The purpose of the trip on Friday was to attend the monthly meeting of the Joint Legislative Fiscal Committee. As the story goes, this committee was created to deal with financial matters when the legislature was not in session, which was most of the time when the legislature met only every other year.
Today, with annual legislative sessions, the Fiscal Committee is still in place with increasing assignments as a result of actions by the legislature. There are 10 members of the committee, five house members and five senators.
Representative Randy Foose (New London) was the sole member of the minority among House committee members and Representative Beverly Rodeschin (Newport), a long time member of the House Finance Committee, serves as secretary of the committee. I serve as one of the five senators as chair of the Senate Ways and Means Committee and vice chair of our Finance Committee.
Among the duties of the Fiscal Committee is to respond to requests of state agencies. That can be as simple as voting to accept and expend federal and other funds. It often brings a roomful of commissioners and other department heads to respond to questions from committee members on their requests.
An example from Fridayís session included a Department of Corrections request to accept and spend $44,316 in federal money to pay for a part time instructor for inmates for whom English is a second language. Committee member questions: How many inmates are eligible? The answer: 21. How many are illegal aliens? Answer: "donít know." How many participated last year? Answer: 10, and six became proficient enough to talk with other English speakers.
While the agenda on Friday was short, there are usually a couple of dozen requests from departments and many elicit tough questions.
There is the tendency to get into minor issues. The legislature decided a couple of years ago to have state employees justify taking their cars home to facilitate their ability to do their jobs. The legislation has the Department of Administrative Services run the program and recommend to the Fiscal Committee who should not have their state car as their commuting vehicle and state business car. The employee using the car can object to the decision of the department by appearing before the Fiscal Committee.
Last month, a Charitable and Racing Commission employee explained why it was important that he have his state car nearby as he often went out at night to look over charitable gaming operations. The department said that was only 15 percent of the carís use and the employee should use a car from the state pool. Between last month and this month the employee decided to follow the departmentís recommendation and his car has been turned in. The Fiscal Committee voted to affirm that decision.
So, some items are very important involving millions of dollars. Others are very minor, at best, and test oneís patience as you wonder if the Fiscal Committee is the place to resolve these issues.
The most time consuming agenda item on Friday was a report by Nicholas Toumpas, Commissioner of the Department of Health and Human Services, on the status of the implementation of a managed care system to reform and change the way the state pays providers who serve Medicaid populations.
Laws passed earlier this year, including one of the budget bills (House Bill 2), require the department to present a status report no later than last Friday on the progress made and a recommendation for a new plan model.
This reads a bit like the fine print of an insurance policy so a summary may be helpful. Medicaid provides services to low income children and adults, mentally and physically disabled and the elderly. There are about 165,000 New Hampshire citizens who receive Medicaid services at a cost of over $1 billion per year. The costs are shared roughly 50-50 with the federal government.
The goal of the managed care mandate from the legislature is to save $32 million per annum beginning next year. It means major changes to the way HHS provides its services as it looks to save costs borne by taxpayers while improving health care for those served.
If we do not slow the cost of Medicaid at the state level, huge problems lie ahead. Some factors include the impact of the recession which has driven people into poverty and thus they become eligible for services. The senior population is growing. Some qualify early on for Medicaid while increasingly seniors spend their own money on their health and nursing home care until their money is gone. Then, impoverished, they qualify for Medicaid to pay their expenses.
Looming on the horizon are the 50,000 New Hampshire citizens who will qualify for Medicaid beginning in 2014. The new federal health care plan will pay the costs for three years but one suspects that in time they will become a state responsibility with New Hampshire forced to assume responsibility for 50 percent of the costs.
How we deliver health care to Medicaid eligible citizens will be a major issue over the next few years.
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