As health care advocates, we are heartened to see some state recognition of the workforce crunch by raising the amount it is paying through Medicaid for substance misuse treatment to $347 a day. All of us see the effects of the opiate crisis, and we are hopeful the new “hub” treatment approach will prove successful.

Now is the time to increase reimbursement for all Medicaid providers. Nursing home care saw an increase of only 17 cents per day, per resident on January 1, bringing the average rate to $168.65 a day. Reimbursement is so low it limits even our largest county’s publicly owned nursing home, which has no profit motive, to offer just $12 an hour for licensed nursing assistants.

Since 2014, the rate of the state’s Medicaid reimbursement for nursing homes has grown at less than half the rate of medical inflation, leaving many facilities on the brink of insolvency. Struggling to compete in the hottest job market since 1988, beds are “offline” due to a staff shortage.

The situation is even worse for home-and-community-based services (HCBS). Assisted living facilities receive less than $51 a day from the state. Medicaid funding for in-home care has suffered terrible neglect, bearing no relationship to actual costs.

For those with Developmental Disabilities, the situation is even worse. Area Agencies, who support those with Developmental Disabilities, have not seen a rate increase in more than a decade. Budgets for individuals who came into the system in the early 1990’s may have never seen an increase thereby making it difficult if not impossible to find providers to serve them.

A recent report prepared for Community Support Network, Inc., the association of the Area Agencies, showed that as of September 2018 there were 234 vacant positions for direct support staff. Without a livable wage, long-term employees are leaving for jobs in retail, food service, and other hourly jobs that pay more, and those who stay often have to take on a second or third jobs to make ends meet.

Policymakers must understand how interdependent our health care system is. If there is not a mental health treatment option, or an available nursing home bed, a patient in need of treatment and care can left marooned in a hospital. If there are no HCBS options to discharge to, a rehabilitated resident can be held in a nursing home. If there is no staff to provide care for individuals to live at home, where their families can do a bulk of the work (80% of individuals still live with their families), then families have no choice but to look for other options, none of which is as reliable or financially responsible as caring for people in their communities.

As is true with long-term care, there are hundreds of vacant positions in hospitals, Community Health Centers, Area Agencies, and Community Mental Health Centers. That puts the lives of children and vulnerable people at risk.

How are we to keep New Hampshire healthy without health care workers?

The good news is that, within existing state revenue, there are opportunities to support and grow our health care workforce. We can invest in scholarship programs, as well as the existing, but limited, Student Loan Repayment Program for health care professionals. We can increase the reimbursement rates for Medicaid providers, so that caregivers, and support staff, can live on the wages supported by such reimbursement, instead of working two jobs or looking for out-of-state opportunities. We can decrease unnecessary administrative costs by being smarter about how we regulate health care.

In total, these solutions will improve the ability of health care providers to recruit, and retain, workers, which in turn will keep our children, friends, neighbors, and communities healthy. Importantly, it is an approach that plays no favorites but recognizes the interdependence of our health care system.

Brendan Williams is the CEO of the New Hampshire Health Care Association. Sarah Aiken is the Director of Communications and Public Policy at Community Bridges.