‘Huge and historic:’ NH care providers celebrate big Medicaid rate increases

Medicaid pays for Joan Ilves to give Tom Kangas care and help with housekeeping in his Charlestown home so he doesn’t have to move to a nursing home.

Medicaid pays for Joan Ilves to give Tom Kangas care and help with housekeeping in his Charlestown home so he doesn’t have to move to a nursing home. Annmarie Timmins / New Hampshire Bulletin


New Hampshire Bulletin

Published: 10-25-2023 12:35 PM

Two agencies that keep 600 people out of nursing homes by providing in-home care have learned the state will give them a direly needed 42 percent Medicaid rate increase — more than they had asked for. 

“It’s a game changer,” said Keith Kuenning, Waypoint’s director of advocacy. “We’ve been working on this for years. This has been astounding.”

Waypoint and Ascentria Care Alliance warned the state this year that without significantly higher Medicaid payments, they’d have to end the care that allows people to manage their health needs in their homes. Doing so would leave their clients at a fork in the road: join nursing homes’ long waiting lists or try to persuade a family member to step in.

“We’re teetering on the edge,” Amy Moore, director of in-home care at Ascentria, told the Bulletin in March. 

The Department of Health and Human Services has since responded with updates Asecntria and Waypoint did not expect. Jake Leon, DHHS spokesperson, said a few other organizations have received similar news regarding boosts to Medicaid reimbursement. 

Those include ambulance providers; the children’s dental program; and pregnancy care providers, including midwives, obstetricians, and birthing centers. The state has seen birthing centers that take Medicaid patients close or struggle because the reimbursement rates have not kept pace with increased costs, particularly for malpractice insurance. 

This year’s budget negotiations were dominated by dire warnings from health and service providers beyond just Waypoint and Ascentria about inadequate Medicaid reimbursement rates. Health care providers partnered to lobby lawmakers on rate increases. They called themselves the “Varsity Team.” 

Lawmakers listened, so much so that when House budget writers were waiting for state revenue estimates, they put a hold on some expenditures such as higher education investments to protect money for Medicaid increases.

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The state’s hospitals prioritized that investment too, telling lawmakers they would give up their Medicaid rate increase to benefit other providers like behavioral health centers and long-term care services that help keep people out of the hospital.

The state budget passed in June had an unprecedented $134 million for Medicaid rate hikes, an amount that comes to nearly $300 million with the federal match. It was far more than the $24 million Gov. Chris Sununu included in his budget proposal for increases.

All providers saw a 3 percent increase in Medicaid payments in July, the start of the budget year. They’ll see additional raises come January. 

Those increases will give the state’s 10 community mental health centers, which also pleaded for more support, $16.6 million plus the federal match. The majority of the 60,000 people the centers treated last fiscal year were insured by Medicaid. 

The Community Behavioral Health Association warned lawmakers in February that they couldn’t begin to meet increasing demand, triggered by the pandemic, given their 340 clinical vacancies. Filling those openings would require higher Medicaid payments, they said. 

Lawmakers required that $15 million of the $134 million in rate increases be targeted to  providers most in need. The Department of Health and Human Services deemed the Choices for Independence Program, which Waypoint and Ascentria work under, as one of those high-need services. 

CFI provides nearly 3,800 Granite Staters who are older or have disabilities with basic care, such as help with bathing, cooking, or dressing so they can remain at home or in a small community setting. 

In an analysis of Medicaid investments, the New Hampshire Fiscal Policy Institute found that between 2011 and 2021, the state’s Medicaid payments to CFI had not kept pace with inflation. If they had, those providers would have seen an additional $152 million in that time, the analysis said.

Waypoint’s Kuenning and Amy Moore, director of in-home care director at Ascentria, said the increase will allow them to increase pay from about $12 an hour to $15, enough to compete with fast-food chains and retail stores that were luring workers away. Both organizations had lost so many workers over low pay that had to turn away people seeking care.

“It’s not that we were threatening,” Kuenning said, recalling his warning to the state this spring. “We weren’t bluffing.”

Moore said her agency is reaching out to people who had turned down jobs because they paid so little, in hopes the wage increase will entice them back. She said the agency is already seeing an uptick in interest. 

Moore emailed news of the rate increase to Ascentria’s finance director, who, like Moore, has seen prior requests for significant rate increases fail. “When he saw (my email), he screamed a little bit,” Moore said. “His wife asked him what was wrong.”

Nothing was wrong.

“This is huge and historic,” Moore said.