Brendan Williams is the president and CEO of the New Hampshire Health Care Association.

Given the precariousness of New Hampshire’s revenue collections, this legislative session in Concord, where a biennial budget must be adopted, is for Medicaid providers reminiscent of Oliver Twist begging the workhouse master for an extra dollop of gruel: “Please, sir, I want some more.”

Worsening matters for nursing homes is uncompensated care for those whose Medicaid applications have not yet been approved. If you are, to give one example, a 72-bed facility awaiting $665,616 in payments, you can imagine the cash-flow challenges you might face in paying your vendors, let alone your staff.

State Sen. David Rochefort, the chair of the Senate Health and Human Services Committee, represents a sprawling North Country district, with many rural facilities that have shaky finances. He introduced Senate Bill 131, which would provide provisional payments to nursing homes for residents with “pending” Medicaid applications. If SB 131 were passed, the state, through federal matching funds, would be repaid what it is out upon an application’s approval. In the unlikely event an application is denied, the facility would repay the state.

SB 131 is an elegant workaround to an existential problem, though it will require setting aside dollars for a revolving fund that would effectively make bridge loans. Money would go out, and money would come back in.

One nonprofit facility testifying in support of SB 131 noted that the amount of uncompensated Medicaid care it hopes to be paid for someday actually exceeds the amount of money it spent on food all last year. This is untenable.

While SB 131 is great, House Bill 548 is inexplicable. As introduced, it would lift the state’s nursing home bed moratorium for either “membership-based” nursing homes or those receiving only direct payments from residents. Yet, the moratorium exists to allow the home and community-based system of long-term care to grow and to reserve nursing homes for those with the most acute care needs. In so doing, it also relieves county taxpayers from unnecessary property tax expenditures. If the moratorium is lifted, under an incoherent free market theory that does not account for the predominance of Medicaid in nursing home care, it would cause untold collateral damage.

HB 548 is ambiguous. Either county taxpayers would be on the hook to fund Medicaid payments to new “membership-based” nursing homes, injuring existing facilities, or new all-private facilities would siphon the direct-paying residents who help keep existing facilities afloat despite Medicaid’s abject failure to pay care costs. In either event, it’s a recipe for system collapse and is opposed by home care advocates, hospitals and nursing home representatives alike.

This session, nursing homes and other Medicaid long-term care providers are buffeted by forces beyond their control. It was not their decision to repeal a century-old tax bringing in $160 million a year. I’m no economist, and it is not for me to say whether that was the right decision, along with other tax cuts. However, I will say that Medicaid providers should not be forced to compensate for the revenue loss and lose even more money by caring for the state’s own clients.

The first principle of state budgeting, as in medicine, must be to do no harm, to do right by the sick. Care bills must be paid before new initiatives are launched. I cannot go into grocery stores and offer 75 cents on the dollar for groceries simply because I want to use that savings to, say, buy a new TV.

As President Ronald Reagan said in 1981, “We want the elderly needy, like all needy Americans, to know that they have a government and a citizenry that cares about them and will protect them.”

That is no less true today.