HB468: relative to caps on total billings by the state to the counties for nursing home care.

HB 468-FN-LOCAL – AS AMENDED BY THE HOUSE

09Apr2009… 1136h

09Apr2009… 1149h

2009 SESSION

09-0434

10/01

HOUSE BILL 468-FN-LOCAL

AN ACT relative to caps on total billings by the state to the counties for nursing home care.

SPONSORS: Rep. Osborne, Merr 12; Rep. Kurk, Hills 7; Rep. Cooney, Graf 7; Rep. McEachern, Rock 16; Rep. Theberge, Coos 4

COMMITTEE: Municipal and County Government

ANALYSIS

This bill revises the annual caps on the total amounts billed by the state to the counties for expenditures for recipients eligible for nursing home care for whom a county is liable.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

09Apr2009… 1136h

09Apr2009… 1149h

09-0434

10/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Nine

AN ACT relative to caps on total billings by the state to the counties for nursing home care.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Department of Health and Human Services; Bureau of Elderly and Adult Services; County Payment of Funds for Persons Eligible to Receive Nursing Home Services; Limitation on County Payments. Amend RSA 167:18-a, II to read as follows:

II.(a) The total billings to all counties made pursuant to this section shall not exceed the amounts set forth below for state fiscal years 2009-[2010] 2012:

(1) State fiscal year 2009, $103,000,000.

(2) State fiscal year 2010, $105,000,000.

(3) State fiscal year 2011, $105,000,000.

(4) State fiscal year 2012, $105,000,000.

(b) The caps on total billings for fiscal years after fiscal year [2010] 2012 shall be established by the legislature on a biennial basis.

2 Effective Date. This act shall take effect July 1, 2009.

LBAO

09-0434

Amended 05/06/09

HB 468 FISCAL NOTE

AN ACT relative to caps on total billings by the state to the counties for nursing home care.

FISCAL IMPACT:

The Department of Health and Human Services states this bill, as amended by the House (Amendment #2009-1149h), would increase state general fund expenditures and decrease county expenditures by $3,732,978 in FY 2011, and $8,960,724 in FY 2012. The Association of Counties states this bill would have no impact on county expenditures. This bill would have no fiscal impact on state, county, and local revenue, or local expenditures.

METHODOLOGY:

The Department of Health and Human Services (DHHS) states this bill would cap the total billings to the counties for long-term care (nursing homes and home and community based care (HCBC) for Medicaid recipients at $105,000,000 in FY 2011 and FY 2012. The current caps contained in RSA 167:18-a, II(a) are $103,000,000 in FY 2009, $105,000,000 in FY 2010, with caps after FY 2010 to be established by the legislature on a biennial basis. RSA 167:18-a, III states that the counties shall have an aggregate credit of $5,000,000 against amounts due under this section for each fiscal year beginning July 1, 2008 and thereafter. In FY 2008, the counties and state entered into a Memorandum of Agreement (MOA) on the recent changes on counties and state funding mix for various categories of service. One of the items in the MOA was a revised county cap on the limitation of payments for FY 2009 and FY 2010. The revised caps after credits are $95,818,800 in FY 2009, and $98,693,364 in FY 2010. The Department estimates the county caps after credits without this bill would be increased annually based on inflation of approximately 5%, resulting in estimated county caps after credits of approximately $103,732,978 in FY 2011, and $108,960,724 in FY 2012. With passage of the proposed bill the county caps after credits would total $100,000,000 in FY 2011 and 2012 ($105,000,000 cap - $5,000,000 credit = $100,000,000). The estimated fiscal impact is as follows -

FY 2011 FY 2012

Estimated County Caps after credits $103,732,978 $108,960,724

HB 468 Proposed County Caps after credits $100,000,000 $100,000,000

Difference $ 3,732,978 $ 8,960,724

As a result of this bill, the Department estimates state expenditures would increase and county expenditures would decrease by $3,732,978 in FY 2011, and $8,960,724 in FY 2012.

The Association of Counties states this bill would continue the provision in law since 1998 establishing a cap on county liability for long-term care (nursing home, and home and community based care) for Medicaid recipients. Current law only provides a specific cap through FY 2010. This bill would continue the established FY 2010 cap of $105,000,000 through FY 2012. With the continuation of the cap at the FY 2010 level, there will be no statewide increase in county expenditures as it relates specifically to county payments for the entire non-federal share of long-term care Medicaid reimbursement rates. The Association states that without the cap there will be an increase in county expenditures because the total non-federal share of Medicaid for long-term care already exceeds the cap amount in FY 2009 by more than $20 million.