NH State Budget for FY2022-2023
(July 1, 2021 - June 20, 2023)
HB 1 & 2

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THE ISSUE:

Every two years, legislators are presented with a budget that outlines the needs for reimbursement for the upcoming two years.  Legislators will deliberate and debate the funds available for state sponsored programs, such as Medicaid.  Over 60% of NH nursing home residents rely on Medicaid to cover the cost of their care. 

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Over the past decade, NH's gap between the cost of providing care to residents who rely on Medicaid and the reimbursement for that care has been among the highest in the nation and we are STILL the highest in New England.  Modest increases in the last biennial budget helped to bridge the gap between cost of care provided and reimbursement by the state.  We cannot lose ground in this year's budget - we must continue to narrow the deficit.

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THE PROBLEM: 

 

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• 70% of a facility's costs are wages.  Failure to increase facility reimbursement leads to an inability to raise wages for caregivers.

• Under-funding has lead to the inability of facilities to increase their wages to compete with other jobs that require less training.  This has lead to a serious workforce crisis.

• Facilities cannot continue to function with ongoing fiscal losses.  Costs of the materials needed to operate their building safely are increasing

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THE FACTS:

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• NH has lead the nation in "substantial compliance" with Federal Health Survey Standards.  (According to CASPER data)

• NH nursing homes have the largest reimbursement deficit in New England according to Hansen Hunter and Co. P.C.

• NH had the highest vaccination rate of long-term care residents and staff members in the US!  A tribute to the communication and trust built between caregivers and residents/families and the dedication of the caregivers.

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HOW THIS AFFECTS RESIDENTS & FAMILIES:

• Residents who pay privately pay higher rates, known as cost-shifting, to offset the funding NOT received from Medicaid.  This leads to spending down of residents' assets more quickly, requiring them to enter the Medicaid system sooner, starting the cycle again.  This means that more of their hard earned savings are going toward end-of-life care than to loved ones or valued charities.

• Facilities are forced to make decisions about where to spend the funds they receive. Where do they make cuts to stay in business: wages, capital improvements, services for residents, staff education? Ultimately, choices and cuts must be made.

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HOW THIS AFFECTS CAREGIVERS:

 

• Our border states, VT, MA, and ME all have higher reimbursement rates and greater ability to pay staff.  In many cases, it is easy for staff to cross the border into these other states for higher wages.

• Without wage increases, caregivers are forced to choose between a career that allows they to care for our elders OR earning a livable wage to support themselves and their family.

• During the COVID-19 pandemic, caregivers have been on the front-lines caring for residents, keeping residents socially connected while visitation was severely limited.  They have watched their beloved residents get ill and pass away.  They have feared contracting COVID-19 and carrying that home to their loved ones, who may also be at risk.  They deserve better compensation for their sacrifices.

 

 

WHY LEGISLATORS SHOULD BE CONCERNED:

• If privately paying residents deplete their resources more quickly due to higher costs, they will need coverage from Medicaid sooner than anticipated.

• Decreasing the availability of Medicaid-eligible beds will leave our most fragile citizens with fewer options for receiving the care they need and deserve.

• Failure to adequately reimburse nursing homes WILL cause nursing homes to close, making it even more difficult for New Hampshire's elders to find quality care when they need it most.

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THE ASK:

• Increase the line item for Medicaid Funding for Nursing Homes.  In the current state budget, there was a 6.2% Medicaid Funding Increase, and that commitment to increasing funding must be maintained as facilities seek to recover from the COVID-19 pandemic.

• In addition, use the American Recovery Plan Act of 2021 Funds to provide $50,000,000 in one-time relief for the nursing home sector, addressing the issues of infrastructure, workforce, and increased operating costs.

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