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NH’s Long-Term Care System: Low Performance, High Cost

According to Raising Expectations, 2014, a report produced by the AARP Public Policy Institute, New Hampshire’s system of long-term supports and services (LTSS) ranks 32nd out of the 50 states and D.C. in its performance for senior citizens and adults with physical disabilities.

Given that in 12 years the first wave of baby boomers will be turning 80 across the country and the Granite State’s particular demographic challenges, the relative underperformance of New Hampshire’s LTSS system for older adults should grab the attention of policymakers.  This is even more significant in light of the estimate that two-thirds of Americans aged 65 and older will need some type of long-term care for an average of three years.

One of the key factors in New Hampshire’s ranking is the cost of long-term care.  According to the report, the typical annual cost of nursing home care in New Hampshire was three times the median household income of a resident 65 or older.  In other words, a Granite State senior citizen would have to work three years just to pay for one year of care in a nursing home.  New Hampshire’s cost of care also ranked above the national average.  While the report indicates that the estimated annual cost of home and community-based care in New Hampshire is far lower than nursing home care, it is still unaffordable.  The median annual cost of home and community based care equaled 92 percent of the typical household income of a 65 year old New Hampshire resident.

It is also troubling that in New Hampshire only 18.9 percent of Medicaid and state funded spending for LTSS for older adults and those with physical disabilities is spent on home and community-based services (HCBS).  Only five other states – Alabama, Delaware, South Dakota, Rhode Island, and North Dakota – spent smaller percentages of their Medicaid LTSS on home and community-based care for these populations.  In contrast, number one ranked Minnesota and high-performing New Mexico spent more than 65 percent of their Medicaid LTSS dollars for this same population on HCBS.  In general, states that are more balanced toward HCBS have lower nursing home use and have LTSS that perform better on affordability and access.

New Hampshire should continue to work on shifting its public spending on LTSS for senior citizens and adults with physical disabilities to home and community-based care.  This should be a priority for three reasons: a significant proportion of our state is aging at a rapid rate; HCBS is the more cost-effective option; and, finally, the desire to remain at home is nearly universal among all people, regardless of their age or care needs.

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State’s Diverse Tax Base Stabilizes Revenue, But Business Tax Changes May Increase Volatility

29 Jun 2017

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New Hampshire’s state tax revenue is relatively stable, but the State’s largest tax may be among the most volatile types of common taxes, a new analysis from The Pew Charitable Trusts suggests. Between 1997 and 2016, New Hampshire’s tax volatility, as measured through percentage changes from the prior fiscal year, was only higher than five other states, suggesting New Hampshire’s tax revenues do not typically deviate dramatically from year to year relative to other states. However, digging into the diverse revenue streams and drawing on the experiences from other states shows some risk for New Hampshire.