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Volume 16, Issue 3
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Spring 2004 |
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| published quarterly by: The New Hampshire Challenge, Inc. P.O. Box 579, Dover, NH 03821-0579 |
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In This Issue
Top Stories |
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There are two major efforts underway at the moment of great concern to anyone receiving services from the NH Department of Health and Human Services. One involves the future of Medicaid and the other is the reorganization of the Department.
There's not much information available about either of these efforts, even though their impact could be enormous. This article will report on the facts that are available, many of which lead to more questions than answers.
Beginning in May and ending in July, Commissioner John Stephen will be holding public forums on the future of Medicaid. There will be eleven forums held around the state - at least one per county - two in Hillsborough County.
The purpose of the forums is not exactly clear. "The future of Medicaid" is a vast topic. There have been signals, however, in the last few months that point in a certain direction.
In February, 2003, President Bush released his budget which included a proposal to reform Medicaid - giving block grants to the states. The National Governors' Association was pressed to support the proposal, but instead decided to create a task force to propose an alternative reform. The task force could not reach a bipartisan agreement to support any reform, so it disbanded.
In January of this year, Governor Benson and Commissioner Stephen went to Washington and met with Secretary of Health and Human Services Tommy Thompson to discuss using a Medicaid loophole to avoid a looming deficit. Washington is clamping down on states that use the loophole to leverage federal funds, and New Hampshire was counting on the money to balance its budget (as it has done since Judd Gregg was Governor).
At the time, there was speculation that Governor Benson struck a deal with Secretary Thompson to give New Hampshire the Medicaid funds requested if New Hampshire would agree to block grant funding for Medicaid. In an exchange with New Hampshire Public Radio's political correspondent John Milne, Benson admitted that he is interested in New Hampshire becoming the first state to test a block grant program. "We are going to have to rethink the way we do things," Benson is reported as saying.
In the last few weeks, rumors have circulated that Commissioner Stephen has contracted with Maximus, Inc. to develop an application for an 1115 Medicaid waiver as a vehicle to bring a block grant to New Hampshire. There are advantages - to the Commissioner - in using the 1115 waiver process. That process does not provide for legislative involvement or approval and the requirements for public involvement are less than stringent.
While Commissioner Stephen has frequently asserted (in The New Hampshire Challenge and during the Katie Beckett hearings) that the Legislature sets policy, not the Department, securing block grant funding is a radical departure from existing Medicaid policy and legislative intent. (See chart). Commissioner Stephen has avoided any direct answers to questions about whether the Department is working toward block grant funding. "We're considering a number of options," he is quoted as saying to the Concord Monitor.
Meanwhile, the Commissioner is moving ahead briskly with a reorganization of the Department of Health and Human Services. In fact, Phase II of the process is scheduled to be completed by the end of April.
A new organizational chart has been released, outlining the consolidation of several divisions. The Division of Elderly and Adult Services, Behavioral Health and the Division of Developmental Services will be consolidated into one - the Division of Community based Services. The purpose of the consolidations, according to a Power Point presentation of the reorganization is to "create client focused integrated networks of care."
Commissioner Stephen is looking beyond that consolidation. In a letter to his employees dated February 26, Commissioner Stephen said that the department has "begun discussions with a number of our key partners in the developmental disabilities and mental health communities on ways to gain more synergy and coordination. The effort will be a major initiative of our Department." What that will mean for these two communities is unclear.
Concurrently, the New Hampshire Institute for Health Policy and Practice at UNH, in conjunction with the Division of Adult and Elderly Services (DEAS), has received a $800,000 grant to develop an Aging and Disability Resource Center system. Over a three year period, centers will be created in communities around the state, with Strafford and Belknap counties chosen as the sites for the pilot programs.
As envisioned, the Resource Centers will be places where adults over the age of 60, adults with disabilities over the age of 18, and caregivers can go to "learn about and access long term support ranging from in-home services to nursing facility care." (According to Aging Issues, Spring 2004, a publication of DEAS)
Individuals will be able to apply for Medicaid and other DHHS programs at the centers, with an emphasis on community-based supports. It is claimed services offered at the centers will build upon and integrate, not supplant, existing services. "We want to create single-entry points to make it easier... to find the help they need," Mary Maggioncalda, administrator of DEAS Bureau of Policy and Community Planning is quoted as saying in the publication.
Other consolidations in DHHS, as listed in the Commissioner's letter to his employees, include:
- licensing and certification functions for all programs throughout the department into a Bureau of Legal Services and Regulation;
- civil rights compliance, workplace safety, ADA and sexual harassment functions into the Ombudsman office;
- all contract related activity into the Bureau of Provider Relationship Management;
- all human resource-related issues, including by not limited to, hiring, evaluations, employment screening, staff development, performance management, employee discipline and program performance measurement into the Human Resource Unit; and
- communications with the Federal government regarding DHHS programs into the Public Affairs and Government Relations Unit.
The Government Relations function is especially important, stated Commissioner Stephen, "during a time when significant changes to Medicaid policy and financial relations are being developed." (A reference to block grants?) |
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Related Stories:
Will New Hampshire apply for a Medicaid block grant?
Medicaid Comparison Chart
Commissioner Stephen to hold hearings on the future of Medicaid
Proposed principles for the NH Medicaid program
Come to a Citizens' Hearing on the steps of the Capitol |
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