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My Turn: Frail seniors shouldn’t pay price for balanced budget



Last modified: Thursday, May 14, 2015
On May 6, the New Hampshire House of Representatives passed legislation that pays nursing homes the funds they are owed for caring for Medicaid clients and balances the state budget with funds intended to help vulnerable seniors stay in their own homes. Gov. Hassan issued a news release signaling her support for this “constructive solution.”

While Senate Bill 8 is good news for nursing homes that are woefully under-reimbursed by the state of New Hampshire, it’s yet another step in the deconstruction of home and community services that help keep our elderly loved ones out of nursing homes.

At issue is the state’s Choices for Independence program. CFI enables low-income seniors whose medical condition qualifies them for Medicaid nursing home care to opt to receive assistance in their home or community.

For instance, a registered nurse will visit when needed to assess the person’s condition and treat medical problems; a home health aide will visit regularly to assist with bathing, grooming and assure that medications are taken; or a personal care provider will assist during the day with important personal tasks such grocery shopping or getting medications from a pharmacy.

Some people who have greater needs may live in an assisted-living setting or attend an adult day care program. The beauty of CFI is that it is tailored to the person’s individual needs. The goal is to enable them to spend their golden years in the comfort of their own home or community. And here’s the bonus – the Choices for Independence program is about half the cost of nursing home care.

The New Hampshire Department of Health and Human Services is facing a deficit and needs to balance its budget. The House version of SB 8 will allow DHHS to use “an unexpected surplus” in state fiscal year 2014 and 2015 CFI funds to bridge the gap.

How could DHHS have millions of dollars in unexpended funds intended for seniors? So far, nobody has a definitive answer.

According to DHHS, an anticipated increase in the number of people needing services never materialized. But the current caseload is similar to past years, and even without new people added, the budget should have been spent to assure seniors get the care they need.

Ask any case manager who helps arrange services or a home care agency that provides nursing care: The level and amount of services that the state approves for CFI clients have diminished to the point where one really wonders if we are truly meeting the needs of our elders. Rather than allow a nurse to visit once a week to check on a client with a painful chronic condition, approval is granted for visits twice a month, or a home health aide who visited twice a week to help someone shower is now authorized to visit just once a week. Imagine how that feels to a person with debilitating pain and who cannot bathe themselves.

There is another way that DHHS has racked up a surplus in the CFI program. The agency has failed to follow RSA 126-A:18-a, a law that was passed in 1997 that requires that Medicaid rates for home care agencies “consider the factors of economy, efficiency, quality of care and access to care” and that those rates be updated annually. It took 11 years and a lawsuit from home care agencies to force DHHS to comply with the law, and even then, the only time it implemented a formal rate adjustment was in 2009. Since then, DHHS has continued to ignore the law. Payments to CFI providers have remained unchanged and are far below what it costs to provide care.

Many community agencies that participate in CFI have been forced to cut back on the number of clients they serve, reduce pay to their care staff, or drop out of CFI altogether. The House version of SB 8 would give CFI providers a one-time, retroactive 2 percent rate increase that would expire June 30. While it is appreciated by providers, it’s a token gesture given that DHHS should have been updating payment rates each year. Low CFI reimbursement has shredded the community safety net. Who will serve our seniors if community agencies cannot?

Rather than use unexpended funds to fill a budget hole, the Legislature should adopt the Senate version of SB 8. This would require all the unused CFI funds to go to CFI providers. This would not be simply a kind gesture – it would follow the law.

The reason the House and governor restored payments to nursing homes is because there is a state law that requires any nursing home budget surplus be used to pay nursing homes. It’s time for DHHS to follow the home health law and bring payments up to 2015 levels. This would restore the safety net to some semblance of stability. Going forward, funds should also be used to assure that seniors at home receive the services they truly need, rather than skimping on baths and forcing them to forgo care.

Mahatma Gandhi once said “a nation’s greatness is measured by how it treats its weakest members.” New Hampshire made a commitment to provide low-income, medically fragile seniors with the Medicaid long-term care services they need. Balancing the state budget with their funds is not a constructive way to honor this commitment. We need to treat our seniors better than this.



(Gina Balkus is the CEO of the nonprofit Granite State Home Health Association, which advocates for home health agencies and the patients they serve.)