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N.H. Nursing Home Advocates Push Back On Proposed $7M Cut

NHPR Staff


New Hampshire’s nursing home advocates are pushing back against a proposed $7 million cut in Medicaid reimbursement rates.

The cut is part of a plan recently unveiled by state officials to close a $58 million shortfall in the current Department Health and Human Services budget, which ends in June.

John Poirier is president and CEO of the New Hampshire Health Care Association, which represents more than 90 nursing homes and assisted living centers across the state.

He joins Morning Edition to talk about his concerns with the plan.

What’s your reaction to this proposal?

This funding was assured to us. Historically, through 2007, the department had money left over at the end of the year and they put that back into the general fund. We were able to, through legislation and through the legislative budget, get a footnote added that would require rolled forward and rolled into rates so that nursing homes can ensure that they’re still funded at the 70 percent of cost level that they’re funded at or have been funded at.

I don’t believe that we should be balancing a state budget off the backs of the people who have spent their entire lives working, earning money and by virtue of personal situations have ended up needed long-term care.

Can you put into context for me what $7 million is in your overall budget?

Typically, a 100-bed nursing home has about a $7 million budget, not coincidentally. When you look at making a cut of this proportion, you’re talking about $100,000, plus or minus. While that doesn’t sound very significant, what you’re looking at is 70 percent of the expenses in a nursing home are direct care staff.  So when you’re looking at where are the variable expenses, it either is staff or additional revenue.

You can’t not pay the mortgage. You can’t not pay the heat. You can’t not pay for food. So we’re looking at potentially either finding alternative revenue sources, which are very, very difficult to find, or looking at staff expense.

You could see staff let go?

I think you will in some facilities, yes.

Are there specific nursing homes or areas of the state that would be hit hardest by these cuts?

It’s not regionally, but it is based on what percentage of the people who live in those facilities are on Medicaid. So if you’re looking at a facility that has 85 or 90 percent Medicaid utilization in their building, they will be hit harder than the facility that has 50 percent of people paid for through the Medicaid program. That’s where the variance comes from.

We heard from state health commissioner Nick Toumpas, who said the department doesn’t have a lot of options.

I agree that it does, but you have to look at what the ramifications of cuts are before you make those cuts. And that simply wasn’t done.

I know Sen. Jeanie Forrester has filed legislation hoping to prevent this cut. How hopeful are you that will happen?

Extremely hopeful. The legislature has been very receptive to ensuring that these cuts don’t ultimately take effect. The rates that are being paid effective Jan. 1 do include these cuts. And they are cuts. I know I have heard from Gov. Hassan and her spokespeople saying if we didn’t do this, they would have a rate increase. It’s hard to say that it’s a rate increase when there’s already nearly a 30 percent reduction in what the state says should be paid to nursing homes.

I know there has been a significant amount of expansion in programs at the health and human services department. To me, you have to pay for the programs you already have prior to cutting programs that already exist.

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