June 6, 2012

The state is being called to task on its abandonment of its obligations to the poor and elderly. The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid, and the State Children's Health Insurance Program, has given Nick Toumpas and the NH Department of Health and Human Services 30 days to provide the information it has been seeking for four months to prove that the budget cuts New Hampshire has been making are not violating the requirements of the law.

CMS wants to be sure that New Hampshire is continuing to operate within its approved plan for providing access to health care as well as meeting the requirements of section 1902(a)(30)(A) of the Social Security Act. The testimony it has been receiving indicates the state has not.

The letter to Toumpas that CMS made public on Monday specifically cites LRGHealthcare's decision to notify 3,000 Medicaid beneficiaries that they needed to find an alternative source of primary care, as the professional group associated with Lakes Region General Hospital would no longer be participating as a Medicaid provider due to the reduced reimbursements from the state. Likewise, CMS cited the testimony provided in the Federal District Court of New Hampshire in the case of Dartmouth-Hitchcock v. Toumpas which raised issues about current and future access to physician services, inpatient and outpatient psychological services, and hospital-related home health services. CMS further cited the sub-acute care facilities' reductions in the number of beds available to ventilator-dependent beneficiaries under the home health benefit.

The documentation CMS is seeking would identify access problems and have the state develop a plan for corrective action to make sure access standards are being met.

We have some sympathy for Toumpas who is trying his best to work within the budget that the NH Legislature has provided while meeting the federal requirements associated with Medicaid and Medicare funds. Perhaps the threat of federal action will cause the penny-wise and pound-foolish legislators to rethink their approach to spending if not force them to acknowledge that they are New Hampshire's "death squad" — abandoning the state's most at-risk individuals with their actions.

After years of diverting federal funds intended to help the sick and elderly, it is time for New Hampshire's leadership to face up to its obligations and do the right thing.