New Hampshire has the nation’s second-oldest population, its lowest unemployment rate, and New England’s worst Medicaid reimbursement. All of these factors have created a perfect storm for those providing Medicaid care as they struggle to recruit, and retain, caregivers.

A united front of providers worked with Senator Cindy Rosenwald (D., Nashua) to help frame what became her bipartisan health care workforce bill, Senate Bill 308. Among its elements was a significant Medicaid funding increase out of recognition that for years the state budget has been “balanced” at the expense of those providing vital Medicaid care. The human consequences have been disastrous.

In a recent legislative meeting, one advocate described people lying bedridden, in their own excrement, in homes because they can’t find home health aides. Hospitals are finding patients awaiting discharge backed up because nursing home beds aren’t available for them because nursing homes take beds offline where they cannot responsibly staff. Nursing homes cannot discharge rehabilitated residents into home-and-community-based settings because Medicaid-serving assisted living facilities are closing and home care help is so hard to find. Our entire health care system is fragile and interdependent.

With that said, providers also understand that “politics is the art of the possible.” While they were disappointed that the Senate’s budget funded Medicaid increases at only half the level of SB 308, they were grateful for any help they could get. They were also relieved that this part of the budget enjoyed unanimous support, free from the partisanship associated with other elements such as paid family leave. And it was to the credit of House budget negotiators that they accepted the Senate approach.

Some have suggested leaving it to the Department of Health and Human Services to determine where the money goes.

That ignores the fact that this vital health care workforce effort has been a months-long public process. Along the way hundreds of people have attended budget hearings – in Concord, Laconia, and Manchester – and shared the pain caused by Medicaid underfunding, often in deeply personal, often heartbreaking, stories. Providers, and legislators, consciously chose a funding approach that plays no favorites, and evenly funds all categories of care. It would be very disrespectful of this process to expect advocates, once again, to now come begging before a state agency to determine their funding fate.

The legislative budget compromise will not undo years of neglect, but it’s a good start. It may at least keep pace with inflation. In New England, for example, the Consumer Price Index rose 1.6% just between February and May. The cost of care bills unpaid by the state continues to mount.

The Spring 2019 Granite State Poll found 63% of residents would increase Medicaid care funding at the expense of the state’s “Rainy Day Fund.” Citizens understand that New Hampshire cannot continue to be an island of funding neglect.

Compassion should be bipartisan, as it is elsewhere. For example, a host of Republican-led states dramatically increased care funding this year by over 10 percent, including Nebraska, Oklahoma, and South Dakota. A failure to invest in care now will lead to disaster.

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

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