Brendan Williams is the president and CEO of the New Hampshire Health Care Association.

These are dispiriting times politically. Unity has never seemed further out of reach, whether you look at the fact it took 15 ballots to elect the current U.S. House speaker, the expelling of two Black Tennessee House members (since restored by appointments), or various culture wars playing out on local and state battlegrounds.

Like Nero allegedly playing music while Rome burned, we seem unable to come together on even the big issues, like the resolution of a federal debt ceiling that is a ticking time bomb with the potential to plunge us into a recession and damage our international standing.

So let us find comfort in the fact that the New Hampshire House could come together and pass a bipartisan budget. After all, it was just six years ago that the House could not pass a budget at all.

As a long-term care advocate, it is also heartening to see legislators of both parties rally around improving Medicaid funding in a state with the nation’s second-oldest median age.

If we think of services for those in greatest medical need as a three-legged stool — home and community-based services (HCBS), nursing home care, and hospital care — two of the legs are so wobbly as to cause the third to collapse too.

From just prior to the COVID-19 pandemic through June 2022 data, home health care and nursing home care in New Hampshire had each lost over one-tenth of their workforces, with assisted living very close to the same pain threshold (a 9.6% loss). Despite significant wage increases, recovering these workers has not proved easy. That is backing up hospitals that cannot send discharge-ready patients home, to assisted living, or to nursing homes.

Only a very substantial Medicaid increase can address this crisis. Two major home care providers have indicated they would exit the Medicaid program without one. And nursing homes have no choice. With an unhealthily large proportion of current residents on Medicaid, over the national average at roughly two-thirds, facilities are atrophying on Medicaid rates that don’t cover costs, with wait lists of as many as 138 residents reported to me. And in a setting where greater age so often equals greater infirmity, nursing home residents here are now three years older upon admission than the national average, with long-term residents over four years older.

For the sake of the HCBS and nursing home settings, our state’s hospitals are willing to forego their own Medicaid rate increase, and this is greatly appreciated.

For over two decades, I have felt like Paul Revere, except instead of warning that the British are coming it’s been the wave of Baby Boomers I have worried about. If we are going to serve our aging population and not suffer a system collapse now is the time for investment.

Other states have gotten the message. In Alabama, typically not a shining beacon of enlightenment, $140 million in American Rescue Plan Act funds have shored up nursing home care. Last year Pennsylvania’s then-Republican legislature, with the Democratic governor’s support, gave nursing homes both a 17.5% Medicaid rate increase and $131 million in ARP Act funds.

The progress made here in the House budget goes a good way toward approaching the commitment other states have made to Medicaid, even if in New Hampshire the ARP Act ship has perhaps sailed. The challenge for the Senate will be to at least maintain what the House has accomplished and think about how best to get a new Medicaid appropriation to staff-starved providers as quickly as possible. Because the only alternative is to drown in the red ink of Medicaid losses and exorbitant out-of-state staffing agency bills.

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