#HB1196 requiring HHS commissioner to apply for a state plan waiver. KILLED 180 to 160

HB 1197-FN, requiring the commissioner of the department of health and human services to apply for a state plan waiver.  MAJORITY:  INEXPEDIENT TO LEGISLATE.  MINORITY:  OUGHT TO PASS.

Rep. Laurie Harding for the Majority of Health, Human Services and Elderly Affairs:  The slim bipartisan majority of the Health and Human Service Committee who voted ITL on HB 1197-FN did so because they wanted to avoid placing additional tax burden on the property taxpayers or private payers in nursing homes.  The Medicaid Quality Incentive Program (MQIP) was created by the legislature in 2003 and 2004 at the urging of the Republican leadership to bring in additional federal money for nursing home Medicaid reimbursement.  This additional federal money was and remains indispensable to the nursing homes, given shrinking state budgets.  Funds raised through the MQIP are matched with federal funds and returned to nursing homes.  HB 1197 requires that DHHS apply to the federal government to exempt Continuing Care Residential Communities (CCRCs) from the MQIP tax base because the residents of CCRCs generally do not end up on Medicaid and therefore do not benefit from the MQIP tax.  However, the inclusion of the CCRCs was thoroughly vetted by the legislature in 2004.  Moreover, if CCRCs are now removed from the MQIP, this would reduce the federal funds which are derived from the MQIP, which would bring about two types of tax increases.  First, county nursing homes would see reduced MQIP revenues, county property taxes would have to be increased to fill the hole.  Second, this would lead to an increase in the so-called “hidden tax” on private payers in county and private nursing homes.  These are people who, like the residents of CCRCs, are not on Medicaid.  They have saved so that they can pay for their own care.  But since nursing homes are receiving less and less funding from the state to cover just a portion of the costs of the state’s Medicaid residents in nursing homes, the private pay residents in nursing homes end up paying a rate that is higher ($238/day) than the costs of care ($180/day), in order to subsidize the costs of the Medicaid residents ($140/day).  Furthermore, last spring, the state budget diverted 25 percent of MQIP funds away from nursing homes to the general fund.  This was in addition to the loss of millions of dollars in MQIP ARRA funding. Vote 8-7.      

Rep. Frank R Kotowski for the Minority of Health, Human Services and Elderly Affairs:  The minority vote supports the contention that residents of Continuing Care Retirement Communities have been, and continue to be taxed unfairly.  Discriminatory taxation for choosing to spare their family and the state of New Hampshire the expense for their elder care needs is inexcusable.  Residents of these C.C.R.C. facilities who have the means, and who prudently planned to fund their own future care by entering into a contract for such care to the end of their lives deserve to have the legislature intervene on their behalf.  The minority position requests that this legislature vote down the majority report and vote OTP.  Doing so would direct the Department of H.H.S. & E.A. to request a federal waiver of the state plan which, upon approval, would relieve those residents from taxation in the future.