Merrimack County nursing home warns of budget hit after state Medicaid adjustment; board approves training and wellness coordinator

Nursing home officials told the Merrimack County Board today that a state Department of Health and Human Services (DHHS) budget adjustment reduced Medicaid reimbursement rates and has put pressure on facility budgets, prompting conservative planning and a small county subsidy request.

Nursing home administrator Heather Mowquin said DHHS initially proposed a 4% cut in the nursing home Medicaid rate—"a really scary proposal of a 4% reduction, which was $14 a day"—but that subsequent advocacy reduced the impact to a 1.1% adjustment effective Jan. 1. "We did still have a reduction, but it was a much better rate than initially proposed," Mowquin said, while warning the current figure only covers through July 1 and that the state will issue new rates that month.

The administration told commissioners that because Medicaid represents about 80% of the facility’s payer mix, the board should expect continued uncertainty into the second half of the year. Mowquin said counties have responded by budgeting conservatively; she said she polled other county nursing-home affiliates and that "the consensus throughout all the counties... everyone is going to budget very conservatively because we're all concerned about that July rate." Staff also said a supplemental program called Proshare remains uncertain and has a finite pool of funds.

As part of attempts to limit the county impact, staff said they trimmed an "agency pool" by $300,000 and planned to hold one recreation full-time equivalent vacant to offset a proposed contractor-funded wellness coordinator. The county will also include a modest subsidy request for the nursing home—the first in about three years—if the July rates do not improve.

On personnel and training, the board approved two items affecting nursing home staff. Commissioners voted to approve tuition reimbursement for a nursing-home employee enrolled in an RN program for a 2026 course after Heather Mowquin requested support for "tuition reimbursement policy" for that employee. Speaker 5 moved approval and Speaker 2 seconded; the board recorded an "Aye" vote.

Separately, commissioners approved an addendum to the facility’s rehab contract to fund a wellness coordinator who would work with recreation and activities staff to expand exercise programming (chair Tai Chi, chair yoga, move-to-music and other classes). Ross Johnson, the assistant nursing home administrator, described the role as requiring a degree in exercise physiology; staff said the addendum’s net budget effect would be offset by leaving one rec FTE vacant and described the net contract-heavy impact as roughly $29,000.

Board members asked whether the state would provide a preliminary July rate; staff said the state expects to issue a preliminary figure in June and committed to share updates with the board. The county will continue to monitor DHHS guidance and Proshare allocations before finalizing second-half budgets.

The meeting also included routine board items and a staff announcement that Jessica Rial will transition to the county jail as the new assistant superintendent. The board later moved into nonpublic session, voted to seal the nonpublic minutes, and adjourned.