Health workers, organizations rally for higher health care spending

  • Peter Evers, CEO of Riverbend Community Mental Health, speaks at a press conference outside the State House advocating for health care workforce spending. Ethan DeWitt—Ethan DeWitt

  • Supporters of a bipartisan bill to invest 110 million in New Hampshire's health care workforce gathered outside the Statehouse in Concord, N.H., on Monday, May 6, 2019, a day ahead of the Senate Finance Committee's first public hearing on the state budget. Advocates estimate there are roughly 2,000 vacancies in hospitals, community health centers, nursing homes and other health care settings across the state. (AP Photo/Holly Ramer) Holly Ramer

Monitor staff
Published: 5/6/2019 5:45:50 PM

It’s been a slow, 13-year squeeze.

In 2006, New Hampshire approved an increase in the rates providers are paid by Medicaid. But after a recession, wild political swings and competing priorities, the rates have stayed the same, and clinics and community centers are feeling the pinch.

Nursing homes have struggled to fill positions. Home health care recipients can hardly get the care workers to show up seven days week. Wages for lower-level nursing employees hover around $11 to $13 an hour.

The clinics have scrimped, stripping back services and stretching reimbursement dollars to maximize their intake. But ahead of a demographic wave of aging retirees and a growing workforce attraction problem felt acutely in New Hampshire, many say the environment is only getting worse.

“In some ways we’re a victim of our own success,” said Peter Evers, CEO of Riverbend Community Mental Health, which operates mental health and substance abuse disorder treatment services across Concord.

The rates have stayed the same despite medical costs increasing 25%, Evers said, and New Hampshire now pays 58% of the U.S. average Medicaid payments.

But by leaning on donations and grant-based revenue sources, Evers explained, Riverbend has been able to present a picture of success, one that masks the underlying problems facing everyone.

“We read a lot about broken systems,” Evers said. “We’re not a broken system. We’re a system that needs help.”

This year, providers are speaking up. On Monday, dozens of patients, clinic representatives and advocacy groups spoke at the State House in support of funding to improve the state’s health care workforce landscape, advocating, among other things, a 12% increase in the Medicaid rates.

A $116 million blueprint proposed by Sen. Cindy Rosenwald would raise the rates over two years, invest $6.5 million into the state loan repayment program to incentivize young workers to stay, fund initiatives for workplace recruitment and telehealth, and streamline the nursing background check system to reduce wait times.

Some providers say it’s a strong start. Scott Wojtkiewicz, the administrator of the 40-bed Holy Cross Health Center in Manchester, which serves religious women who largely took vows of poverty, said the organization was bending over backward to try to make the funding levels work.

“I have pulled out my bag of tricks,” Wojtkiewicz said. “I am down to the last one. We really need some help.”

Rosenwald, a Nashua Democrat, pointed to new and popular state programs to improve care, from the 10-year mental health plan to the hub-and-spoke opioid treatment system unveiled to fanfare by Gov. Chris Sununu.

Without higher reimbursement rates, she said, those initiatives could struggle.

“None of these important efforts will work without the competent, professional clinicians we need all over New Hampshire,” she said. “Workforce is simply a foundation not only to caring for our population, but also for economic growth right here in New Hampshire.”

So far, it’s an idea with bipartisan support. Sen. Jeb Bradley, a Wolfeboro Republican, hailed the importance of raising the Medicaid rates Monday. But he cautioned that whether the final amount is exactly the suggested 12% increase will come down to priorities in budget negotiations.

“It is (an) incredibly important piece of legislation,” Bradley said. “I have to say, there’s a lot of other things that members of the Senate Finance Committee are going to have to fund that are priorities for the state of New Hampshire, and do it in a way that keeps our economy strong, protects taxpayers.

“Blending all this together, we have to have realistic expectations.”

That could prove a hang-up. In late March, the Senate voted to pass Senate Bill 308 – until then a standalone bill – unanimously. But following common practice, they immediately tabled it, allowing it to be introduced as an amendment to the budget process. The process makes the legislation susceptible to major revisions or reductions as the budget moves ahead, as the bill faces increasingly competitive interests.

Still, Bradley said he would advocate that colleagues support it. “I’m not on the Finance Committee so I don’t have an initial vote on it, but certainly if people are listening to my voice ... that’s what I hope that they’ll do,” he said.

Convincing the governor could be another battle. Though a champion of the 10-year mental health plan and other initiatives to broaden access to care, Gov. Chris Sununu did not include increases to Medicaid reimbursement rates in his proposed budget and has also urged caution.

“While Governor Sununu will review the final language of the legislation should it reach his desk, he is concerned about such a large expenditure outside of the budget process – especially with ongoing costs,” spokesman Ben Vihstadt said in a statement. But Sununu supports workforce development and has pushed for $24 million in funding to boost nursing education, Vihstadt added.

The Senate will hold a budget hearing open to the public at 1 p.m. and 6 p.m. Tuesday in Representative’s Hall in Concord.

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