Do right by all Medicaid care providers and their vulnerable clients
If New Hampshire’s nursing homes are to continue to be a vital safety net, the 17-cents-a-day Medicaid funding increase they received January 1, for the over-4,000 residents whose care is state-funded, is not going to sustain them.
New Hampshire’s unemployment rate is at its lowest level since 1988. For all employers, that creates a real challenge in recruiting workers. For health care employers that serve the Medicaid poor this challenge is a full-blown crisis – they cannot raise “prices” to offset some of the nation’s worst Medicaid payment shortfalls.
In raising rates to $350 a day for in-patient substance-use treatment, the state cited the need to “ensure our providers have the means and workforce they need.” That is admirable. But what about the nursing home providers struggling to recruit, and retain, staff on an average rate of $168.65 a day? Do not they, and the vulnerable population they serve, also deserve adequate funding?
This question is especially important since neighboring Maine and Massachusetts have rolled out the red carpet for caregivers with sizable Medicaid funding increases especially targeting low-wage nursing home workers. New Hampshire is at risk of becoming an island of neglect in the middle of New England, even as its population – already the nation’s second-oldest – continues to age.
The means exists to do better, within existing revenues. Frugal budgeting, including years of underfunding Medicaid, has resulted in a robust state budget surplus of over $200 million, according to the Comprehensive Annual Financial Report released on December 27. In his inaugural address, Gov. Sununu announced he “will be proposing the state’s single largest ever investment into workforce training – a $24 million one-time investment – to grow our states nursing and health care workforce and double the number of those graduates in New Hampshire schools.”
That is very promising. But the means must also be provided to keep that workforce here upon training. And that will take a substantial investment in Medicaid. Otherwise we might as well hand our nursing graduates job listings in Maine and Massachusetts.
For New Hampshire’s nursing homes, such an investment might mean that a licensed nursing assistant, with 100 hours of training, can finally make as much as a liquor store clerk, or a restaurant dishwasher. Providing care to the elderly should be a living wage profession. Nationally, over 90 percent of front-line caregivers are women, and many are single moms trying to support their families by working overtime if not two jobs. Their dedication should be honored.
For assisted living, increased funding might mean that additional facilities would view Medicaid care, which presently pays bargain-motel rates, as an option. That would help more people to be able to age-in-place in their own communities, instead of moving across the state in search of care – often leaving place-bound loved ones behind.
Similarly, for in-home care, more funding would mean that more seniors could benefit from the dignity of aging in their own homes with some assistance with their activities of daily living, such as bathing, eating, getting dressed, moving, and toileting. Oregon, for example, is the nation’s leader in funding home-and-community-based services for long-term care needs. Not only does its funding schedule ensure home care workers make at least $14.65 an hour, but its nursing home rates are twice as high as New Hampshire’s.
The 2019 legislative session can bring the historic opportunity in Concord to do right by all Medicaid care providers and their vulnerable clients.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association.