Don't miss the big stories. Like us on Facebook.  

We're not saying it's going to happen, but the warning signs are there: If the state doesn't increase Medicaid rates to care for the poor, some of the state's nursing homes will close.

The already critical shortage of low-paid health care workers who help seniors remain at home rather than in a nursing home will increase. More and more families whose members can't afford to quit work to care for a loved will be forced to ask, "What do we do with grandma?"

The answer, we fear, will be county nursing homes that, if enough private nursing homes closed, could be forced to expand. That means the state, under Gov. Chris Sununu, will have succeeded in downshifting a big portion of its Medicaid expenses to, you guessed it, local property-taxpayers.

New Hampshire's Medicaid reimbursements, which among a host of services pays doctors to care for the poor and nursing homes to care for indigent senior citizens, are the lowest in the nation. The rates have not been raised across the board in 13 years. Nursing homes are now paid $49 per resident per day less than it costs to care for each elderly resident.

As Brendan Williams, CEO and spokesman for the organization that represents 78 of the state's long-term care facilities explained in these pages last month, the state of Oregon's Medicaid rate for nursing home care is more than $100 per day higher than New Hampshire's rate.

Low rates guarantee low wages. Licensed nurse assistants, the people who bathe patients, help them eat and use the bathroom, must go through 100 hours of training and two police background checks to be certified. Their starting wage is $12 per hour, $3 per hour less than the starting wage of a toll attendant and about the same pay that can be earned bagging groceries.

Last year, Williams wrote, the state lost a net 567 LNAs to other states or better paying jobs. In May, Republican state Sen. Jeb Bradley, a supporter of bills to increase reimbursement rates, told lawmakers that there were 2,000 unfilled health care positions.

Support our journalism. Subscribe today. →

Initially, a bill to raise reimbursement rates by 5 percent in 2020 and 7 percent in 2021 passed with unanimous Senate support. Those numbers were cut to 3.1 percent in each of those years, an increase that will barely keep the system afloat but one that's essential to the survival of adequate long-term care in the state. But Sununu vetoed the budget approved by the House and Senate.

The governor and Health and Human Services Commissioner Jeffrey Meyers opposed the across-the-board Medicaid increase. They favor allowing Meyers's department to target the aid to where they believe it's most needed, essentially feeding the starving baby birds that squawk the loudest.

It's a terrible idea that forces agencies who work in tandem to compete against each other for scraps.

New Hampshire's population is the second oldest in the nation, behind Maine. The baby boom generation has begun to reach the age when long-term care may be necessary. The state is ahead of many when it comes to providing options, through its Choices for Independence Program, to help people age in place. But the state's Medicaid rates, which by one estimate are only 58 percent of the national average, are starving home health care agencies and driving away the health care workers needed to care for its residents.

Governors and lawmakers of both parties have shortchanged Medicaid providers for decades. It's time for that to end.

— The Concord (N.H.) Monitor, Aug. 4