The process of passing a state budget is rarely pretty. It consists of tedious meetings, ever-changing revenue projections and shifting partisan priorities. The final budget is never perfect. It’s a compromise — which usually means that nobody gets everything they want. There is always angst among advocates about what the final appropriations will be and who the winners and losers are.

This year’s budget was no different — except for the groan that could be heard around the State House when the governor issued her veto. Here’s why: health and human services make up the bulk of the budget and those services have historically been underfunded. But this year, most health and human service advocates were satisfied with HB 1 and HB 2, the Legislature’s budget bills. The final appropriations were generally better than in prior years.

Home health agencies — such as non-profit Visiting Nurse Associations and small, privately-owned companies that provide nursing services — were satisfied with this year’s state budget. Home health is a small but important piece of the budget, because it’s one of the services that saves the state money in the long run.

N.H. Medicaid’s Choices for Independence (CFI) program pays home care agencies to assist low-income, medically-fragile adults — mostly elderly citizens. With regular nurse visits and home health aides or personal care providers to assist with activities of daily living, New Hampshire’s seniors can stay out of nursing homes and hospitals. Individuals remain safe and independent in their homes, where most prefer to be and where the cost of care is much lower.

The budget passed by the Legislature for CFI home health services is not perfect. In fact, it spends a lot less on these services than the budget for the last two years. But this budget is a reasonable compromise because it includes a much-needed 5 percent rate increase for CFI home health services and a retroactive supplemental payment to help close the gap between what home care agencies were paid and what they should have been paid for some CFI services delivered in 2015.

These two budget provisions are critical to assuring that seniors continue to receive care. Here’s why: the state’s payments for Medicaid CFI services are notoriously low and haven’t been updated in years. Historically, most home care agencies covered CFI losses with positive margins from the federal Medicare program.

Recent federal policy changes and burdensome regulations have eroded Medicare margins; it is no longer possible to cover Medicaid losses with Medicare surpluses. This has created an access crisis. A large home health agency in Keene recently announced that it could no longer afford to serve 98 CFI clients. Several others have quietly discontinued CFI services. With home health agencies dropping out of the provider network for CFI, vulnerable seniors and others who need care will have difficulty obtaining long-term care services at home.

The state is currently operating under a continuing resolution; the rate increases and special payments that home health agencies desperately need are on hold. Now is the time for House and Senate leaders and Gov. Maggie Hassan to resolve their differences. Both sides have offered compromises, but there seems to be little movement. It’s awkward for health and human service advocates; nobody wants to pick sides. But the longer this impasse drags on, the harder it is for health care providers such as home care nurses and aides to deliver the care our seniors need.

On behalf of home care nurses, caregivers, and the patients and families who depend on them, I urge Republicans and Democrats in the Legislature and Gov. Hassan to enact a state budget soon one that supports access to home care services for our most vulnerable citizens. If they can’t agree by the time the Legislature returns on Sept. 16, then the solution is clear: Legislators should vote to override the governor’s veto and allow the budget they have already passed to take effect.

It’s not perfect. It’s a compromise.

Gina Balkus is the CEO of the non-profit Granite State Home Health Association, which advocates for home care agencies and the people they serve.


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