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Case managers and advocates press lawmakers to fix long‑term care eligibility redetermination; committee opens bill for changes
Summary
Case managers and legal advocates told the Senate committee that Choices for Independence medical eligibility assessments are producing contradictory findings that cut services for people who still need help with daily activities; the department agreed improvements are needed.
The Senate Health and Human Services Committee heard extensive testimony on Senate Bill 125, which would revise clinical eligibility criteria and the redetermination process for the Choices for Independence (CFI) program that pays for home‑ and community‑based supports.
Case managers, legal services attorneys and program administrators told the committee that the state’s medical eligibility assessments (MEAs) — the clinical documents used to decide whether participants remain eligible — are often incomplete or scored in a way that excludes participants who still require help with activities of daily living. Carolyn Virtue of Granite Case Management and Cheryl Steinberg of New Hampshire Legal Assistance described cases in which longstanding CFI recipients were found “independent” on MEA forms despite clinical notes saying the clients use walkers, shower chairs or needed assistance with bathing and transfers. Testimony included redacted MEA pages and nurse notes that the witnesses said showed contradictory assessments.
Witnesses said problems include inconsistent attention to the CMS definition of activities of daily living (which counts performance using assistive equipment as a limitation), poor record retrieval from primary‑care providers, turnover among contract assessors and unclear identification of the licensure or credentials of the staff making eligibility decisions. Several speakers asked the committee to require that the department record or disclose the licensure category of the “skilled professional medical personnel” who make final determinations and to direct the department to obtain physician corroboration before terminating services in close or contested cases.
The Department of Health and Human Services representatives (including Henry Littman, Medicaid director, and Melissa Hardy, division director for long‑term supports and services) opposed parts of the draft statutory language but acknowledged recurring problems and agreed to continue work with stakeholders. Littman said that a large share of cases appealed to the administrative appeals unit are ultimately reopened once additional medical documentation is provided; the department said the core issue is obtaining more complete records up front so eligibility decisions are made on a full clinical record.
The committee did not vote. Sponsors and department officials said they would use stakeholder meetings to propose specific statutory changes that narrow the disagreements while preserving program integrity.
Ending: Committee held the bill for further negotiation and requested technical fixes and process improvements from the department to reduce later appeals.
