2 weeks Ago
DEALT A bad hand by a revenue shortfall, the New Hampshire House passed a bad two-year budget for long-term care. Now it is up to the Senate to fix it and make it more consistent with what Gov. Kelley Ayotte has proposed.
Medicaid providers were very grateful for a historic funding increase in the current budget. It does not diminish that gratitude, however, to point out that this increase was really a modest down payment on addressing years of funding neglect. Medicaid providers were hardly swimming in cash suddenly.
Case in point: Since February 2020, average nursing home wages have increased more than 33%, or over 6% a year. As wages and benefits comprise so much of nursing home care costs, a substantial annual funding increase is necessary to even meet their Medicaid share-of-cost, whether they compensate direct care workers, or activities, dietary, housekeeping, and maintenance staff. Yet the House adopted a budget that would cut Medicaid rates by 3%.
It is unclear how the House imagines this would be survivable for nursing home care in our state, which has the nation’s second-oldest population. Even with substantial wage increases, nursing homes have not yet recovered their pre-pandemic workforce. In a highly competitive job market, the most recent quarterly data showed New Hampshire’s nursing home workforce is 7% smaller than it was in February 2020, almost double a 3.
7% average drop nationally. Expecting nursing homes to endure a loss of Medicaid funds over the next two years would only worsen this workforce crisis. Does the House expect facilities to cut wages, lay off caregivers, or do without dietary departments? Like New Hampshire families, nursing homes are experiencing other inflationary pressures.
Frustrated by the high cost of eggs and groceries? Imagine buying eggs for hundreds of people. Catholic Charities New Hampshire, which has operated nursing homes since 1948, paid 32% more in food costs for its residents in 2024 than in 2020. Worried about tariffs? Tariffs apply to care supplies that nursing homes need.
Even before tariffs, nursing homes were expecting cost increases of at least 14% for general disposable items or consumables and 22% for equipment — for this year alone. Tariffs will cause inflationary costs to skyrocket further. With home health support keeping them out of nursing homes until they need that intensity of care, Granite Staters receiving nursing home care today are very old and sick and have exhausted financial resources.
That was certainly true of my wife’s last home health client entering a nursing home, as she managed to live in her own apartment until 96. The life-sustaining care needs of such frail residents cannot be dialed back by 3%. And a problem with even the current Medicaid rates is that nursing homes are not receiving them for those whose Medicaid applications are not yet approved.
That makes it not uncommon for a facility to provide free care to a dozen residents or so while the state awaits documents from families or is challenged by its own staffing shortage. Thus, in addition to a Medicaid rate increase, it’s vitally important that a legislative fix to this problem of “pending” Medicaid applications be adopted so that facilities can make payroll and pay their vendors on time. You cannot “balance” a budget by shirking care bills.
If passed into law, the House budget would be an extinction event for New Hampshire senior care. We trust that compassionate state senators working with Gov. Ayotte will rescue that care.
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