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Pembroke, NH - New Hampshire’s nursing homes are reeling after learning that the NH Department of Health and Human Services (DHHS) has cut $7 million dollars from the amount designated to pay for the care of the nursing home residents who rely on Medicaid to cover their nursing home stay.

 

On Friday, January 23, DHHS Commissioner Nicholas A. Toumpas addressed the Joint Legislative Fiscal Committee and shared a plan to close a $58 million department budget shortfall.   Governor Maggie Hassan and DHHS want to re-direct $7 million dollars from the Medicaid Reimbursement line item to cover overspending in other areas of the department’s budget.

 

In 2013, NH legislators voted upon and approved a set spending level for the NH DHHS, including an amount appropriated to nursing homes to cover the cost of care provided to residents covered by Medicaid.  In July 2014, the previous year’s budget overage was slated to be carried over into the current fiscal year to offset the Medicaid reimbursement rate, which is already below the cost of providing care.  This carryover is mandated by a footnote in the budget.  However, when nursing homes received their January 1st reimbursement rates, this money was not included in their rates.

 

“We do not have the option of ceasing to provide care to these residents, as this is morally and legally unacceptable,” comments Patricia Ramsey, owner of The Edgewood Centre in Portsmouth.  “I do not understand how Governor Hassan, Commissioner Toumpas, and DHHS can make this decision to take away money from the residents, among the frailest and most impoverished in the state, and the people who care for them. Not only are we required by regulation to provide exceptional care to our residents – our residents and their families expect and deserve exceptional care.  How can we continue providing this quality care when we are continuously underpaid for providing it?”

 

“There is a specific calculation used to determine rates of reimbursements to nursing homes to cover the costs of providing care to their residents who rely on Medicaid.  This rate-setting formula is designated by law.  When setting their budgets, DHHS states that there is not enough money available to pay the rates calculated using this law and they reduce nursing home rates by almost 30% to create a rate that they can “afford”.  Now, DHHS is telling the legislature that there are excess funds available from the nursing home reimbursement line item that can be used elsewhere.  Both of these statements cannot be true.  If you cut rates to make your budget initially, how can you have a surplus to use as you move through the budget cycle?” asks John Poirier, President & CEO of the New Hampshire Health Care Association.  “They are going against the law by cutting the initial rates and they are going against law by suggesting that they use the “surplus” funds to cover anything other than reimbursements for care provided to nursing home residents supported by Medicaid.

 

“Nursing Homes are already under-reimbursed for the cost of providing care to their residents who rely on Medicaid.  This cut widens the gap between the cost of providing care and the reimbursement that care providers receive from the state.  The average nursing home relies on Medicaid to cover the cost of care for 67% of their residents – and that number is much higher for the County-based facilities.  Most nursing homes will have cuts in excess of $100,000,” says Roxie Severance, Executive Director of the Morrison in Whitefield, NH and Chair of the Board of the NHHCA.  “When I discussed this with my residents, they were outraged at this decision.”

Legislators have spoken out against this decision, including Senator Jeanie Forrester of Meredith, NH.  Forrester released a statement saying, “The Legislature clearly directed these funds be spent on nursing home reimbursements. The Governor approved the raid of funds dedicated to our county and private nursing homes as part of her effort to fill the budget shortfall in DHHS. However, the budget, signed by Governor Hassan, does not allow this action per a footnote explicitly prohibiting transfers or reductions of the state’s nursing home funding.”