Group takes on elder-care law

While most of the Legislature will enjoy a break from the State House this week, a group of lawmakers is hard at work on legislation that would change the way New Hampshire cares for its elderly.

A bill now before the House Health and Human Services Committee, and sponsored by Rep. Neal Kurk of Weare, would grant the health department greater oversight in determining where elderly people receive care: in a nursing home or in a less restrictive, community-based setting.

The bill would also make it easier for the state to claim assets of people who transfer property in order to qualify for public health insurance and would fine tune the list of physical ailments a person must have in order to become eligible for a nursing home. The bill would also give much greater leeway to the health commissioner in divvying out state funds for nursing homes and other long-term care options, a sum that totals nearly $300 million in the current budget.

The proposed legislation would implement some of the most far-reaching pieces of the GraniteCare Medicaid reform plan of Health Commissioner John Stephen. Since introducing his plan late last year, Stephen has said the state can save money and improve the quality of health care for the poor and elderly if state officials have more control in limiting the number of people admitted to nursing homes.

Supporters of the changes say it offers more options to those in need of long-term care and helps ensure the financial stability of Medicaid. But the proposed changes have raised questions among some who wonder whether the state is ready to shift away from a nursing-home-centered approach to a more community-focused system. Others say they're worried that the proposals grant too much authority to the health department at the expense of personal desire of those receiving the care.

"It's as if the department is being granted decision-making ability without any fixed policy to follow," said Michelle Winchester, a Medicaid expert with the Institute of Health, Law and Ethics at Franklin Pierce Law Center. "That should be happening in reverse."

Kurk, however, said his proposals are part of a gradual health policy evolution away from institutionalized care. And part of that transition, he said, is accounting for the supports available to people who seek public assistance in their old age.

"If you've got a healthy spouse living at home, I'd assume you'd need less nursing care," Kurk said in an interview this week. "We're trying to match the resources available to the person's situation."

Kurk said he believes most people prefer to be cared for in their home, if possible, and the state should accommodate that desire as much as possible. Providers of home- and community-based care, like visiting nurse services and adult day-care centers, will respond to that new demand by increasing their staff and offerings, Kurk said, as long as the state pays adequate reimbursement rates.

But such assumptions raise questions for others, who worry that there needs to be a slower transition to one of the most expensive programs in the state.

"If we don't have those facilities ready for them, do we then have to create a new waiting list?" said Rep. Rogers Johnson, a Republican from Stratham and member of the House Health Committee.

Gov. John Lynch is among those who favor a more deliberate timetable to Medicaid changes. Lynch has said he won't support any major reforms before gathering more information from health-care providers and people already in the system.

But outside events could compel him to change that plan. President Bush and federal health officials have indicated that they want to reduce their Medicaid payments to states. Lynch has been in Washington for the past three days for a meeting of the National Governors Association. He met last evening with the new health secretary, Mike Leavitt; Medicaid reform was at the top of their agenda.

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