NH health providers say state’s low Medicaid rates contribute to staffing ‘crisis’

Health care providers in New Hampshire are pushing for a big increase in Medicaid rates this year, saying it would help them address increasingly severe staffing shortages.

During a hearing Wednesday, health care leaders told lawmakers that the reimbursement they receive from the state’s Medicaid program often falls short of what it actually costs to provide care. This makes it difficult to pay competitive wages at a time when organizations across the healthcare sector are struggling to fill vacancies.

“In the last nine months, we spent $1.2 million on agency staff,” said Joe Bohunicky, administrator of Mt. Carmel Rehabilitation and Nursing Center in Manchester, which has 30 open nursing positions, said. “Why? Because there is no additional staff out there that we can hire.”

The hearing in question an account proposed by state Sen. Cindy Rosenwald, a Nashua Democrat, who will put $145 million dollars toward raising Medicaid rates over the next two years.

The lack of workers has ripple effects throughout the health system. Long-term care facilities have had to leave beds unused because they cannot staff them; some nursing homes have waiting lists of 100 people. And with those facilities full, hospitals have few options when they want to discharge patients who need continued support — putting additional pressure on hospitals’ own capacity.

“Patients across the state remain in hospital beds when they no longer require acute inpatient care,” said Paula Minnehan, a senior vice president of the New Hampshire Hospital Association. “This is becoming a crisis. They cannot leave because there is nowhere for them to go.”

She urged lawmakers to devote more Medicaid funding to long-term care, as well as mental health care. Dozens of people are held in hospital emergency departments on any given day, waiting for inpatient mental health treatment.

Roland Lamy, the head of the Community Behavioral Health Association, told NHPR that New Hampshire’s 10 community mental health centers have more than 300 vacancies. Low Medicaid rates are a big driver, he said. He estimates community mental health centers would need a $28 million boost in Medicaid revenue to make their wages competitive.

“A masters-level psychologist, you know, we might pay $29 an hour, and the market pays $45 an hour,” he said.

Ryan Donnelly, an advocacy coordinator at Granite State Independent Living, said shortages of direct care workers make it harder for seniors and people with disabilities to stay in their homes.

“A few of our consumers have even made, or are considering, the very undesirable decision to move into nursing homes to get the personal care they need to live safely, “because it has become too difficult to rent and to retain home caregivers.”

Senate President Jeb Bradley, a Wolfeboro Republican who sits on the Senate Health and Human Services Committee, asked for more clarity on exactly how the money would be divided before moving forward.

“I don’t want to pit Peter against Paul, but between this bill and Senate Bill 36, we heard about the need for DD rate increases, long-term care, CFI, behavioral health,” he said, using acronyms for developmental disabilities and Choices for Independence, a home care program. “I suspect there are others. But some sort of definition of where we’re going, I think, would be helpful.