LACONIA — Belknap County is slated to receive more than triple the amount of ProShare money for the Belknap County Nursing Home that it received last year, but the state is asking the county to voluntarily return half of that increase.
In a convoluted process designed to maximize the state’s ability to qualify for federal matching funds, it is asking each county to send money back to the state Department of Health and Human Services.
DHHS sends supplemental payments – known as Proportionate Share Incentive Adjustments, or ProShare funds – to county nursing homes to help make up the difference between the nursing homes’ Medicaid reimbursement and what Medicare would have paid. Most nursing home residents are on Medicaid, which has lower federal reimbursement rates than Medicare.
Last year, Belknap County received $1.26 million in ProShare money but, this year, it will receive $3.94 million, an increase of $2.679 million.
DHHS Commissioner Jeffrey Meyers and DHHS Medical Director Henry Lipman explained in a recent letter to the county that the increase is largely due to a change in the way the department calculates ProShare payments.
Meyers met with the Belknap County Delegation last month to ask for its cooperation in meeting the matching-fund requirements for the state to receive $10 million a year in federal money. That federal money would ensure that a five-year, $150 million mental health and substance abuse program would continue through 2020.
Meyers said the program, coordinated by the Community Health Services Network LLC, has more than 350 workers statewide who provide services through integrated delivery networks, also known as IDNs.
There are seven integrated delivery networks in the state, and Belknap County is part of the Central and Winnipesaukee public health networks.
The state obtained a waiver in 2016 to allow it to use Medicaid money to pay for drug treatment programs delivered through the networks. The waiver was good for five years, and the $30 million annual costs were split equally – at $10 million each – by the state’s general fund, the in-kind services that county nursing homes provide for which they have not been previously reimbursed, and the federal government’s match.
Meyers explained that a change in the way the federal government calculates the matching fund component now requires that the money go directly to the counties, rather than to the state. Doing so reduces the state funds necessary to qualify for the federal match.
In asking for voluntary contributions, Meyers said the money would only be sought through 2020, when the federal waiver expires.
DHHS has circulated a draft resolution for sharing the ProShare increase that he is asking all 10 counties to adopt. He plans to return to Belknap County within a few weeks to explain the full program.
Belknap County Commissioners said they would like to meet with Meyers before they meet with the county legislative delegation to better understand what benefits the waiver program has for the county and its service providers.
“We want to know what the state is doing with the money they are asking us to voluntarily turn over to them,” said Commission Chairman Dave DeVoy (R-Sanbornton).
Belknap County Administrator Debra Shackett said that, as a result of the increased funding, the nursing home would have to pay an additional $217,000 in the so-called “bed tax” to the state.
It also would add an estimated $2.7 million to its revenues but Shackett estimates that reductions in other nursing home revenues will offset about one-third of that amount, resulting in $1.8 million in additional revenue over what was budgeted.
Commissioners DeVoy and Hunter Taylor (R-Alton) are looking at transferring $150,000 of that revenue to meet shortages in the Information Technology and Corrections Department budget.
Commissioner Glen Waring (R-Gilmanton) said he thinks the commission should ask the delegation for a supplemental appropriation for those departments, rather than trying to transfer money from other departments.
“The revenue is there, but we can’t spend it without an appropriation,” said Waring.
DeVoy said he is skeptical about getting cooperation from the legislators. “Who knows what the delegation will do?” he asked.
Taylor argued for a delay, summing up the convoluted and confusing situation by saying, “We should hold up on taking action until we know what we’re doing.”