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Garry Rayno's State House Dome: Senior advocates to sound off Tuesday

GARRY RAYNO
State House Dome

May 16. 2015 5:26PM




TWO WEEKS ago at the public hearing on the proposed $11.2 million biennial budget, Senate budget writers announced an agreement had been reached to restore about $4 million earmarked to cover rate increases for nursing homes.

Administration officials had set aside $7 million to help the Health and Human Service Department offset a more than $50 million budget shortfall, but a larger than expected budget surplus put aside that concern.

That meant nursing homes could receive the rate increases they anticipated this year.

That is half the story. Lawmakers and administrators are going to hear the other half at a press conference scheduled for Tuesday, when senior advocacy and home health groups lay out what they say is a terrible situation.

Without changes, advocates are expected to say, many providers will go out of business, and there will be no one to provide the care services many at-home elderly need to survive.

At issue is the Choices for Independence program, which provides Medicaid services to low-income elderly and adults.

Surplus money in the CFI program allowed House budget writers and Gov. Maggie Hassan's office to reach an agreement that allows nursing homes to receive their anticipated rate increase.

While the nursing homes are taken care of in Senate Bill 8, the health and home care providers in the CFI program said they are not.

The House plan would give the agencies a one-time 2 percent rate increase.

"While Senate Bill 8 is good news for nursing homes that are woefully under-reimbursed by the state of New Hampshire," said Gina Backus, CEO of Granite State Home Health Association, "it's yet another step in the deconstruction of home and community services that help keep our elderly loved ones out of nursing homes."

Backus' organization represents 39 home care agencies licensed in the state that serve many of the people in the CFI program.

Under the program, those who qualify financially can receive personal and medical care services at home. Those served are eligible for nursing home services, but instead opt to remain at home, at about half the cost of care in a nursing home.

The department decides what services the people may receive at home and how often, according to Backus.

The program will not spend about $5 million of the $14 million appropriated for this fiscal year.

"Ask any case manager who helps arrange services, or a home care agency that provides nursing care - the level and amount of services that the state approves for CFI clients have diminished to the point where one really wonders if we are truly meeting the needs of our elders," Backus said.

Reduction in services authorized is not the only problem, the home health agencies have not received a rate increase since 2010 and went without an increase from 1999 to 2005 until they sued the state, although state law required an annual review and adjustment for costs.

Some of the providers have reduced the number of CFI clients they serve or dropped out of the program.

"Low CFI reimbursement has shredded the community safety net," Backus said. "Who will serve our seniors if community agencies cannot?"

Case managers who oversee the services clients receive and "keep the state honest" are in a similar boat with no bumps in reimbursements and growing client lists.Bob Clegg, who represents Heritage Case Management and Granite State Independent Living, said case managers have not had a rate increase since 1988 and many companies are just getting by.

"I was trying to explain to the Senate if you don't pay up, a lot of these companies are going to go out of business," Clegg said. "(The state) is not providing the same level of care and covering the needs of folks, and they call that cost savings."

The Senate is in the final stretch of crafting its budget plan and on Thursday decided not to agree to the House version of SB 8 and instead wants to negotiate.

The press conference on Tuesday might provide some more ammunition for the home care providers.

A former House Speaker used to say every budget year is a balancing act between the very young and the old. How the scales tip this year remains to be seen.

Renewable energy fund

The Senate Finance Committee last week quickly and unanimously reversed the House's action to raid the Renewable Energy Fund to help balance the next biennium's budget.

The quick work may have something to do with the legal problems associated with what the House did.

The House wanted to use $5 million that was not already encumbered for approved projects or those in the pipeline currently in the fund. Eventually the House decided to use all of the projected money over the next two fiscal years that utilities have to pay into the fund if they do not use enough electricity generated from renewable sources such as water, wind or wood.

The House's action makes it impossible to carry out the funds stated purpose: to fund renewable energy projects for businesses, individuals and cities, towns and school districts.

When the money in the fund is moved into the general fund, it pays for government services and operations. That would transform a dedicated fund into a state tax, and several lawyers contend that requires it to meet the state constitutional requirement that taxes be proportional and reasonable and on all people and estates.

That is not the case because each utility is assessed a different charge depending on how much electricity they purchase for their customers that is generated by renewable energy sources.

The charges are in turn included in what the utilities charge their customers for energy costs.

Opponents of taking the money said if lawmakers want to change the law and make the charge a tax, that is fine, but then it has to follow the constitutional requirements, which would mean every electric customer would have to be assessed at the same proportional rate.

The legal minds fighting the raid said the situation is similar to the Medicaid Enhancement Tax. When hospitals got back most of what they paid the state, the money was used for health care, but when lawmakers in 2011 decided to put some of the money in the general fund, it became a general tax subject to the constitutional restrictions.

Hospitals and rehabilitation centers sued the state and won two court decisions before the state reached an agreement with the hospitals and centers to go back to the old method before the state kept some of the money.

The legal folks expected a similar ruling and settlement if lawmakers went ahead with the raid on the energy fund.

For the moment the issue is dead, but the House and Senate will have to work out a budget compromise, where it could surface again.

Legislative budget

For years, the House and Senate, unlike state agencies, were allowed to retain the money they did not spend in their budgets.

Over the years the House and Senate amassed some significant war chests. The war chests came in handy in 2000 when the House decided to impeach former Supreme Court Chief Justice David Brock, which costs millions for all involved.

The slush funds ended when revenues began going seriously south about a decade ago, and everyone was grabbing for any money they could find.

Since that time the House and Senate budgets have been subject to lapse requirements. Lapses are more than 3 percent and are what state agencies are expected to save from their appropriations. So if an agency was given $1 million for appropriations, it is expected to save $30,000 and return that money to the general fund.

It is essentially another back-of-the-budget or across-the-board cut in state spending.

Much was made of whether state agencies would meet lapses when the fiscal 2014 budget closed last year only to find they did, but the Senate did not.

When the issue came up at the Senate Finance Committee last week, Senate President Chuck Morse, R-Salem, said the Senate would increase what it would lapse in the current budget by about $600,000.

He noted both Republican and Democratic offices were down one employee this year and that he hoped by rolling the surplus money forward those reductions could be reversed.

The executive and judicial branch lapses remain in the budget.

Broadside location

Last week, the Joint Legislative Historical Committee approved moving several portraits that line the hallway outside the House Speaker's office in order to make way for the broadside found recently at the state archives.

The broadside, "The Administration of the 4th, 1876," marks the country's centennial and was signed by then President Ulysses S. Grant, Cabinet members, Supreme Court justices, and members of Congress.

Then Vice President Henry Wilson, a New Hampshire native, did not sign the document. He had died in office just before the documents were signed.

grayno@unionleader.com


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