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Home‑ and community‑based programs get broad support as cost‑effective alternatives to institutional care
Summary
Providers and advocates told the committee that Choices for Independence, Choices for Independence‑like programs, private‑duty nursing and home care prevent costly hospitalizations and nursing‑home placements and asked for stable reimbursement increases and targeted funding for housing‑related supports.
Home‑health agencies, Choices for Independence (CFI) providers, hospice and Meals on Wheels speakers told the House Finance Committee that state funding for home‑ and community‑based services stabilizes health outcomes and saves public money.
Speakers described services ranging from private duty nursing for ventilator‑dependent patients to congregate housing support, nutrition programs and the CFI waiver that serves people with nursing‑home‑level needs who prefer to stay at home. "If home and community based services are adequately resourced, hospitals will be able to discharge patients," said Cindy Bergeron of Granite VNA, which reported subsidizing Medicaid care and said predictable Medicaid rate increases help avoid bottlenecks in hospitals.
Home‑care and hospice representatives cited concrete savings when supports are provided: fewer ER visits, fewer avoidable hospital stays and delayed or avoided institutional placements. Local home‑health providers supplied program statistics showing prevented admissions and months of care that would otherwise have cost the state more in nursing‑home rates.
Choices for Independence providers asked that codes and billing rates reflect housing‑related supports so agencies can continue housing‑stability interventions that prevent eviction and homelessness — outcomes that speakers said generate additional public costs. Laconia Housing and Home Health Agency presented a conservative return estimate of 2:1 (and argued the real return approaches 4:1) on investments in CHSP and CFI programming through avoided nursing‑home and hospital costs.
Private‑duty nursing agencies urged annual cost‑of‑living adjustments tied to market conditions to retain skilled nurses who provide continuous in‑home care for medically complex pediatric and adult patients. Providers warned that any reimbursement backtracking would shrink the workforce and force patients into institutional care.
Meals on Wheels urged reimbursement increases informed by a DHHS cost study so agencies that deliver nearly 1.8 million meals annually can remain solvent and continue nutrition and wellness checks that keep seniors out of higher‑cost services.
Speakers asked the committee to preserve and augment CFI funding lines, adjust Medicaid billing codes and rates where necessary, and support programs that keep people housed and cared for in the community. The committee accepted testimony and indicated it would consider provider requests during budget deliberations.
