Federal Medicaid cuts will cause deep pain for NH seniors: Williams
July 31, 2025 | Uncategorized
Seacoastonline.com (July 31, 2025).
In its final analysis of what was known as the “Big, Beautiful Bill” – before that title was stripped in the Senate – the Congressional Budget Office (CBO) estimates the new federal law will cause $1.06 trillion in Medicaid cuts.
Directly impacting long-term care providers is reducing by a month payment for care provided prior to a Medicaid application’s filing. As the Medicaid application process is enormously complicated for anyone, let alone seniors needing long-term care, forcing providers to eat a month of care costs will be a hit. It seems a cruel way to pick up $4.2 billion in savings in a bill that adds $3.4 trillion to the deficit.
That $3.4 trillion in red ink will trigger the Statutory Pay-As-You-Go-Act of 2010, and, according to the CBO, result in 4% Medicare cuts to providers totaling $535 billion over 10 years. To put a 4% cut into perspective, nursing homes were only to receive a proposed 2.8% Medicare increase on October 1 under the Trump Administration. Even worse, home health was already facing a proposed 6.4% Medicare cut on October 1.
The long-term impact of a trillion dollars in Medicaid cuts mostly aimed at hospitals – but collaterally damaging other providers and state budgets alike – will be severe. That is especially true in rural states like New Hampshire.
Tragicomically, the bill purports to offset the rural impact by making $10 billion a year available for five years “for a program that supports the provision of health care in rural areas.” There is no real detail for how this will be spent, and one fears political games may be played as some Republican senators have already declared money is committed to their states. Ohio’s senators claim $1.3 billion of the first $10 billion will go to Ohio hospitals.
By one measure, 42.4% of New Hampshire’s population is rural, as compared to 24% of Ohio’s. Under the new federal law, a Kaiser Family Foundation analysis suggests New Hampshire’s rural areas alone will see a $1 billion Medicaid loss over 10 years, which, relative to population, makes us easily pass Ohio as one of the states taking the biggest cut.
Our health care system doesn’t have money to spare. Franconia, for example, is losing its federally qualified health center by year’s end, in a harbinger of what is to come.
The new federal law will cut the ability of New Hampshire to draw federal dollars by reducing the net patient services income that our state’s Medicaid Enhancement Tax upon hospitals applies to. At a rate of 5.4%, the tax is expected to produce $348 million from hospitals this year, generating $485 million in federal funding. The new law will eventually reduce the tax to 3.5%, which, if in effect today, would cut the amount brought in from hospitals by $112.5 million, eviscerating the federal match that funds our Medicaid program.
As New Hampshire budgets within a no-new-taxes construct, with reliance on county property taxes a conspicuous exception (but hardly a limitless well), state legislators are already greatly challenged budgeting within current revenue. This past legislative session providers greeted with enormous relief the decision of legislators, and Governor Ayotte, to abandon 3% Medicaid cuts that passed the House.
Yet to survive is not necessarily to thrive, and as the state with the second-oldest population we will see growing Medicaid needs that the new federal law will shortchange even as it piles new unfunded expectations upon our always-beleaguered Department of Health and Human Services. This will make decisions in Concord immeasurably more difficult, with state policymakers taking the blame for circumstances forced upon them from above.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association.