To The Daily Sun,
It is universally acknowledged that care at home is preferable and far less costly than care in a facility. In New Hampshire, the average cost of maintaining a Medicaid recipient in their own home is about $18,360 per year while the average cost of care in a nursing home is about $44,000 per year. So, keeping Medicaid-eligible people at home in New Hampshire makes economic sense. The formula works as long as there are willing home-health providers in the community. And that is where the problem arises.
Community-based home health agencies have been paid the same rate to provide service under the Medicaid "Choices for Independence" (CFI) program for the last six years — and even longer for some types of service. This has occurred in spite of the fact that the state was ordered to review and amend rates yearly following a legal settlement. Nevertheless, the rate revision has occurred only once — in 2009. Since then, agency costs to provide care have risen steadily. The increasing difference between agency cost to provide care and the state payment for care has caused a number of New Hampshire agencies to question whether or not they are financially able to serve CFI clients.
Some agencies have already elected to discontinue serving the CFI program altogether because they simply cannot afford to lose so much money and continue to service the broader needs of their communities. Many more are considering this option.
As the state budget debate commenced, home health agencies learned that the Bureau of Elderly and Adult Services reported significant unspent funds in the CFI line item that should have been used to fulfill the state's obligation to its Medicaid population. Instead, these unspent funds were planned to be used elsewhere. Ultimately, home health professionals worked with the budget committee to appropriate a portion of those funds — $1.8 million — back to the CFI budget line. This portion was earmarked for a retroactive supplemental payment. Additional funds were appropriated for a 5 percent prospective rate increase to service clients under CFI — consistent with state rules.
The current state budget impasse places these appropriations in limbo. While the budget debate continues and the state engages in its "continuing resolution", agencies are faced with the question of whether or not they can afford to continue staffing or accept new CFI clients at a financial loss.
The irony is that every case that does not get picked up by a home health agency ends up in a far more costly health-care facility at higher expense to the state. That is wildly inconsistent with our economic interests and our stated values concerning home-based care. The clock is ticking. But nothing in this debate is helpful to individuals in need of care. When the Legislature and the governor meet again to negotiate the budget, we want this issue to be in their minds.
Margaret Franckhauser, RN, MS, MPH
Central New Hampshire VNA & Hospice
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