Senate committee hears bill to provide bridge payments to nursing homes awaiting Medicaid approval

Grant Bossie, deputy chief of staff for the New Hampshire Senate, introduced Senate Bill 5 43 as a refile of last year’s proposal to provide bridge financing for nursing homes when residents enter before Medicaid eligibility is finalized. He told the committee the bill would create two administrative positions and carry an appropriation of $1,500,000 intended as a revolving fund that the state would be repaid from retroactive Medicaid payments.

The bill’s proponents included Bridal Williams, president of the New Hampshire Health Care Association, who told senators the association represents most of the state’s nursing homes and urged passage. "There would be no greater certainty, obviously, for a nursing home, than to receive a provisional payment for a pending Medicaid application," Williams said, citing examples of facilities owed more than $700,000.

Officials from the Department of Health and Human Services supported the concept but raised implementation and fiscal questions. Henry Littman, the state Medicaid director, and Melissa Hardy, division director for long-term supports and services, said the department had worked with the association and supported the program’s objectives but warned that $1.5 million would likely be insufficient relative to conceptual needs discussed earlier and that administration (including hiring and contracting) would be required to operate a revolving fund.

Hospital representatives and providers emphasized downstream impacts. Courtney Tanner of Dartmouth Health said hospitals have dozens of medically cleared patients who cannot move to long-term care because placements are delayed; Ben Bradley of the New Hampshire Hospital Association said his organization’s recent review found up to 147 medically cleared patients statewide and estimated that roughly 45% of them were waiting on Medicaid determinations.

Committee members asked how the proposed positions would be affected by the governor’s hiring freeze and whether the statute’s mechanics were sufficiently prescriptive. DHHS acknowledged the freeze could affect timing and suggested the contractual and administrative elements could be implemented within existing capacity if the program were modest; the department also noted it would defer to biennial budget processes if additional appropriation were needed.

The hearing closed without a vote; sponsors and stakeholders said they would continue work with DHHS and the finance committee on funding and operational detail.