Granite State health providers frustrated by continued cuts to Medicaid, other supportive program funding

LACONIA — Health care providers said they are tired of having to defend the necessity and benefit of Medicaid and other government-funded programs in the state budget during a roundtable discussion Thursday.

The forum brought together local providers to discuss policy proposals which threaten access to health care coverage for Granite Staters. Horizons Counseling Center, Family Resource Center, Community Support Network, Mid-State Health Center, Lakes Region Mental Health Center, North Country Health Consortium, Waypoint NH and Navigating Recovery of the Lakes Region were represented at the event, moderated by Jake Berry, vice president of policy for New Futures, at Lakes Region Mental Health Center downtown. According to its website, New Futures is an advocacy organization working to improve well-being of state residents through public policy change and civic empowerment.

The discussion focused on House-passed budget cuts to the Medicaid reimbursement rate, premiums and copays, as well as reductions in funding for mental health services, changes to the funding structure for the alcohol fund, and defunding the developmental disability waitlist and Choices for Independence waiver programs.

“I feel like every two or three years, we have to have these wake-up calls with our leadership to remind them of how important these safety net services are for our residents in our communities, but also for the economic success of our state,” said Wendy Williams, grants and programming director for Mid-State Health.

“To put it simply, there's not one age set or demographic group that we aim to serve that would not be deeply and irrevocably harmed by the budget cuts under consideration right now at the state and federal levels,” Berry said.

Much of the concern came from cuts to Medicaid. It was clear many clients of staff at the table rely on Medicaid. Jacqui Abikoff, executive director of Horizons Counseling Center, said her staff serves 900 clients experiencing substance use and severe mental illness, and almost 85% benefit from Medicaid, and 10% are on a sliding scale. Only 5% of the people they serve are privately insured. Abikoff said as a nonprofit, it’s her organization's mission to increase access to services, for as long as is necessary.

“Medicaid has made the sustainability of the scope of services that we are able to provide possible,” Abikoff said.

Some at the table expressed cuts to certain programs will end up being more expensive for the state.

“It's forever going to be far more expensive to pay for the crisis, then it will be to stick with prevention,” Kris van Bergen, director of workforce development and public health programs of the North Country Health Consortium, said.

Another point of concern is freezing the state loan repayment program. Williams said the program is essential for recruitment in primary care, specifically for dentists, doctors, nurse practitioners and physicians assistants, who are struggling with debt from school. For an doctor of medicine, those loans could be up to $500,000. The student loan repayment program is especially important to bring medical professionals to rural areas, where there are also shortages in medical care.

“That gives us an opportunity to attract some folks we might not automatically get in our rural region, because they could go somewhere else and make more money,” Williams said.

Cuts could also mean less funding, putting more work on fewer employees. Van Bergen said North Country Health staff already have an issue with experienced employees not having time to mentor students in the field, limiting the growth of new medical professionals that are needed.

“Folks who typically were maybe more seasoned and had a little more free administrative time in their schedules to precept students or mentor students are now managing patient care and providing more direct care and saying 'no' to student placements,” van Bergen said.

Cuts also create instability within organizations which help fund nonprofits like those represented at the discussion. Beth Vachon, director of development and public relations for Lakes Region Mental Health Center, spoke to this.

“The uncertainty that surrounds that and the loss of staffing has trickled down to private and foundation funders that we are dependent on as nonprofits to supplement our income, our general budgets.

"They're starting to see more requests, and as a result, many of us are getting ‘nos.’”

Editor's note: This story has been updated to indicate Waypoint NH participated in the roundtable.