Lawmakers hold the key to increasing Medicaid reimbursement rates for nursing homes, a legislative committee was told Thursday as it prepares to finalize its report to the Legislature.
The legislative Committee to Study the Safety of Residents and Employees in Long-Term Care Facilities has focused on what many consider two key concerns: Medicaid reimbursement rates and retaining and attracting workers for the facilities, which have borne the brunt of COVID-19 fatalities in New Hampshire.
Of the more than 450 people who have died, 81.4 percent have been in long-term care facilities, mostly nursing homes.
Over the course of its work, many of the people testifying before the committee said New Hampshire’s reimbursement rates for Medicaid services in nursing homes are among the lowest in the country, and in order to provide “a living wage” to workers, the rates need to increase.
Health and Human Services Commissioner Lori Shibinette was asked about the rates and how they impact the workforce shortages the long-term care industry faces.
Shibinette noted the federal government pays half the rate and counties pay the no-federal share to a capped amount, and the state pays the remaining match.
The state budget is fairly small, she noted, but raising rates would raise the cap on county costs so they would need more money, raising property taxes, and the state would provide additional money as well.
“It’s truly a budget issue,” Shibinette said. “It’s not simple because it’s both state and county and if you bump up the rates you will hit county taxpayer dollars.”
The chair of the committee, Sen. Jon Morgan, D-Brentwood, asked if increasing the Medicaid rates would help facilities retain employees and attract more workers.
Shibinette said she believed the vast majority of nursing homes would pass the additional money to employees, but noted “those facilities with a competitive pay rate have a hard time recruiting staff.”
Morgan noted that four more people in long-term care facilities died in the past few days and asked if legislators could institute a policy that would better support the facilities and make them safer.
Shibinette said the vast majority of what they were charged to study has already been done through federal rules, laws and regulations.
The Center for Medicaid Services guides New Hampshire operations, she said, and facilities have had to meet those standards for decades.
The state controls licensing, Shibinette said, but the federal guidelines and regulations are far more stringent than the state’s.
One committee member and several members of the public suggested one way to address the safety of residents is to expand the in-home services program so the elderly may remain in their homes longer before needing institutional care.
Rep. Charles McMahon, R-Windham, said he proposed increasing wages to in-home service providers, noting the unofficial cap is $15 an hour.
He noted it is far less costly to provide services in the community rather than in nursing homes. He noted those who provide the health-care services are not appreciated as they should be.
McMahon said most people will not do anything until it directly affects them, so now is the time with the pandemic to take action to better support the in-home program.
Cheryl Steinberg of NH Legal Assistance agreed the program needs more financial support.
“We learned in the pandemic it is safer to be in your home than in a nursing home,” she said. “As a recommendation, this is something we really need to look at. We’re the second oldest state in the country and we’re only going to get bigger.”
Several of the committee members expressed concerns the state is changing its testing program for nursing homes.
“I’m concerned the testing in real life has gotten less and the costs have shifted,” said Rep. Paul Berch, D-Westmoreland, “and both concern me.”
He said both residents and staff were tested fairly frequently but now only staff will be tested and the costs will be paid for by the nursing homes.
“At a minimum, I hope the state continues to pick up the cost of testing with funds from CARES (Act) money,” Berch said, “and not have the burden at this time placed on nursing homes.”
Shibinette said nursing homes have asked for flexibility to do their own testing because the state was testing seven days a week, and some had to call their entire staffs in on a Saturday or Sunday.
The state has tested 100 percent of staff and residents every 28 days, but staff is really the only way the coronavirus enters a facility.
She said facilities asked for more flexibility and a “self-directed testing program,” to make it easier for staff, but if there is one positive test, the state comes in and tests everyone.
Moving away from the state-directed surveillance program to their own has been scary for some, she said, but her department has worked with them every other step along the way including finding contractors.
The state will reimburse the facilities $100 for each test which is the going rate for most labs, she said. The facilities do their own testing and send the specimens to a laboratory, she said, but if facilities want to do more testing, they will have to pay for it.
The change begins next week, Shibinette said, but it is not a hard deadline.
The change will allow the state public health lab to test other long-term care facilities not just nursing homes, she said.
“We’re not kicking them off the program,” Shibinette said, “we’re helping them to get more flexibility.”
The state is seeing fewer outbreaks and is better positioned to deal with them than this spring, Shibinette said, and noted there should be no problem with personal protection equipment either.
She said the testing costs are budgeted through the end of the year, but after that additional money will be needed.
Rep. Jerry Stringham, D-Lincoln, noted the state’s high mortality rate for nursing home residents and asked if there were some explanation.
Shibinette said the media took “one data point” and ran with it, noting the overall death rate in New Hampshire nursing homes is below other states.
The state’s community death rate from COVID-19 is low and when you compare it to nursing homes, she said, it is 80 percent but that does not mean “we have more nursing home deaths than everyone else.”
“The only way to change the percentage is to have more people in the community die,” Shibinette said, “and we don’t want that.”
Once COVID-19 is in a long-term care facility it is very difficult to stop, she said, but if you catch it before it goes into the resident population, the nursing home will not go into outbreak status.
“We are doing what they need to do with sentinel testing, sufficient PPE and tons of education,” Shibinette said. “The highest mortality rate is for those over 65 to 70 years old with underlying conditions, and everyone in a nursing home has underlying health conditions.”
The committee also heard from long-term care facility ombudsman Susan Buxton who told the committee changes in nursing home design with more single rooms would help reduce the spread of illnesses.
“We need to rethink how we provide long-term care in the future beyond just nursing homes,” she said, “we need more care in the community.”
The committee meets again to finalize its report Oct. 22 at 9 a.m.
Garry Rayno may be reached at firstname.lastname@example.org.