Latest news with #MedicaidEnhancementTax
Yahoo
23-05-2025
- Business
- Yahoo
Ayotte, hospitals settle bitter suit over Medicaid tax scheme
The state and acute-care hospitals have settled what had become a bitter lawsuit over charges that New Hampshire was getting ready to exploit a federal cash reimbursement provision under Medicaid to land a nine-figure profit while giving hospitals $70 million less under this new design. Gov. Kelly Ayotte announced the settlement that Attorney General John Formella's team had negotiated with the New Hampshire Hospital Association, Dartmouth Health and Concord Hospital that all had sued the state over its Medicaid Enhancement Tax (MET) program. 'This agreement is a win for our state, for rural health care access, and, most importantly, for patients,' Ayotte said in a statement. 'I am proud of my team's tireless efforts to reach a deal, and I thank Dartmouth Health, Concord Hospital, and the Hospital Association for coming back to the table to deliver the best possible outcome for everyone.' This was the third time hospitals had sued over changes to the reimbursement. Two Superior Court judges in the past had ruled the Medicaid tax to be unconstitutional because it's imposed on the state's 26 acute-care hospitals, but not on other providers, such as rehab or day surgery facilities. As with the previous two suits, hospital executives held further talks with state officials after the suit to reach a deal. 'This agreement is an important step toward ensuring that Dartmouth Health can continue to provide critical care to our patients and communities where and when they need it,' said Dr. Janet Conroy, CEO and president of Dartmouth Health. 'We value our partnership with the state and are grateful for Governor Ayotte's support to reach a resolution. We look forward to continued collaboration in support of a strong, sustainable healthcare system for our patients.' According to state officials, the agreement is a 'budget neutral solution' that would deliver $1 billion in total payments to hospitals over the next three years, consistent with what hospitals had requested. In turn, the state would receive $60 million more in benefits compared to previous proposals. 'We are pleased that we were able to reach a settlement agreement with Governor Ayotte that will help strengthen the Medicaid program, support hospitals and other essential providers, and most importantly ensure continued care for the patients and communities who count on our hospitals to be there for them when they are needed most,' said Steven Ahnen, president of the NHHA. In 1991, the state imposed the Medicaid Enhancement Tax on hospitals to qualify the state for bonus matching grants from the federal government. Under the plan, the state pays back the hospitals for nearly all that they paid out in taxes, often on the same day. The state received more than $300 million in annual reimbursements from Washington that it must spend on the federal/state Medicaid program. The Biden administration ordered all states to change the hospital tax and payment arrangements that critics here always called a 'scam.' Federal officials are requiring states to also make direct payments to the hospitals to receive the qualifying federal help, rather than just impose a tax on hospitals and then pay them back. Since a 2018 settlement, hospitals, in the aggregate, had received 91% back of what they paid the state. Former Gov. Chris Sununu last summer directed state officials to lower that reimbursement to 80% and to direct more grants to mental health, substance abuse and federally qualified health care centers that were financially beleaguered. In her two-year state budget plan offered last February, Ayotte stuck with the 80% model for 2026-27. Ahnen said this would have given the state $137 million more than it receives currently, while the hospitals would have gotten $70 million less than they do now. The state's 11 largest hospitals as a group would have lost $100 million, Ahnen said. To ramp up the pressure for a deal, Dartmouth Health, Concord Hospital and other major hospitals withheld the April 15 tax payment putting at risk the state's ability to generate the bonus federal match. 'We are encouraged that through this agreement with the state of New Hampshire quality, affordable health care will continue to be available to the patients and communities we serve at Concord Hospital Health System,' said Robert P. Steigmeyer, president and CEO of the Concord hospital system. 'We remain committed to working with state leaders to uphold our community-focused, charitable mission — now and for generations to come.' This deal puts in the rearview mirror some tough rhetoric from Ayotte after the hospitals had filed a suit. 'Unfortunately, the plaintiffs are only focused on driving more money to billion-dollar corporations and have resorted to playing political games and misleading the public,' Ayotte said at the time. 'They should return to the table and come to an agreement that benefits all Granite Staters.' The 'big beautiful bill' the U.S. House passed by one vote earlier this week to restore Trump tax cuts also would limit such Medicaid Enhancement Taxes to 5%. This could cost this state and the hospitals each tens of millions of dollars in lost revenue. Ayotte, a former U.S. senator, told reporters she won't overreact to the House proposal. 'When it's working its way through the process, it's hard to react to what the impact will be on New Hampshire,' Ayotte said. Many Senate Republicans led by Sen. Josh Hawley of Arkansas have said they would oppose any significant cuts to Medicaid as part of this global federal budget agreement. What's Next: The House Ways and Means Committee meets Tuesday on legislation (SB 249) that deals with this reimbursement scheme. The panel may decide to amend that bill to include terms of this settlement. Prospects: Now that all the major parties are on board, the Legislature will follow suit and with some legislation embrace these terms. klandrigan@
Yahoo
29-04-2025
- Business
- Yahoo
House budget writer: Make Senate find $38M to boost payments to hospitals
A chief House budget writer said it's up to the Senate to find $38 million in higher taxes or further spending cuts to sweeten payments to hospitals under the Medicaid tax plan that already had the support of Gov. Kelly Ayotte and the House of Representatives. 'This is the wrong venue, time and method for this bill,' said House Finance Committee Vice Chairman Dan McGuire, R-Epsom. 'It will cost the state $19 million a year, which isn't in either the governor's budget or the House budget. That is a $38 million drain on the Rainy Day Fund in the biennium which should be unacceptable.' Meanwhile, Steve Ahnen, the president and CEO of the New Hampshire Hospital Association, called the state Senate-passed bill (SB 249) providing those hospitals more reimbursement money a 'great, first step forward,' but added more is needed to reduce the harm done to some institutions. 'Hospitals will still lose money, we are simply trying to lose less and do so in a fair and reasonable way,' Ahnen told the House Ways and Means Committee Tuesday. "It (Senate bill) needs to do a little bit better." In 1991, the state imposed the Medicaid Enhancement Tax on hospitals to qualify the state for bonus matching grants from the federal government. Under the legal maneuver, the state pays back the hospitals for nearly all that they paid out in taxes, often on the same day. Under the arrangement, the state received more than $300 million in annual reimbursements from Washington that it must spend on the federal/state Medicaid program. The Biden administration ordered New Hampshire and all states to change those hospital tax and payment arrangements that critics here always called a legal "scam." Federal officials are requiring states to make direct payments to the hospitals to receive the qualifying federal help, rather than impose a tax on hospitals and then pay them back. Since a 2018 lawsuit settlement, hospitals, in the aggregate, had received 91% back of what they paid the state in MET. Former Gov. Chris Sununu last summer directed state officials to lower that reimbursement to 80% and to direct more grants to mental health, substance abuse and federally qualified health care centers that were financially beleaguered. Hospitals sued In her two-year state budget plan offered last February, Ayotte stuck with the 80% model for 2026-27. Ahnen said this will give the state $137 million more than it receives currently, while the hospitals will receive $70 million less than they do now. The state's 11 largest hospitals as a group would lose $100 million, Ahnen said. That's why the biggest hospital group, Dartmouth Health, joined the New Hampshire Hospital Association in suing the state for the third time in the past decade over the issue. Matthew Houde, Dartmouth Health's system vice president of government relations, said it would lose $31 million under the plan and if it stands, service reductions would be unavoidable. Through nine months, Dartmouth Health operated at a 1.4% profit margin which totals $35 million, Houde said. In response to the suit, Ayotte accused hospitals of being solely focused on 'playing political games and misleading the public.' 'Unfortunately, the plaintiffs are only focused on driving more money to billion-dollar corporations and have resorted to playing political games and misleading the public,' she said. 'They should return to the table and come to an agreement that benefits all Granite Staters.' Last month, the Senate amended its bill to restore the 91% reimbursement rate which is what former Senate President Jeb Bradley, R-Wolfeboro, tried but failed to get Sununu's support for last spring. 'Now that we have been sued, what happens will be anyone's guess,' said Senate Majority Leader Regina Birdsell, R-Hampstead, the bill's prime author. McGuire urged the House panel kill or retain Birdsell's bill and force budget writers to find the $38 million in additional reimbursement to the hospitals as it produces an alternative state budget plan next month. But Houde pointed out Dartmouth Health and other providers have withheld MET payments that were due to the state on April 15. This threatens the state's ability to obtain all that bonus federal money in the coming weeks if a deal isn't reached soon. 'There is a timeliness component here with regards to getting the match from the federal government,' Houde said. Ahnen reminded that two past superior court judges found the MET tax to be unconstitutional because it's not levied on 'similar' providers such as ambulatory surgery centers or rehab hospitals. Losing again would deny the state more than $400 million in federal reimbursement, he warned klandrigan@
Yahoo
15-04-2025
- Health
- Yahoo
Hospitals again sue state over tax reimbursement plan
Hospitals, Ayotte spar over Medicaid tax, new payments plan Gov. Kelly Ayotte accused the state hospital lobby of "playing political games and misleading the public" after it sued the state, challenging a Medicaid Enhancement Tax it pays to leverage additional federal grants to the state. For the third time, the state's hospital lobby has gone to court challenging the constitutionality of a state Medicaid Enhancement Tax plan that it claims cheats them out of $70 million in reimbursements to their members. Gov. Kelly Ayotte fired back a strong response, accusing the hospitals of being solely focused on 'playing political games and misleading the public.' The exchange reveals that a year later, Ayotte finds herself in the same place as former Gov. Chris Sununu, who engaged in a long public debate with hospital executives after he moved to divert some of their reimbursements to federally qualified health and substance abuse recovery centers. In 1991, the state imposed the Medicaid Enhancement Tax on hospitals to qualify the state for bonus matching grants from the federal government. Under the legal maneuver, the state pays back the hospitals for nearly all that they paid out in taxes, often on the same day. Under the arrangement, the state receives more than $300 million in annual reimbursements from Washington that it must spend on the federal/state Medicaid program of health care for the poor, disabled and many senior citizens. The Biden administration ordered New Hampshire and all states to change these so-called disproportionate share hospital payment plans. Federal officials are requiring states to make direct payments to the hospitals to receive the qualifying federal help, rather than impose a tax on hospitals and then pay them back. This suit charges the state is violating the 'takings' clause of the U.S. and state constitutions because the Medicaid Enhancement Tax is imposed on all net patient revenue but then hospitals are being reimbursed only for services provided to New Hampshire residents. For example, 40% of Dartmouth Health's patient revenue comes from care of out-of-state residents, the suit said. 'The DH Providers are paying taxes on revenue generated from services for which New Hampshire will no longer provide reimbursement,' said the six-count suit filed in Merrimack County Superior Court. The dispute in 2024 was over Sununu's insistence that at least 9% of what comes from the Medicaid Enhancement Tax go not to hospitals but be given to other Medicaid providers the former governor said struggled to thrive. April 15 was the date for hospitals to pay the tax, which triggered the lawsuit, according to Steve Ahnen, president and CEO of the New Hampshire Hospital Association. 'With no resolution in sight, hospitals have no choice but to file this lawsuit to protect access to important health care services for all patients,' Ahnen said in a statement. Hospitals sue state, claim Medicaid tax scheme cheats them out of $70 million Steve Ahnen, president and CEO of the New Hampshire Hospital Association, filed a lawsuit in superior court with member hospitals charging the new reimbursement scheme the state uses to leverage for itself federal grant money cheats them of up to $70 million they should rightfully receive back. 'The solution put forward by the governor embraces the punitive cuts to hospitals and the 80% distribution formula put in place by the prior administration. Under that formula, hospitals lose $70 million annually, to the benefit of the state, and at the expense of patient care in local communities." Joining the NHHA in its lawsuit was Dartmouth Health and Concord Hospital, along with its affiliate hospitals. Attorney General John Formella's office issued a statement that the state is prepared to fight the suit in court. 'The state is fully committed to ensuring access to quality health care while protecting taxpayer resources," Formella's office said. Ayotte said her last offer would have increased grants to all 26 hospitals and provided added benefit to the more than a dozen 'critical access hospitals' that provide care in underserved parts of the state. 'Unfortunately, the plaintiffs are only focused on driving more money to billion-dollar corporations and have resorted to playing political games and misleading the public," she said. "They should return to the table and come to an agreement that benefits all Granite Staters.' Ahnen pointed out that in the past two superior court judges found the Medicaid Enhancement Tax to be unconstitutional and an agreement only came about after hospital executives returned to the table to hammer out a compromise with state officials. 'This year, the MET is anticipated to generate $348 million; that funding will be used to bring $485 million in additional federal funding to New Hampshire to support the State's Medicaid Program,' Ahnen said. 'Without a new agreement the state would have to look to the general fund to finance the Medicaid program.' By not getting what they requested, the hospitals could see restrictions on services that affect all New Hampshire families, Ahnen said. 'This tax increase will cause hospitals to lose $70 million and will have a rippling effect on their ability to deliver health care services to the communities who depend on them and will harm the ability of patients to get the care they need, when and where they need it,' Ahnen said. 'This will force hospitals to make decisions about the services they are able to provide.' Leading Senate Democrats blamed Ayotte for putting at risk as much as $400 million in federal grants. 'This would be catastrophic to our state's healthcare system — the cost of healthcare for every Granite Stater will skyrocket, and hospitals, the largest employers in many communities, would be forced to cut services and potentially even close entirely," said Senate Deputy Democratic Leader Cindy Rosenwald of Nashua. "This could have been avoided altogether had the governor led on this issue.' klandrigan@
Yahoo
22-02-2025
- Health
- Yahoo
State House Dome: Hospitals to state: 'Let's make a deal'
Feb. 21—New Hampshire Hospital Association President and Chief Executive Officer Steve Ahnen urged a key state Senate committee last week to accept his group's offer to resolve a bitter dispute with the state over how much to reimburse hospitals for providing free care to patients. Last year, outgoing Gov. Chris Sununu ripped up the previous agreement the state had with hospitals, reducing its reimbursement rate from 91% to 80% from what hospitals pay the state under a Medicaid Enhancement Tax in order to leverage additional federal grants. Sununu did so in order to set aside more grants for non-hospital providers of Medicaid services including cash-strapped substance-abuse recovery and mental health centers. Senate Majority Leader Regina Birdsell, R-Hampstead, proposed a bill (SB 249) that uses the Sununu plan "as a starting point" for negotiations in the coming weeks. The hospitals are facing a deadline for that cut in reimbursement to kick in April 15 when the Medicaid Enhancement Tax is due to be paid. Ahnen said the change would lead to a $70 million cut in reimbursements while the state would be receiving an increased share of the pie totaling $67 million. Instead, Ahnen proposed lawmakers and Gov. Kelly Ayotte change this reimbursement scheme to be higher "direct payments" rather than a tax on hospitals. This change would give the state about the same as it is to receive under the existing Sununu-imposed system while hospitals would see a "slight positive" impact rather than deep cuts. All together hospitals would receive $36 million more than under the previous agreement. "This isn't a windfall for hospitals," Ahnen told the Senate Health and Human Services Committee. "There are some hospitals that will still receive less back than what they have paid into the system." Under the Hospital Association's proposal, the state would receive $104 million more than it got under the system in place last year. Ahnen said his team met with Ayotte on the matter and intends to have follow-up talks in the coming weeks. Ayotte makes first DC trip Ayotte took advantage of her first winter session with the National Governors Association in Washington to meet with Trump administration Cabinet heads about New Hampshire's top priorities. She discussed transportation projects with Transportation Secretary Sean Duffy last Tuesday and later the same day sat down with Secretary of Veterans Affairs Doug Collins. Ayotte spoke with Collins about the progress being made on the veteran campus complex in Franklin. Buckley faces big test A three-way race is set for March 15 to decide who will be the next chairman of the New Hampshire Democratic Party, and nine-term incumbent Raymond Buckley of Manchester is the clear favorite. What's helping Buckley this time is the fact that he faces two opponents, raising the likelihood that the better-known and well-connected incumbent will comfortably win. Both of Buckley's opponents have a history of activism in the party. Mat Stover of Chester is the fresher face, having served as chairman of the Rockingham County Democratic Committee and as a "campaign planner" for state Senate and House candidates last year. "With Trump and Musk in the White House there is no longer protection coming from Washington. Never has it been more urgent to win control of state government," Stover said in his announcement. "Change must come now. Together, we can build an NHDP that wins — for every Democrat, every community, and every voter in New Hampshire." Stover signed onto a memo critical of Buckley's leadership that surfaced last week. The memo doesn't advocate Buckley's removal but it takes issue with the party's "performance, governance and transparency." It refers to the 2024 election results as the "weakest" in recent history and to an ominous "downward trend." Buckley's other opponent is Newmarket restaurant owner Jon Kiper, who finished a distant third in his primary run for governor last fall. Both Kiper and Stover vow if elected to end the lucrative practice of charging candidates large fees to purchase the party's exclusive voter list. Kiper said when he ran for governor it would have cost him $75,000 to buy it. For his part, Buckley points to the party's record of winning races for Congress in nine of the past 10 elections. Conversely, Republicans have now won the governor's office five times in a row and held majorities in the Legislature and on the Executive Council for the past three elections. Last week, Buckley demonstrated why he will be tough to beat, releasing a list of more than 100 Democratic State Committee members backing his candidacy. About 280 party leaders are eligible to vote for chairman. The initial Buckley backers include former Gov. John Lynch; Bill Shaheen of Madbury, husband of Sen. Jeanne Shaheen; former U.S. Reps. Annie Kuster, Paul Hodes and Carol Shea-Porter; the two top Democrats running for governor last year, nominee Joyce Craig and former Executive Councilor Cinde Warmington; Nashua Mayor Jim Donchess and former Senate President Donna Soucy of Manchester. In other contests, 2018 congressional candidate Maura Sullivan probably has an edge in her campaign for first vice chair to replace incumbent Martha Fuller Clark, who is not running again. Tony Labrance and Caitlin Rollo, the party's current treasurer, are also seeking the No. 2 post. The race for second vice chair should be competitive with Nashua activist and former state Rep. Manny Espitia facing off against state Sen. Donovan Fenton of Keene. Trump promotes NH campaign director As we first reported on social media, Trevor Naglieri, the New Hampshire state director of Trump's campaign, landed a significant role in the president's political shop in the White House. Trump announced Naglieri would be deputy director of the Office of Political Affairs and also serve as a special assistant. Trump also awarded regional political director posts to key aides who had worked on his winning campaigns in the battleground states of Pennsylvania, Arizona, Michigan and Iowa. UNH survey: NH split on issues and Trump New Hampshire residents remain closely divided over President Donald Trump's handling of the economy and foreign affairs, according to a new poll from the University of New Hampshire Survey Center. The survey said 48% or respondents approved of Trump while 51% disapproved and the other 1% was unsure. This minus-3% rating for Trump is better than he had when he took office at the beginning of his first term in 2017 (minus-9%) and much better than when he left office in 2020 (minus-13%). But UNH Survey Center Director Andrew Smith pointed out New Hampshire respondents were much more bullish about Trump than residents of Vermont were and slightly more positive than Maine as well. On policy topics, the poll found strong support for Trump executive orders regarding the release of records regarding the assassination of JFK in 1963 (65%) and the reinstatement of soldiers who had been discharged for their refusal to take a COVID-19 shot (56%). As for billionaire Elon Musk's giant-sized role as an unpaid Trump adviser, 51% said it was inappropriate while 42% said it was fine. There was strong opposition (58% to 37%) when it came to Trump's blanket pardons of those charged for their roles in the riot at the Capitol on Jan. 6, 2021. The survey saw even bigger opposition to the pardons that outgoing President Joe Biden granted to members of his family (21% approved, 68% opposed). US attorney pick here remains a mystery A month into his administration, Trump has yet to fill most of the nation's nearly 100 U.S. Attorney positions. Last week, Trump confirmed that he was firing all of the Biden-era picks, which is what every newly elected president does. Jane Young, appointed New Hampshire's U.S. Attorney by Biden, left her post just prior to Trump taking office. The few names that have emerged as possible picks include Hillsborough County Attorney John Coughlin of Amherst and Manchester Aldermanic President Joe Kelly Levasseur. Coughlin has long been a Trump supporter and did a lot of advance security work for all the stops that Trump made here during 2023 and 2024. Levasseur finished in a very competitive third place in the crowded 1st Congressional District GOP primary last September won by former Executive Councilor Russell Prescott of Kingston. During that race, Levasseur was the most full-throated Trump supporter in the group, with roadside signs proclaiming "Trump Or Bust." Amplify pushes Ayotte on proposed Medicaid cuts Amplify New Hampshire, a Democratic special interest group, called on Ayotte to loudly protest possible cuts to Medicaid, the health insurance program that provides insurance coverage to more than 252,000 lower-income residents. New Hampshire is the only New England state that would lose its Medicaid expansion coverage if Congress were to reduce the 90% federal support. The Republican-led state Legislature applied a trigger that says expanded Medicaid coverage would go away six months after the feds lower the reimbursement rate. Ayotte recently acknowledged "widespread uncertainty" about the future of the program during a recent interview. "'Uncertainty' is not an acceptable reaction from Ayotte — it's her job to create certainty and deliver results," Amplify NH Executive Director Ryan Mahoney said in a statement. "If she and Republicans in Concord aren't willing to fight against these cuts and act to protect this critical health care, they should be held responsible for nearly a quarter of our state's population losing health insurance coverage." In her budget proposal, Ayotte retained the Medicaid coverage using payments by insurance companies as the state match. Transgender bill draws a crowd State Rep. Jim Kofalt, R-Wilton, called his proposal (HB 148) to allow locker rooms, prisons and sports teams to be limited to members of the same biological sex his "Can't we all just get along?" bill. "This is left to a local school board to set reasonable, practical guidelines to make sure everyone can work together, play together with mutual respect," Kofalt told the House Judiciary Committee last week. But over 3 1/2 hours of testimony, dozens of opponents insisted it would relegate transgender people to second-class citizens that could be discriminated against under the code of state law. New state Rep. Alice Wade, D-Dover, is an aerospace engineer and for six years has been transitioning to a woman. "This bill serves no legitimate benefit and serves no purpose other than to harass trans people for being who they are," Wade said. The bill is identical to one that former Gov. Sununu vetoed last year warning it could create a security conflict in the prison system and could run afoul of the 2018 state law that bans discrimination based on "gender identity." During last week's hearing, 2,910 registered opposition online to the bill while 206 backed it. Kevin Landrigan is the Union Leader's State House bureau chief. Contact him at klandrigan@
