Brendan Williams: A good legislative session for long-term care in New Hampshire

For the Monitor
Published: 5/19/2018 12:09:59 AM

For long-term care advocates, the 2018 legislative session concludes more promisingly than it began.

A chronic workforce shortage will not be solved by means other than improving dreadful Medicaid rates, but legislators have tried to ease barriers to entry. The latest success was Senate Bill 334 from Sen. Jay Kahn, a Keene Democrat, that would allow certain health professionals recruited from other states to practice while awaiting New Hampshire licensure, which can take a while.

The session also featured resolution of the longstanding debate over how, and whether, to integrate long-term care into a managed care model, something required by a 2011 New Hampshire law. There were many unanswered questions as to how this would affect long-term care, and, after prior study and delay bills, House Bill 1816 from House Finance Chair Neal Kurk, a Weare Republican, sought to stop this transition altogether.

With the wisdom of Solomon, Senate Majority Leader Jeb Bradley, a Wolfeboro Republican, also a savior of Medicaid expansion, brokered an HB 1816 compromise whereby the Department of Health and Human Services is authorized to pursue developing new Programs of All-Inclusive Care for the Elderly to potentially provide adult day health for hundreds of residents, but nursing home residents, recipients of home-and-community-based services, and others no longer face the threat of mandatory Medicaid managed care. DHHS deserves credit for agreeing to this.

A key question remains how to bolster our fragile long-term care system, as the status quo is clearly not working, even if one believed managed care was not the answer to fix it.

While we are not Louisiana, where a budget impasse is currently threatening the shut off of services to 37,000 Medicaid recipients, including the eviction of 19,000 nursing home residents, we are not exactly flush. New Hampshire nursing home rates are calculated twice a year, and after a rate increase Jan. 1 that averaged only a nickel a day per resident, the July 1 rate increase looks to be higher by 2 percent thanks to efforts by Senate President Chuck Morse, a Salem Republican, and others to infuse the system with additional resources for the coming fiscal year.

While that is good news, it simply cannot keep pace with inflation. Medicaid rates have effectively been stagnant for too long. And a 2 percent Medicare cut for nursing home care, agreed to in the Bipartisan Budget Act of 2018 as a means to pay for more defense spending, will not help. Labor costs, including health care, make it almost impossible to be viable as a New Hampshire long-term care provider, especially given an unemployment rate that is among the nation’s lowest. Why be a personal care assistant in someone’s home for $10.50 an hour when you can make more money collecting tolls or flipping burgers?

According to Paraprofessional Healthcare Institute data, 91 percent of nursing assistants are women, and nursing assistants in New Hampshire actually made less in 2016 than they did in 2006. There are county jails that spend more on inmates than we do as a state on nursing home residents. A March report to Congress revealed the average nursing home nationally had only a .7 percent margin in 2016, a margin New Hampshire providers could only envy.

The managed care fight allowed long-term care advocates to look outside the silos of their own favored care settings, giving hope that this year’s legislative success can be collaboratively built on. With the nation’s second oldest population only getting older, we are committed to working alongside DHHS, legislators and Gov. Chris Sununu on ideas to sustain our most vulnerable residents.

(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)

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