The other night at the public hearing on the Belknap County budget Commissioner Daigneault let everyone in attendance know that they had increased their revenue projections. This has a direct affect on the amount to be raised by property taxes through each town and Laconia. The revenue increased is $100,000 from the Surplus Fund; 5% ($100,000) from Gunstock, who had a banner year; and $151,000 in Medicaid payments from the state.

There were a lot of questions about the expenditure side of the budget. It is valid to ask these types of questions but looking at an expenditure increase of 3.9% seems fairly reasonable. When you take into account the relatively small level of increase in the expenditures I believe that you are never going to see a significant impact on what is to be raised by taxes.

It was mentioned that the Commissioners and Convention should have taken the shortfall in revenues into account when preparing the budget. With increases in prices for goods and services (fuel, repairs, etc…) and contractual agreement increases for wages it would be extremely dangerous for the county to run a flat line budget equal to 2007. That being said it is important to take the revenue side into account when determining expenses when preparing a budget. There is nothing to suggest that this wasn’t done with this budget, but I think it deserves a closer look and questions asked.

Much of the problem in revenues was placed on HB2, which shifted costs between the state and counties for Medicaid/Medicare reimbursements, which was sponsored by Sen. Sgambati. A lot of questions were answered about the caps in place under the new legislation that takes effect on July 1, 2008, which is the start of the 2009–10 state budget year. This was very confusing to me because of the “hold-harmless” portion of the bill.

This bill covered a number of sections in the RSA and below is an excerpt of the bill signed by the Governor. Pay attention to 167:18 a IV, which is the highlighted paragraph.

263:17 County Reimbursements; Limitation on Payments. RSA 167:18-a is repealed and reenacted to read as follows:

167:18-a County Reimbursement of Funds; Limitations on Payments.

I. These expenditures shall in the first instance be made by the state, but each county shall make monthly payments to the state for the amounts due under this section within 45 days from notice thereof.

(a) Counties shall reimburse the state for expenditures for recipients for whom such county is liable who are eligible for nursing home care and are receiving services from a licensed nursing home, or in another New Hampshire setting as an alternative to a licensed nursing home placement and are supported under the Medicaid home and community-based care waiver for the elderly and chronically ill, as such waiver may be amended from time to time, to the extent of 100 percent of the non-federal share of such expenditures. Expenditures shall not include payments made for skilled care.

(b) Counties shall not be liable for Medicaid recipients in state institutions, the Crotched Mountain Rehabilitation Center, and intermediate care facilities for the mentally retarded (ICF-MR) approved by the department of health and human services and servicing developmentally impaired persons.

II.(a) The total billings to all counties made pursuant to this section shall not exceed the amounts set forth below for state fiscal years 2009-2010:

(1) State fiscal year 2009, $103,000,000.

(2) State fiscal year 2010, $105,000,000.

(b) The caps on total billings for fiscal years after fiscal year 2010 shall be established by the legislature on a biennial basis.

III.(a) The counties shall have an aggregate credit of $5,000,000 against amounts due under this section for each fiscal year beginning July 1, 2008. The credit shall be allocated as follows:

(1) For fiscal year 2009, $4,000,000 shall be allocated among the counties based upon the proportion each paid for such expenditures in the prior fiscal year, and $1,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.

(2) For fiscal year 2010, $2,000,000 shall be allocated among the counties based upon the proportion each paid for such expenditures in the prior fiscal year, and $3,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.

(3) For fiscal year 2011 and for each fiscal year thereafter, $5,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.

(b) The credit shall be made available as soon as possible after the start of the fiscal year. The department shall adopt county credit criteria in consultation with the county-state finance commission and in accordance with the provisions of RSA 541-A. The credit under this paragraph shall not reduce total reimbursements due under paragraph II.

IV. Notwithstanding the procedures of paragraphs I-III of this section, no county shall be liable for total billings in fiscal year 2009 or fiscal year 2010 in an amount which would be greater than the amount of liability projected for that fiscal year using the methodology for determining county payments in former RSA 167:18-b prior to its repeal.

V.(a) Any shortfall between the state audited Medicaid allowances incurred by the state’s county operated nursing homes and amounts otherwise reimbursed by federal 50 percent Medicaid matching funds or other income, shall be certified as a public expenditure and be eligible for additional federal funding match.

(b) The department of health and human services shall seek federal Medicaid assistance match for any state audited county nursing home Medicaid expense which is not fully reimbursed through rates. Any revenue realized through such a match shall be paid to the nursing homes which incurred the unreimbursed expense.

Paragraph II shows the caps everyone was talking about and I questioned paragraph IV, which to me says that the counties will not pay more than they should have under the old bill. It was explained to me that the state, in order to have a neutral budget realized that the additional expenses to the state under paragraph IV was going to exceed the caps they had to budget for in paragraph II. When they realized this they simply reduced the reimbursement rate paid so that the $103 Million (to be shared by all counties) was not exceeded.

Is this another example of the NH Legislature and Governor passing the buck at the expense of the property taxpayer?

There is a lawsuit by the counties to change or repeal this law and we won’t know for some time what the outcome of that is. In the mean time we need to be cognizant of who we elect to represent us in the State Senate, State House, Executive Council and Governor’s Office.