Residents at the Epsom Health Care Center stopped seeing beef as frequently on their plates several months ago.
The facility needed to find ways to tighten its belt. Hamburger ended up on the chopping block, swapped out for its less expensive sibling, turkey meat.
Medicaid rate changes at the start of the year left the facility — and many others across the state — reeling with an unexpected funding decrease. Coupled with rising cost-of-living prices, the rate change required the nursing home to adapt its finances to meet a tighter budget.
The center has tried to mitigate the effects on residents to the best of its ability, said Epsom Health Care Administrator Tammy Bishop.
“I think it’s restrategizing how we look at the business,” said Bishop. “So the hardest part is, when you look at groceries, there’s been around a three-and-a-half percent increase in groceries. There’s like a 20% increase in fuel. There’s all of these added expenses that we still have to provide for every single resident, all the snacks that they want, three meals a day, fuel, electricity.”
Over half of the residents at the 108-bed facility are on Medicaid, which provides healthcare for low-income individuals and people with disabilities. With the newest reimbursement rates implemented on January 1, the Epsom Health Care Center was handed a 3.5% decrease, finding itself down $9.27 per resident per day. The nursing home, like many others, had anticipated a steady rate or even a rate increase. Instead, the team was confronted with a prospective year-long deficit of over $365,000.
The rates are determined from an assessment of the medical needs of a facility’s residents, captured on a specific date, said Brendan Williams, president and CEO of the New Hampshire Health Care Association.
But recent changes to this system, coupled with cost-cutting at the state level, threw a wrench in the outcome, causing an “aberration,” Williams said.
“[There] was the real disconnect within the rate system between one methodology interacting with another methodology because the state had changed how the medical needs of residents are captured,” he said. “It was interacting with one system that was in 2023 with another system that is now in place. It created an unexpected result.”
Epsom is among 73 nursing facilities in New Hampshire, according to data from the National Center for Assisted Living and the American Health Care Association. Combined, these locations serve over 15,000 patients statewide. Nearly two-thirds of all residents are on Medicaid.
With the new rates implemented on January 1, over three dozen facilities saw a decrease, after the rates had only increased in preceding years. The largest decrease was about $45 per resident per day.
“We had never really seen this before, where there’s really a wild variability in the rates,” Williams said. “Some facilities went up, some facilities really went down. And so one of the things that we’re trying to figure out is how can we prevent that from happening again.”
It’s been a difficult several months for half the nursing homes in the state.
With a rate decrease of $3 per resident per day, the Merrimack County Nursing Home was staring down the barrel of a $600,000 budget reduction for 2026. Still, it was better than the $11 decrease the nursing home was originally anticipating, said Administrator Heather Moquin. In the past five years, they’d always had a rate increase, even if only very slight.
“To sort of offset that reduction in revenue, we did adjust expenses, but there still remained $500,000 of operating expense that we were not able to cover,” said Moquin.
An adjustment to the county tax allowed the nursing home to close that gap.
Now, with House Bill 155 amended to allocate $4.75 million, to be matched equally by the federal government, some respite is in sight.
According to Williams, the average nursing home rate only rose by 0.01 % at the start of the year. For the July 1 adjustment, rates were slated to increase by an average of 2.37%
“Along with the modest average increase already projected for July 1, this added funding will help stabilize nursing home care,” he said in a statement, also thanking legislators for their bipartisan efforts to get the amendment passed.
However, fifteen facilities, including the Merrimack County Nursing Home, are still facing more reductions for the next rate period. Luckily, the county home “budgeted a more conservative rate,” so the next cycle won’t hit as hard. In fact, because the home was planned for a steeper rate decline, it will actually make up an estimated $321,500 in revenue, per Moquin.
Epsom, however, will see a rate increase of $14.64 per resident per day.
Even with this improvement, Bishop continues to worry about her facility’s ability to attract and maintain caregivers, especially given the shortage within the state and beyond.
“It’s like we’re all competing for the same nurses, the same LNAs. And so it’s very difficult when you have these funding shortages. So how are you going to incentivize? You’re having to out-compete,” she said.
The local, close-knit feel of the town draws people to work at the center, Bishop added, although it’s more challenging when there are other places that can afford to pay more.
Still, Epsom adapts because it has to, she said.
“There’s things, yes, you’re going to accommodate, but it puts a lot of strain and stress that, to me, that energy should be focused on the residents,” Bisphop said.
