A Better Care System for New Hampshire

Doug McNutt is a member of the State Commission on Aging, a former Advocacy Director at AARP, and a former Director of Elderly and Adult Services.

As we approach Thanksgiving and families gather, now is an opportune time to discuss how our current long-term care system is failing many of us. Too often older people and adults with physical disabilities do not have access to the care they need as the current system is fragmented, uncoordinated and underfunded.

To ensure everyone has access to the timely delivery of long-term home and community services with a meaningful range of long-term care options, we need to improve existing infrastructure to build a comprehensive and coordinated care system.

There have been several recent reports identifying problems with the long-term care system for older adults and people with physical disabilities, including Barriers to Health Care Transitions in New Hampshire: A Snapshot Review New Hampshire Hospital Association Foundation for Health Communities; Long-Term Services and Support of the New Hampshire Fiscal Policy Institute (NHFPI) in New Hampshire: A Review of State Medicaid Funding for Older Adults and Adults with Physical Disabilities; Giving care: A strategic plan to expand and support the New Hampshire health workforce and annual report of the State Commission on Aging.

To achieve the goal of healthy aging, the New Hampshire Alliance for Healthy Aging is proposing legislation aimed at creating a more comprehensive, coordinated, cost-effective, and better-funded system of long-term care that would enable healthy aging all in any setting who you choose.

This legislation aims to create a methodology for estimating the cost of providing services under the Choices for Independence (CFI) waiver to assist in making informed decisions about reimbursement rates to adjust future investment levels for cost changes. The CFI waiver provides services under Medicaid for those who are eligible for a nursing home and choose to stay at home.

To best support this program, we recommend that the Department of Health and Human Services submit a budget request for all adult home and community-based abstinence programs funded at least at the Centers for Medicare and Medicaid Services ambulatory health agency market basket price. This position is informed by the NHFPI report, which shows that funding for CFI services is not in line with current rates of inflation.

Additionally, there is no standardized method for determining the cost of CFI services, which has contributed to the underfunding of the CFI program. Implementing an agreed rate methodology would help prevent CFI services from falling behind.

The NHFPI report interviewed many people who work regularly with the long-term care system; They all felt that the system was too confusing and took too much time to keep people in crisis and those in need away from the facilities.

The Department of Health and Human Services has an average time frame of 45 days to process requests for assistance. 45 days is too long. Families in crisis need and deserve an expedited eligibility process to determine eligibility in a shorter time frame. Other states (Washington and Ohio) do this with a small margin of error. Additionally, this expedited process would help hospitals, as the Hospital Association report shows that 26% of people who experienced delays in hospital discharges were due to the Medicaid application process.

In order to make the eligibility process more streamlined and understandable for both consumers and providers, supports for navigating the system to track applications must be in place. The existing ServiceLink network, which already plays a role in the application process, could provide such assistance.

A dedicated space for consumers to raise concerns and complaints about the application process is also needed. This would require additional posts to be created in the long-term Ombudsman’s office, which focuses on home care issues. The ombudsman’s office is currently focusing on complaints relating to nursing homes and assisted living.

Implementation of these recommendations would not only help stabilize the long-term care system, but also provide more and better options for people who need long-term care services in New Hampshire.