Maplewood administrator warns ProShare formula change could cut county Medicaid payout by millions

Catherine Pindoff, Maplewood Nursing Home administrator, told Cheshire County commissioners on April 2 that lingering federal and state pandemic‑era rules and a newly applied ProShare calculation threaten a substantial drop in the county's Medicaid supplemental payment.

Pindoff said federal oversight remains strict for nursing facilities and described administrative burdens that persist from COVID‑era rulemaking. “We really are the most highly regulated, and it's a very punitive environment,” she said, noting mandatory weekly reporting and staffing gaps that complicate compliance. She also reported a recent on‑site Medicaid revalidation audit that produced no E‑tag deficiencies and described ongoing quality‑assurance work, collective‑bargaining updates and other operational items.

The central financial concern came from county staff explaining a recently refined eligibility approach for New Hampshire's ProShare program. Cheryl Traum, who presented ProShare calculations to the board, said the program draws down a share of the delta between allowable nursing‑home costs and receipts; in one cited example the delta was about $10,000,000, producing roughly $5,200,000 in ProShare the previous year. Traum said state officials now appear to compare customary private‑pay charges against cost‑report per‑diem figures and apply a 60% threshold for certain drawdowns, and that change could shrink the county's payment substantially.

“Our current customary charge is $436 a day,” Traum said. Based on the county's 2024 cost report, she presented an estimated daily cost of roughly $659.51, which would require a customary private‑pay charge under about $395 per day to satisfy the 60% test for the current fiscal calculation. Traum said the county currently has about 20 private‑pay residents, and she estimated that a drop in ProShare could be in the millions of dollars annually.

Commissioners pressed staff on options. The board discussed three approaches the staff flagged: (1) a short, targeted rate reduction for May–June to try to affect the current year's calculation; (2) a permanent rate reduction effective July 1 to change the next fiscal year position; or (3) temporarily or artificially increasing the customary charge for reporting purposes. Traum cautioned the board that the federal rules require 60 days' notice for rate changes and that reducing the rate could carry unintended consequences if state calculations instead base eligibility on a customary charge that was recently lowered.

Traum said county staff are seeking additional detail from New Hampshire Department of Health and Human Services staff (Susan Ryan and Christy Roy were named as points of contact) and will report back when the state provides the paid‑days and other variables used in its preliminary calculations. Commissioners did not take a formal vote on rates at the meeting; Traum said the county hopes to have enough information within days to decide whether to act quickly and, if necessary, call an emergency meeting.

Why it matters: ProShare is a Medicaid financing mechanism that counties and providers use to recover part of allowable costs. Commissioners said a multi‑million‑dollar swing could meaningfully affect the county budget and the nursing facility's operations. The board also discussed the limits of local control: several members said the county has limited ability to change federal or state policy and that the only viable route to mitigate harm may be rapid, well‑informed adjustments once the state supplies the calculation inputs.

The commissioners asked staff to continue pressing the state for the data needed, to explore legal constraints on notice requirements, and to return with recommended language and timing should a rate change become necessary. The board did not approve any immediate rate change during the April 2 session.