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AARP AARP States New Hampshire Advocacy

AARP Supports Increases in the Choices for Independence Program

Doug McNutt head shot

Doug McNutt, Associate State Director for Advocacy for AARP New Hampshire, offered this testimony at today’s Senate Finance Committee hearing.

I am here today to support increases in the Choices for Independence or CFI program and also SB308 which supports the broad range of Medicaid providers.  We are specifically asking for general funds to be added to the CFI program so that these increases do not impose a burden on counties.  The needs has been evidenced by the Department of Health and Human Services data that shows CFI recipients receiving only about 70% of the services they are approved for.

The needs in the Choices for Independence program are great, as evidenced by a recent AARP study which shows New Hampshire’s support for home- and community-based care to be among the lowest in the country.  I am going to speak about two services to point out the direct impact of this lack of support.  I want to be clear that the other services in the Choices for Independence program are also in great need.

The first service I would like to highlight is Adult Medical Day Care which is a vital service for those keeping family members at home, some of whom need respite or need a safe place for their loved one, while still needing to work themselves.

In speaking to an adult care provider, I found the average cost per day is approximately $74 per day, yet the Choices for Independence program on Medicaid pays only $51/day to take care of very fragile people for 9-10 hours per day while family members are working.  The private pay rate for this provider is $95/day, almost twice the Medicaid rate.

Over the last four years, adult day facilities have closed in Manchester, Concord, Nashua, Portsmouth, Londonderry and Brentwood.  There were two facilities in Concord and as of last November, there are none.  This is what happens when a system is underfunded over a long period of time.  When rates haven’t been raised for many years, providers are unable to compete to keep employees.  In order to stay open, adult day facilities need to have a mix of payers including private pay, VA and Medicaid.  If this mixture breaks down and facilities close for lack of funding, then this option is gone for private payers as well as Medicaid.

When the last adult day care in Concord – TLC – closed last fall, a woman who worked full time and sent her mother there, said the following:

“When you have someone that has Alzheimer’s or is challenged in any way, to have a safe place to put them is so important.  I don’t worry that anything bad is going to happen to her.  My mom might fall, but I don’t worry about that stuff because they’ll take care of her.”  (Concord Monitor, October 31, 2018)

Unfortunately, that is no longer an option in Concord.

The other service I would like to cover is the Personal Care Services program (PCSP) which is one of the most used services in the CFI program.  This program provides flexible services to over 300 people statewide.  This program’s rate has increased 88 cents over the last 12 years.

At this point, the Department is only able to provide people approximately 70% of the services they are approved for.  So, there is already a shortage of services for those already receiving the services.  At the same time, the two major providers of this service are already unable to provide services for additional clients and are turning down 40-50 people per month.

These two programs are just examples of the problems CFI providers are having.  If we don’t provide more support for these programs. The services will be available for fewer people when the need is increasing.

We need to provide more support now by adding general funds to support the CFI program.


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