Commentary: NH Lawmakers can help nursing homes collect Medicaid payments faster

Brendan W. Williams
Guest Columnist

I recently visited a nursing home in Dover that was not receiving any payment for 17 of its 100 residents.

How can this be, you might wonder?

Medicaid accounts for the payment of most nursing home residents, which requires proof that a resident is impoverished.  Processing this documentation takes time.  Under federal law, a state has up to 90 days to approve a Medicaid application.  But this timeline gets thwarted by workforce challenges, as well as any delays by family members, or financial institutions, getting the state the information it needs.

Brendan Williams

The Dover facility was awaiting approval on 17 applications.  No one argues that Medicaid payments cover care costs, but to be shortchanged is better than receiving nothing at all.  The uncompensated care provided to date was worth over $700,000. 

Nor is this facility alone. Throughout New Hampshire there are facilities awaiting approval of Medicaid applications, and when they are not getting paid, they cannot pay their own bills.  They have no margin for error.

According to a federal government presentation, the average nursing home operated in the red in 2022.  And because study shows the sector has led all of health care in wage increases since the COVID-19 pandemic began (an average of 24.9% between February 2020 and September 2023 alone), it’s clear the finances of nursing homes have not improved since 2022 – especially given inflation in other cost centers like food.

Strafford County’s own nursing home, Riverside Rest Home, has provided care since 1867.  It does not, of course, have unapproved Medicaid applications going back that far, but it does have one that dates to 2020, and it, too, is currently out around $700,000 in uncompensated Medicaid care.

There is another implication to Medicaid applications going unapproved, whatever the setting might be.  If someone receiving long-term care, whether in a home or in a facility, dies during a lengthy approval process, the surviving family loses any incentive – beyond honesty – to provide missing documentation so the provider can get paid for the care it provided.  Because once that application is approved, not only does the provider get paid, but the state is entitled to recover whatever it is legally entitled to from the estate.

Having once been deputy commissioner of a state agency, I cannot be appreciative enough of our Department of Health and Human Services (DHHS). Too often those in public service hear only criticism, not praise.  Being familiar with other states, I don’t know any counterpart to DHHS more collaborative with providers.  DHHS has handled in a careful, compassionate way the massive undertaking of “unwinding” the Medicaid eligibility expansion that occurred during the national COVID-19 Public Health Emergency.  And DHHS has clearly worked hard to come up with ideas to facilitate more timely Medicaid application processing.

With that said, however, New Hampshire legislators should give DHHS a helpful new authority.  And that is a model used in states like Illinois and Rhode Island, making Medicaid applicants provisionally eligible, with payments for long-term care in their homes or facilities, 90 days past an application’s filing.  Rare is the instance where subsequent developments would find the applicant ineligible, and providers here would be willing to take that rare risk of paying back the state for care, as opposed to not getting paid in the first place.

In the current state budget, legislators and Governor Sununu made a historic investment in Medicaid funding.  Let’s do all we can to make sure it gets to caregiving as timely as possible.

Brendan Williams is the president and CEO of the New Hampshire Health Care Association.