Strafford County delegation hears report: Riverside Rest Home running structural Medicaid losses, options to shift care debated

A Strafford County delegation meeting on an internal report concluded that Riverside Rest Home is running sustained, structurally driven operating losses, shifting the burden of care onto county taxpayers.

The committee’s financial review showed the facility posted an operating loss of $7,165,426 in 2024 and reported cumulative Medicaid-related operating shortfalls over 2015–2024 that committee materials summarized as about $66.2 million. The presenter told members these Medicaid cost-report figures reflect actual revenues and expenses for Medicaid-certified nursing facilities and argued the pattern indicates a structural mismatch between reimbursement and the cost of care at current census levels.

Why it matters: the delegation was told that, under county ownership, those annual operating shortfalls are absorbed in county budgets and ultimately borne by property taxpayers. Committee materials and presenters argued that a major capital recommitment or a new county-owned facility would lock in decades of continued subsidy unless reimbursement or utilization patterns change.

Options discussed and constraints

Committee members outlined and debated several paths forward rather than endorsing a single solution. The options discussed included: - Maintaining county ownership while seeking state or federal relief (including efforts to secure fuller Medicaid funding). Members emphasized that state and federal funding choices determine county exposure. - Transferring some or all residents to private or nonprofit providers, or pursuing public–private partnerships; members warned that private operators typically require a mix of private-pay and Medicaid residents to be financially viable, and some local nonprofits (for example, Catholic Charities) reported operating deficits that limit immediate capacity to absorb county residents. - Creating voucher programs or other placement mechanisms for indigent residents to use private beds, subject to Medicaid rules and federal restrictions. - Phased downsizing, partial service consolidation or other options to reduce fixed costs while protecting placements for indigent residents.

Labor and cost drivers

The briefing noted several recent wage and benefit increases agreed with unions from 2021 through 2026 and emphasized how step increases, overtime, payroll taxes and benefit bases compound expenses in a labor-intensive operation. Presenters and some members said those commitments, combined with declining census and low Medicaid rates, increase per-resident costs and grow the operating gap.

Legal and policy context

Speakers traced the problem in part to long-running shifts in Medicaid funding and cost-sharing between state and counties. Committee discussion referenced federal and state Medicaid funding structures and the Affordable Care Act in broader context, and members urged the delegation to press for legislative remedies if the state does not change funding formulas.

Next steps

The committee approved the minutes and agreed to finalize the written report documenting the $7.1 million gap and related analyses. Members voted to convene a full delegation meeting in the near term (dates in March or April were discussed) to present the findings, deliberate options, and authorize further study or negotiations with potential private or nonprofit partners.

The meeting ended with a commitment to circulate the committee’s report to members and to schedule the follow-up delegation meeting for detailed deliberation and possible action.