Grafton County Nursing Home VA Contract

Grafton County owns and operates a nursing home in North Haverhill, and the county's adopted budget carries the VA revenue for its veteran residents. The FY2027 Operating Budget lists, under the nursing home's revenues, "02-5020-114 ROOM & BOARD - VETERANS" adopted at $1,591,896.00 and "02-5180-332 VETERAN RX" at $130,000.00 with the annotation "Based on VA Census"; FY2026 carried $1,159,893 and $63,648 on the same lines. The contract. At the commissioners' April 2, 2026 budget meeting the Nursing Home Administrator "stated that they entered into a new contract with the Veterans Administration. Under the new agreement, it is a streamlined process and improved the rates that the nursing home is receiving for reimbursement. An average rate for veterans is $545.17 and this is a $55 increase in the rate they were previously receiving." The Veteran RX costs, the same minutes record, "are costs the nursing home has to pay upfront but are reimbursed for through the VA contract." On June 2, 2026 the administrator explained the VA was shifting contracted skilled-nursing providers into a new Veterans Choice contract arrangement; the transition "lost their ability to take Part A VA referrals" until the county "signed the contract two (2) weeks ago and are now able to resume taking Part A referrals from the VA." The census. The Executive Committee's minutes carry the nursing home's payer table quarter by quarter - "Veterans 9" budgeted and actual at September 22, 2025; "Veterans 9 10" at November 17, 2025; "Veterans 9 7" at March 23, 2026 - and at the June 5, 2026 budget session: "they are budgeting a census of eight (8) residents. The current census is nine (9), and they have signed a new agreement with the VA, and in doing so, the rates have changed. $545.17 per day is what they are estimating for an average, noting that these rates are individually based on the needs of each resident."