Brendan W. Williams: Let’s unite around doing what’s right for NH
June 12, 2025 | Uncategorized
NH Union Leader (June 12, 2025).
NEW HAMPSHIRE nursing home care providers have been in a state of heightened anxiety since January. At the federal level, Medicaid cuts have been discussed to help pay for massive tax cuts in what has become known as the “One Big Beautiful Bill Act” (HR 1). In Concord, the elimination of the century-old Interest and Dividends Tax, as well as decline in other revenue sources, set up the toughest state budget cycle in over a decade.
Medicaid cuts that passed the U.S. House will have direct, and indirect, impact upon nursing home care. For example, under current law, states must provide Medicaid coverage for qualified medical expenses incurred for up to 90 days prior to the date of a Medicaid application. However, this period would be limited to one month under HR 1, a $6.35 billion cut over 10 years.
To illustrate the impact, for my biggest nonprofit member, Catholic Charities New Hampshire, essentially losing 60 days of retroactive Medicaid coverage in 2024 would have cost $1.3 million in revenue — on top of money lost by providing Medicaid care generally.
The Medicaid application process is complicated, and a great deal of senior care would be denied if facilities only admitted residents with completed Medicaid applications. Even being able to recover three months of care costs under current law occasionally does not fully pay for the care provided.
HR 1 would also impose considerable new federal unfunded expectations upon our Department of Health and Human Services (DHHS), such as more frequent income vetting of those receiving health care under Medicaid expansion and determining whether those seeking such coverage are able to work. The bandwidth of DHHS, a vital agency routinely the target of state legislative cost-cutting, is already more than consumed by its current duties, and new bureaucratic burdens will impair its ability to perform those duties and assist care providers.
Federal threats make it more urgent that state legislators stand by our most vulnerable Granite Staters.
Within her austerity budget, Governor Kelly Ayotte maintained modest forward progress for nursing home care funding. Providers are very grateful this was preserved by the Senate, which rejected 3% House cuts. And the Senate acted upon an existential crisis facing New Hampshire nursing homes struggling with the pace of Medicaid application finality.
Members of the Senate Finance Committee alone represent eight nursing homes awaiting over a quarter-million dollars each in Medicaid payments for care already provided, with one facility, as of the Senate’s hearing on the House-passed budget, awaiting a staggering $931,331.66.
Senator David Rochefort, R-Littleton, whose sprawling North Country district includes more nursing homes than any other, proposed an innovative bill under which nursing homes would get provisional payments while awaiting Medicaid application approvals. Unfortunately, the resources were not there to monetize the revolving fund this approach would require, even though there would be no net loss to the state as federal matching funds would repay the fund once applications were approved.
As nursing home care could not survive with this problem going unaddressed, the Senate Finance Committee took an alternative approach by providing funding to DHHS to contract out for assistance in avoiding Medicaid application backlogs for long-term care. The nursing home sector volunteered to contribute a portion of this funding through a higher license fee.
We are proud to partner with DHHS and our state legislators in preserving senior care in the Granite State for the nation’s second-oldest population. We may not be able to control what happens in Washington, D.C., but we can be united in doing the right thing in Concord.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association. He lives in Pembroke.