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Strafford County commissioners raise alarm over Medicaid processing delays, staffing shortages and rising contract nursing costs
Summary
Commissioners reported on a state $6 million RFP to hire vendors to process Medicaid applications for nursing-home residents, discussed 25% state staffing vacancies, and warned that reliance on contract (pool) nursing is driving weekly costs well into five figures; they debated whether counties should be re-established as gatekeepers for Medicaid.
Commissioner "Mister Baba" (member, State and County Finance Committee) briefed Strafford County commissioners on Oct. 9 about state efforts to hire outside contractors to speed Medicaid eligibility processing for nursing-home residents and about local impacts from staffing shortages and contract nursing costs.
"Remember, the state appropriated $6,000,000 to hire a vendor to assist them in processing applications for Medicaid for people that are going into nursing homes," Mister Baba said, noting the state is running roughly 25% short of staff in the relevant offices and that an RFP to secure outside help is underway with decisions expected in December. He urged county-level attention and suggested the counties might press Governor and Council support for a contractor that will move applications faster.
Commissioners discussed an alternative raised historically—having counties act as gatekeepers for Medicaid applications—because counties are closer to residents and could potentially process applications with less outside spending. "If they gave us as an example $600,000, it seems to me we could process applications for Medicaid within $600,000," Mister Baba said, referring to a per-county hypothetical tied to the $6 million appropriation.
The meeting also focused on nursing-staffing shortages and the county’s rising use of pool nursing (contract nurses). Commissioners said county spending on pool nursing had reached high levels: "we're currently spending about $10,000 a week," Mister Baba reported, and that total pool nursing costs have risen to multiple millions over the past period. Commissioners argued that higher wages for regular county staff would reduce reliance on costly pool nursing and improve quality because permanent staff are familiar with residents and facility operations.
County leaders also raised concerns that expanding county financial obligations for long-term care—when the state sets program rules and reimbursement—would strain county budgets. Commissioners noted the issue will be on the agenda at the upcoming Association of Counties convention, and the county’s president of commissioners said she would put it on the convention agenda for broader discussion.
No formal vote on statewide policy was taken at the meeting; commissioners agreed to pursue discussion with delegation members and to raise concerns about the state's approach to hiring outside vendors and the financial burden on counties.
