who hide their assets to meet the Medicaid financial requirement.
Donovan: The people who were opposed to this bill, I would say a good 50 to 60 percent would have voted for this bill if those loops weren’t there.
Some on Medicaid have taken advantage of legal loopholes allowing them to pass their savings on to their heirs instead of paying nursing home costs.
As it is, the government can look back through three to five years of people's financial records to see if they gave their assets away.
The new bill would increase what's called the look back period to five to ten years, depending on how people disposed their assets.
House Democratic Leader James Craig argued that this provision would hurt the middle class.
Craig: And we're just like everybody else. We know we're going to have to be taken care of. Is it wrong for people to try to pass their assets to their children in a legitimate, legal way? Is that wrong? Or is that just looking for dignity at the end?
But Representative Donovan pointed out that Medicaid was not designed to take care of the middle class.
Donovan: It was designed for people who do not have the means. Who are vulnerable, who are ill, who are displaced, who don't have those supports systems, who are dying, and without means. That's what Medicaid is for.
In response, Critics, however, highlighted another part of the bill that would allow people with means to receive Medicaid benefits.
For those who purchase long term care insurance, the financial requirement to qualify for Medicaid would disappear..
Hanover Democray Hilda Sokol argued that this provision does not help the poor.
Sokol: Long term care insurance is not a viable alternative for people who cannot even afford health insurance, but protects those who can afford this expensive long term insurance so that their assets are not included in this.
Sokol also critized the more popular part of the bill that aims to keep elderly patients at home or in the community rather than in nursing homes.
The bill would restore long term care assessments to face to face meetings with registered nurses rather than patients filling out paperwork.
The idea is that these meetings will help direct people away from nursing homes.
But Sokol said that without the infrastructure to support home care, the effort is impotent.
Representative Donovan agreed that community and home care options are underfunded, but he said that adding stronger case management will move the effort along.
Donovan: If we're that committed, then we have to make it work. And we will make it work. It's a charge for us to make it work. Old social workers like me have been doing this for years and good case management will force the issue.
House bill 691 is part of Health and Human Services Commissioner John Stephen's GraniteCare plan for Medicaid.
He called 691's passage is a victory for seniors and the financial integrity of the Medicaid program.
The bill must go through the House finance committee by next week before it heads to the Senate, where it is expected to pass.
For NHPR News, this is Kerry Grens.
For more on Medicaid, read our Medicaid: Basic Facts page
