Advocates seek $300 million to address health care workforce shortage
Feb. 1—CONCORD — A coalition of providers embraced a state senator's request Wednesday to spend up to $300 million in state and federal grants to expand New Hampshire's health care workforce.
The Health Care Workforce Development Act of 2023 (SB 86) would give the Department of Health and Human Services the money to grant rate increases for health care providers based on need.
The legislation also would professionalize a class of existing health care workers and support proposed rural health training and medical residency programs.
Senate Deputy Democratic Leader Cindy Rosenwald of Nashua, the bill's prime sponsor, said COVID-19 and a chronic workforce shortage have put the system on the verge of collapse.
"When COVID happened, there was an incredible pull on all of our providers all at once. The cracks have become so wide and so deep, I think we can truly say our entire system is clearly in crisis," Rosenwald told the Senate Health Care Committee.
Her pitch was the first of many to be made as lawmakers prepare to write the next state budget for the two-year cycle, which begins July 1.
In the last state budget, the Legislature approved across-the-board rate increases for all Medicaid providers of 3.1% for two straight years.
Rosenwald said that helped, but rates remain well below what providers receive for reimbursement in most states.
"It is difficult in New Hampshire to get a hospital bed if you need it. It is difficult to get patients transferred out to a nursing home because they can't staff all of their capacity," said Rosenwald, who serves on the Senate Finance Committee.
Since COVID, hospitals have lost 6% of their staff, and nursing homes have lost 9%, she said.
"Some of our frail elderly are literally dying before they can be served and even evaluated," Rosenwald said.
The legislation for the next two-year budget would set aside:
—$145 million for provider rate increases;
—$9.65 million for Area Health Education Centers;
—$2 million for advanced Rural Health Training Program;
—$1 million for a Rural Residency Program.
The federal government matches what the state spends for its standard Medicaid program, which would make about $300 million in total grants for for the next two years, Rosenwald.
Medicaid spending for the current two-year cycle is roughly $2.5 billion.
The Granite State Advantage Program, which expanded coverage for low-income adults, offers 90% federal grant support to the state. Lawmakers this year must decide whether they wish to continue offering that coverage.
Henry Lipman, the state's Medicaid director, said this level of more spending, if it were applied across the board, would mean raising rates by about 11%.
Senate President Jeb Bradley, R-Wolfeboro, and Rosenwald made history when they jointly sponsored the across-the-board hike, the first in at least 14 years.
The Department of Health and Human Services traditionally has favored being allowed to differentiate how much providers should receive.
The state clearly faces greater challenges in some health care fields than others, Lipman said.
The legislation would create certification of community health care workers who perform non-clinical work. This would lead to higher pay for these workers and take the load off clinical staff, Rosenwald said.
Ken Gordon, CEO with the Coos County Family Health Services, said his program has already received a federal grant to develop a medical residency program in the North Country.
"The notion of growing our own doctors rather than relying on recruiting from outside the state is an attractive opportunity that has been successful in other states," Gordon said.
The New Hampshire Health Care Association that represents private nursing homes cited AARP research that concluded New Hampshire has the second-worst shortage of staffing in the country, said Alex Koutroubas, a lobbyist who represents the group.
Joe Bohunicky, administrator with the Mount Carmel Rehabilitation and Nursing Center in Manchester, said he has 30 open nursing positions and has spent $1.2 million over the past nine months on outside agency staff to work at his facility.
"Hospitals are getting angry with us due to the limitations we have put on them. We need help," he testified.
