For health care providers serving New Hampshire’s Medicaid poor, there was much to be proud of following passage of the state budget. Despite efforts to divide them, they had hung together, and insisted on the same percentage increase across the board for Medicaid funding.
Gone were the “Hunger Games” days when vulnerable populations competed against one another for resources from a frugal state government. Though Medicaid funding will easily remain New England’s worst, it begins improving Jan. 1.
That’s the good news. The bad news is that a fragile long-term care system is still fragile, at a time when, with the nation’s second-oldest population, we must shore up existing capacity for the coming baby boomer age wave – what some refer to as a “Silver Tsunami” – quite apart from preparing for the future.
Our long-term care system’s fragility is compounded by the fact that the state itself is not putting much money into it. Indeed, more nursing home funding comes from the federal match on a fee nursing homes pay than it does from the state. Wrap your minds around that: Nursing homes provide more nursing home funding than the state does. And the lion’s share of funding comes from county property taxes, as New Hampshire predominantly relies upon counties to fund its long-term care system.
This cannot continue indefinitely. A hope had been that the state would start to shoulder its responsibilities this budget cycle, as all other states do, but instead it was counties that again came to the rescue.
Effectively, this has allowed some policymakers to maintain a winking “no new taxes” posture while those owning property see their taxes rise, and, in turn, blame county officials.
Long-term care needs a more balanced funding approach if it is to be sustained. Roughly 64% of our state’s nursing home residents are on Medicaid. That figure will only grow in an era where defined benefit pensions are a thing of the past, and retirement savings are sparse. As a consequence, some have predicted we may see the worst rates of elder poverty since the Great Depression. Too many people are under the mistaken belief that Medicare will pay for their long-term care needs, when, in fact, it pays only for some nursing home care following a qualifying three-day hospital stay.
The emphasis on county funding also carries with it a paradox here in New Hampshire, as every county must also run its own nursing home (two in Coos County), in addition to providing the funding for private nursing homes and home- and community-based services. That is a lot to ask of counties. While private nursing home providers (many of which are nonprofit) are grateful for any lifeline thrown their way, it is also in their best interests that funding be sustainable in the long-term. To add some irony, they’re paying property taxes, too. One Concord facility paid $395,587 last year.
At stake: The state budget assumes 4,100 New Hampshire residents are on Medicaid in nursing homes. We are amidst a severe workforce crisis fueled by low unemployment, an aging population and poor Medicaid reimbursement. The state suffered a net loss of 567 licensed nursing assistants over a one-year period, and facilities are taking beds, and even entire wings, offline where they cannot staff responsibly to serve need. According to Paraprofessional Health Institute data, 92% of nursing assistants – the front-line caregivers in any nursing home – are women. Shouldn’t the state itself honor their dedicated caregiving?
This is a conversation New Hampshire must have going forward.
(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)