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County leaders seek study of Medicaid rules after long waits for nursing‑home payment approval
Summary
Senate Bill 257 would create a study committee to examine whether New Hampshire should change from SSI‑based Medicaid rules (SSI‑209(b)) to the 1634 system used in most New England states, and to examine broader long‑term‑care access. County officials say delayed Medicaid approvals leave people paying privately or waiting for placement.
Sen. Tara Reardon and Merrimack County Commissioner (and former House Speaker) Steve Shurtleff urged the House committee to create a study committee to examine Medicaid eligibility rules governing long‑term care and to consider whether New Hampshire should move from the SSI‑209(b) pathway to the SSA 1634 option used in most New England states.
Shurtleff, who represents Merrimack County, described conversations with his county nursing home administrator and said the facility had 249 residents and 38 pending applicants waiting for Medicaid eligibility determinations. He told the committee county staff or the facility itself do not assist applicants with the Medicaid forms in every case and that when counties do help, wait times for approval averaged around 70 days; he recalled hearing a 90‑day average when applicants complete paperwork themselves. “For a senior … justice delayed is justice denied, and I think for a senior … that’s true for our elderly people that have a genuine health problem and need that 24‑hour coverage of nursing care,” Shurtleff said.
The bill as filed asks the committee to study the administrative differences between the two federal options (SSI‑209(b) and SSA 1634), whether state practice should change, and how the “system of care for healthy aging” should be applied in New Hampshire. Senator Reardon said the bill grew from conversations about residents leaving incarceration and needing continuity of care but was amended to broaden its scope and to move its effective date to allow more time for review.
Cheryl Steinberg of New Hampshire Legal Assistance cautioned that the 1634 pathway applies solely to SSI recipients and would not, by itself, address the entire waiting‑list problem; she also cited a 2021 Guidehouse report commissioned by DHHS that reviewed long‑term care options and concluded a statewide switch would not necessarily relieve delays because administrative costs and eligibility profiles differ. Steinberg and other advocates urged the committee to consider broader fixes (staffing, process improvements and better consumer assistance) rather than assuming a statutory switch would solve the problem.
Commissioner Shurtleff and other supporters said the study should include a close review of look‑back rules, documentation requirements and whether the state can better support applicants and county facilities to reduce the time people spend waiting for long‑term‑care placement and payment.
No committee vote was taken at the public hearing; members asked for follow‑up information and noted related legislation to create a standing advisory body for the system of care for healthy aging.
