DHHS presents healthy‑aging system and explains nursing‑home financing structure and county cap

Chris Santanello and other DHHS officials told the Finance Division II the state needs a coordinated approach to healthy aging because New Hampshire is among the nation’s oldest states and demand for long‑term services will remain high.

Santanello summarized the department’s healthy‑aging vision as a coordinated, statewide system that emphasizes community supports, nutrition, elder‑abuse prevention and options for care that keep older adults at home whenever possible. He said policymakers and stakeholders use a shared visual to align efforts of the department, the State Commission on Aging and the Alliance for Healthy Aging.

Meals, social contact and protective services

The department reported that in 2024 about 15,000 people received Meals on Wheels through department‑supported programs; 61% of those recipients identified the delivered meal as their primary source of nutrition for the day, and 41% said the meal delivery driver was the only person they saw during the day. Santanello highlighted Adult Protective Services (authorized under RSA 161) as the program charged with investigating and preventing abuse, neglect and exploitation of vulnerable adults.

Medicaid eligibility and HB 2 changes

The department told the committee that HB 2 changed resource disregards and the look‑back period used for Medicaid financial eligibility. DHHS said it now can use a 36‑month look‑back—compared with the prior 60‑month period—so long as automated database scans do not flag transfers of assets that would require additional review. The department said it obtained federal approval for the 36‑month approach and that the change is intended to speed eligibility determinations for long‑term‑care services.

Choices for Independence, nursing facilities and the county cap

Santanello and Chief Financial Officer Nathan White outlined the financing for Choices for Independence (CFI) and nursing facilities. They explained that an accounting unit (identified in materials as accounting unit 2152 during the hearing) funds both CFI and nursing‑facility payments and that the line is supported by a federal match, state general funds and county contributions. White described a statutory county‑cap mechanism (RSA 167:18‑a) that sets a biennial county contribution to these payments; the statute also includes a default $5 million credit applied to the county amount and a 2% annual growth cap on county obligations. Department staff said actual Medicaid and long‑term‑care costs have recently been rising faster than the statutory 2% cap, which has required larger state general‑fund contributions to balance total program costs.

Santanello also said the department completed a Choices for Independence rate study and has used federal funds to enhance the state’s New Hampshire EASY portal (the department’s gateway to services) to streamline eligibility and provider interactions. The department reported longer‑term goals to expand community alternatives to institutional care but emphasized that capacity constraints remain a challenge: providers and case managers told the committee they sometimes lack available direct‑care staff to scale services rapidly.

Why it matters

The combination of demographic pressure, statutory county responsibilities, federal‑state match rules and rising costs means budget decisions in this area affect county budgets, state general‑fund obligations and the availability of home‑ and community‑based alternatives to nursing facilities. Department staff committed to provide a two‑page financing explainer and additional briefing materials to the committee for deeper review.

Provenance

topicintro: "So, healthy aging. If you see this first slide, this is demographics as to why do we need to focus on healthy aging as a state. New Hampshire is the second oldest state in the country... nearly 20% of New Hampshire's population is age 65 and over." (transcript excerpt)

topicfinish: "There was also an element of statute that was added a few years ago that limits the growth of the county cap by 2% each year... you will see those general funds increasing at a fairly high rate..." (transcript excerpt)