Some nursing home operators in New Hampshire are facing Medicaid cuts due to a disconnect between old payment methodology and a newer one, spurring legislative action.
The discrepancy stems from a formula that relies on case mix index measuring patient needs on a specific date. This figure is compared against an overall patient mix that includes private pay and Medicare patients, Brendan Williams, president and CEO of the New Hampshire Health Care Association noted in an editorial for a local media outlet.
Earlier data showed higher patient complexity compared to more recent Medicaid-specific data, leading to the negative adjustments for many facilities in the state.
In response, legislators put forth a bill that would create a working group to study Medicaid reimbursement in the state and recommend changes, much like the Medicare Payment Advisory Commission (MedPAC) for the federal Medicare system.
The bill passed the Senate last month and is being discussed in the House, according to the state website.
Legislators aim to fix fundamental flaws in the Medicaid system, which disproportionately affects operators caring for those on Medicaid with the greatest medical needs. About 33 facilities received cuts even after a fund transfer from New Hampshire Gov. Kelly Ayotte and the state Department of Health and Human Services.
The bill also adds additional $5 million in emergency funding this legislative session to assist nursing home care, but only for facilities that received a new daily reimbursement rate below 95% of what they had received as of July 1, 2025.
Rockingham County Nursing Home, for one, has lost more than 9% of its care funding per resident per day, or $26.43 per resident per day, according to Williams.
The operator has already had to take 51 beds offline at the 226-bed facility due to staffing constraints.
The issue reflects a larger national problem – a lack of comprehensive long-term care policy in the country. States are left to manage Medicaid funding on their own, leading to widespread disparities, Williams said.
Some states provide significantly higher rates despite having populations with lower care needs. New Hampshire serves one of the oldest nursing home populations in the country, he said.
Companies featured in this article:
