Delegation forwards Riverside nursing-home budget after members highlight $7.17M Medicaid cost-report loss

A Strafford County delegation subcommittee voted to forward the proposed Riverside nursing-home budget to the executive committee after staff reviewed the facility’s operations and a member cited a $7,165,426 operating loss reported in the 2024 Medicaid cost report.

Ray Bal, who presented the budget to the subcommittee, said the proposed budget is largely level-funded and that leadership had eliminated some positions while adding a small number of targeted roles. “I can say one good thing is we’re fully staffed,” Bal said, noting the facility had even received an inquiry that morning from a unionized staff at another government facility about openings.

The discussion turned to long-term solvency when a delegation member identified as Kelly reviewed the Medicaid cost report. Kelly told the subcommittee that the 2024 report shows a $7,165,426 operating loss and argued the figure reflects a structural mismatch between Medicaid reimbursement and the cost of providing care. “A Medicaid cost report loss of this size indicates that reimbursement rates are materially below the cost of providing care,” Kelly said, urging the group to use the report as evidence to inform policy on reinvestment, sale or other structural options.

Committee members pressed staff on line items and operational decisions. Bal described several program-level details: the hospice house (Haidider) uses contract physicians and brings in revenue of roughly $550 per day for respite/routine hospice care and about $1,100 per day for general inpatient hospice cases; the facility performs in-house swallowing assessments to avoid hospital transfers; and a recent IT incident at a peer facility prompted continued cybersecurity vigilance and Primex insurance coverage.

Labor and contracting also drew scrutiny. Kelly questioned why a maintenance crew line showed increases despite a hiring freeze; Bal said consolidation of maintenance functions across sites and union contract terms (budgeted as a 4% package—2% step plus 2% cost-of-living) explained the change. Members discussed limits on revising negotiated contracts without reopening union negotiations.

The subcommittee also reviewed staffing and program changes intended to improve quality and revenue: the facility has added a dedicated room-turnover position to accelerate vacancy turnaround; contracted physical-therapy coverage is being used to expand skilled-care capacity; and the activities program operates daily from 8 a.m. to 8 p.m. and serves roughly 170 residents, which staff said supports fall prevention and engagement.

After discussion, a member moved to endorse the proposed Riverside budget as reviewed and forward it to the executive committee; the motion was seconded. The subcommittee voted by raised hands: five in favor and two opposed. The chair noted the executive committee meeting is scheduled for Feb. 20.

What’s next: The endorsed budget will go to the executive committee for consideration on Feb. 20. Several members asked staff for additional historical cost-report data (back to 2017) and for a spreadsheet of wage/step changes over recent years to inform upcoming negotiations and decisions on whether to reinvest in or restructure the facility.