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NH health providers say state's low Medicaid rates add to staffing ‘crisis’

File Photo, NHPR

Health care providers in New Hampshire are pushing for a major increase in Medicaid rates this year, saying it would help them address increasingly dire staff shortages.

During a hearing Wednesday, health care leaders told lawmakers that the reimbursement they receive from the state’s Medicaid program often falls short of what it actually costs to provide care. That makes it hard to pay competitive wages, at a time when organizations across the health care sector are struggling to fill vacancies.

“In the past nine months, we have spent $1.2 million on agency staffing,” said Joe Bohunicky, administrator of Mt. Carmel Rehabilitation and Nursing Center in Manchester, which has 30 open nursing positions. “Why? Because there is no additional staff out there for us to hire.”

The hearing concerned a bill proposed by state Sen. Cindy Rosenwald, a Nashua Democrat, which would put $145 million dollars toward increasing Medicaid rates over the next two years.

The lack of workers is having ripple effects throughout the health system. Long-term care facilities have had to leave beds unused because they can’t staff them; some nursing homes have 100-person waitlists. And with those facilities full, hospitals have few options when they want to discharge patients who need continued support — putting an added strain on hospitals’ own capacity.

“Patients across the state remain in hospital beds when they no longer need acute inpatient care,” said Paula Minnehan, a senior vice president with the New Hampshire Hospital Association. “This is becoming a crisis. They cannot leave, because there is nowhere for them to go.”

She urged lawmakers to devote more Medicaid funding to long-term care, as well as mental health care. Dozens of people are held in hospital emergency departments on any given day, waiting for inpatient mental health treatment.

Roland Lamy, the head of the Community Behavioral Health Association, told NHPR that New Hampshire’s 10 community mental health centers have more than 300 vacant positions. Low Medicaid rates are a major driver, he said. He estimates community mental health centers would need a $28 million boost in Medicaid revenue to make their wages competitive.

“A masters-level psychologist, you know, we might be paying $29 an hour, and the market is paying $45 an hour,” he said.

Ryan Donnelly, an advocacy coordinator with Granite State Independent Living, said shortages of direct care workers are making it harder for seniors and people with disabilities to remain in their homes.

“A few of our consumers have even made, or are considering, making the very undesirable decision to move into nursing homes to get the personal care they need to live safely,” he said, “because it has become too difficult to hire and retain home care workers.”

Senate President Jeb Bradley, a Wolfeboro Republican who sits on the Senate’s Health and Human Services Committee, asked for more clarity about how, exactly, the money would be divvied up before moving forward.

“I don’t want to pit Peter against Paul, but between this bill and Senate Bill 36, we heard about the need for DD rate increases, long term care, CFI, behavioral health,” he said, using acronyms for developmental disabilities and Choices for Independence, a home care program. “I suspect there are others. But some sort of definition as to where we’re going, I guess, would be helpful.”

Paul Cuno-Booth covers health and equity for NHPR. He previously worked as a reporter and editor for The Keene Sentinel, where he wrote about police accountability, local government and a range of other topics. He can be reached at
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