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CMS Letter Validates Hospital Concerns

Federal regulators have given the New Hampshire Department of Health and Human Service 30 days to provide information about the state’s Medicaid program.

Really, the Centers for Medicare & Medicaid Services (CMS) want to know if the state has cut funding so deep, low-income people can’t get care.

If state officials don’t meet the one month deadline, CMS says New Hampshire’s $600 million in federal funding could be at risk.


Dan Gorenstein (DG): Many hospitals believe New Hampshire lawmakers and Gov. John Lynch have used Medicaid as a life raft to navigate troubled Recession-era waters.

And to their deep satisfaction, Dartmouth Hitchcock’s Frank McDougall says hospitals think that ride may finally be over.

McDougall: “We view the letter as validation that the state has a significant Medicaid problem.”

DG: In May, the Centers for Medicare and Medicaid sent a letterdemanding more information about the impact of a series of state budget cuts.

This is just the latest chapter in what McDougall calls the Medicaid problem, which dates back to 2008, when the state slashed reimbursement rates.

The state also gutted Disproportionate Share Hospital payments, leaving 15 hospitals some $250 million lighter over the current two year budget.

In a federal lawsuit against the state – headed by Dartmouth-Hitchcock and Lakes Region General Hospital – administrators have testified that reductions have forced them to curb services.

In this letter, CMS makes it plain that access to doctors for New Hampshire’s 140,000 Medicaid patients is its central concern.

Dartmouth-Hitchcock’s McDougall says it’s a real good question.

McDougall: “Over the last four years, since 2008 the state has cut Medicaid by $327 million ... $327 million. No program is sustainable in that kind of environment, and that’s what we are faced with here. Our patients are at risk, access for those most vulnerable is at-risk.”

DG: CMS has given Health and Human Services until mid-June to provide data it needs to better understand the landscape.

If HHS doesn’t meet that deadline, the state could lose some portion of its $600 million in federal funding.

The department declined to comment on the story, citing the on-going lawsuit.

But officials provided Commissioner Nick Toumpas’s response to CMS.

The commissioner wrote, that “CMS implies unfairly that the department has been non-responsive to CMS access questions for a period of four months.”

He says HHS has sent “substantial ‘data and analysis’ that is responsive to the requests made.”

Toumpas’s bottom line is clear.

He wrote, “we do not have any information now indicating that we have an access problem.”

Hospitals and their advocates say this kind of thinking is just more ‘circle the wagons’ state mentality.

Steve Ahnen, president of the New Hampshire Hospital Association, says this letter is serious business.

Ahnen: “They don’t issue letters like that and do that without having the utmost concern for this program, and I think their concern is very well founded.”

DG: The state has often defended Medicaid cuts by saying that during difficult times, hospitals are in a better position to take a hit than others.

People less sympathetic to hospitals point to the seemingly endless construction projects, the competitive advertising and highly paid executives.

Steve Norton with the New Hampshire Center for Public Policy Studies is concerned too many people won’t see past the CMS/HHS quarrel.  

He says, ‘sure, it’s true, Medicaid cuts – especially the Disproportionate Share Hospital reimbursements -have caused real pain for Dartmouth-Hitchcock and the rest.’

But Norton says that’s not the whole story.

Norton: “There are a whole set of problems that hospitals are facing....Medicare has been squeezing rates over the past 10 years, that actually has a much bigger impact on local hospitals. And the Recession has hit everyone, including hospitals who have seen a decline in the number of discretionary services they provide.”

DG: Norton says more than HHS and CMS locked in some fight, this letter raises fundamental questions about the future of hospitals in New Hampshire.

He says the outlook isn’t rosy.

The Affordable Care Act will add people to the Medicaid program....Medicaid rates look to stay low, and the state’s population keeps aging; Norton says there is more pressure to find a way to pay for healthcare than ever before.

But those are the big questions for places like Norton’s Public Policy Center.

Commissioner Nick Toumpas,in his letter, promised to provide CMS what they want, trying to ward off any more trouble.



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