Come to this website for up to date information, current developments, and tips for how you can get involved to help ensure that NH’s safety net of vital services for our most vulnerable citizens is maintained.
This is just a brief post to inform NH Cares members that we will be planning a meeting to be held some time after Labor Day to discuss the odds and ends left over from the most recent legislative session and how best to tackle these issues. Stay tuned for an official meeting date to be posted soon.
Evidence recently presented to New Hampshire’s Medicaid Expansion Study Commission suggests that Medicaid expansion would benefit roughly 48,000 New Hampshire residents at little cost to the state.
The state Department of Health and Human Services calculated that the cost to the state of expanding Medicaid would be about $18 million between FY 2013 and FY 2020 — but that these costs would be offset by $64 million in revenues and savings elsewhere in the budget, leaving the state with a net savings of roughly $45 million.
A fact sheet compiled by the New Hampshire Fiscal Policy Institute summarizes the latest information about the costs and benefits of extending Medicaid to more hard-working families in the state.
For a more in-depth look courtesy of NHFPI click here.
Here is very complete summary of this year’s legislative session from Sulloway & Hollis, on behalf of the greater Concord business community.
July 15, 2013
After four months of budgetary wrangling which included heated debate over casino gaming and gas tax revenue, the legislature quietly and almost unanimously passed a compromise budget as well as a smattering of new laws which may affect your business and the greater Concord region. In this final legislative alert of the session, we bring a budget wrap-up, a peek at the capital budget which will potentially have a large impact on Concord, and a potpourri of measures, large and small, which have made it onto “the books.” We also touch on the Medicaid Expansion Commission’s work – an endeavor which may mean a rare special session of the Legislature this fall.
I. In like a Lion, Out like a Lamb: Compromise Budget Sails Through
Recall that Governor Maggie Hassan’s budget was released on Valentine’s Day. Four-and-a-half months later, a budget which resembles the budget adopted by the Republican-controlled state Senate received overwhelming passage in both houses, winning bipartisan praise—not to mention bipartisan credit-taking. House Bill 1, the operating budget, passed the state Senate unanimously and cleared the House on a 337-18 vote. House Bill 2, the so-called “trailer bill,” which makes changes to state laws as part of implementing the budget, also passed the Senate unanimously and the House on a 346-12 vote.
Of note, the $10.7 billion budget does not increase any taxes or fees. Several much-debated revenue sources including casino gaming, the gas tax, and an increase to the cigarette tax, all went down in defeat. The big winners in the budget were increased funds for the mental health system, robust funding for community colleges, and some restoration of cuts to the University System of New Hampshire, which saw its funding halved in the last session. The historically shortchanged Land and Community Heritage Investment Program (LCHIP) was fully funded, and the budget included funding for four new public charter schools.
Interestingly, the end of the session was not dominated by renewed negotiations over gambling or the gas tax – initiatives much beloved by the Senate and House, respectively. Rather, the final legislative sticking point was whether New Hampshire would accept several billion dollars in funds as part of Medicaid expansion. As a refresher, states across the country are debating whether to accept additional funds from the federal government as part of national healthcare reform. The funds are meant to provide more coverage for uninsured Americans. Governor Hassan strongly supports accepting such funds. Estimates are that in New Hampshire, approximately 58,000 low-income residents would receive health care if the state accepted additional Medicaid funds.
New Hampshire Republicans fiercely oppose Medicaid expansion, fearing that once New Hampshire accepts multi-billion dollar Medicaid expansion grants, it will become dependent on the funding which may not last forever. Democrats, on the other hand, believe the state would be foolhardy to turn down money to insure some of New Hampshire’s neediest citizens. In addition, Democrats point to a positive economic impact on the state, especially in the hospital sector which is a major source of state growth and revenue.
Interestingly, some of the most well-known conservative Republican governors in the country support Medicaid expansion including Governor Chris Christie, Republican of New Jersey, and Jan Brewer, the well-known governor of Arizona who has made headlines over her hard line stances on immigration and national border security. New Hampshire Republicans, especially leadership in the state Senate and former Speaker William O’Brien in the House, are not following suit and are holding firm in opposition.
The compromise that ultimately allowed passage of a budget was the appointment of a Medicaid Expansion Commission. This nine-member commission will have until October 15th to study and release a report on whether New Hampshire should opt-in to the expanded Medicaid system. The commission consists of both Democrats and Republicans and is chaired by Jim Varnum, the former president of Dartmouth-Hitchcock Medical Center in Lebanon. Travis Harker, president of the New Hampshire Medical Society and a family care physician practicing in Concord is among the panel members. Governor Hassan and others predict that a special session will be convened in the fall to vote on whether to accept Medicaid funds after the Commission’s report is released. Expect to see the 2014 election loom large on how individual members of the commission posture during its work. At least one purported candidate for higher office is serving on the commission: Concord businessman and Republican Senator from Bedford, Andy Sanborn.
II. Capital Budget Could be Major Boon to Concord
A $245 million “capital budget” also cleared the State House and was signed by Governor Hassan. The capital budget includes funds for public works projects. The biggest ticket item in the capital budget this biennium is $38 million for a new women’s prison, likely to be built in Concord. Although funding for a new women’s prison has been a political football for some time, a recent lawsuit which was highly critical of the conditions of the women’s prison in Goffstown is widely seen by commentators as the impetus for legislative action this year. The capital budget also includes funding for two other Concord buildings. The Circuit Court in Concord will get a new roof, and, more visibly, the State House dome will be re-gilded – just in time for the massive downtown redesign project which is set to break ground in September.
III. Legislative Potpourri
The budget was certainly the most important and high-profile aspect of the last session. However, a number of other measures made it through an at-times tortured path to becoming law. Among new laws going into effect are the following:
* Speed limits north of Concord on the state’s highways will soon be 70 mph (from Canterbury to the Vermont border, but not in Franconia Notch).
* Bars in New Hampshire will now be allowed to stay open until 2 a.m. instead of 1 a.m. if towns and cities allow them to do so.
* New Hampshire will become the 19th state to legalize medical marijuana and the last in New England to do so. Proponents of the law believe that it is the most stringent in the nation in terms of safeguards against drug abuse. The law is already prompting economic development debates about where to site medical marijuana facilities and several North Country locations have been floated in recent days.
* New Hampshire will soon be required to disclose the percentage of dollars that go to charities from charitable gaming. Neal Kurk, R-Weare, urged passage of this bill to bring some transparency to the question of just how much charitable gaming money is actually going to charities and how much is being pocketed by vendors.
* The state’s home brewer law has been expanded to allow home-vintners to make between 100 and 200 gallons of wine at home depending on household size.
* Bed and breakfasts will be able to get licenses to serve liquor to their guests.
* The white potato officially becomes the state vegetable on August 3rd. A group of students from Derry championed this measure.
This legislative alert was prepared by Martin Honigberg and Jay Surdukowski of Sulloway & Hollis, PLLC, at (603) 224-2341.
On June 20th, the State Budget Committee of Conference reached agreement on a final version of HB 1 and HB 2, the bills that make up the State Budget. This budget has won support from the Governor, the Senate President, the Speaker of the House and the House and Senate minority leadership. Some feel it’s possible that the vote in the State Senate could be unanimous. Both the House and Senate will vote on the budget Wednesday, June 26.
The proposed budget spends over $400 million more than the current budget. Much of this “increased” spending actually went toward restoring some of the cuts made to the University System and many programs of the Department of Health and Human Services during the last budget process.
• There were no changes of funding levels to community based services for Developmental Services, Behavioral Health or the Elderly from the Senate’s proposals. The good news here is that no further cuts were made to the funding for these programs. The bad news is that this means there also were no badly needed increases in the rates paid to Medicaid Service Providers.
• All tax and fee increases were deleted.
• A Senate included provision to create an “Innovation in Medicaid Delivery Commission” was killed. It would have worked to create a new Medicaid waiver application, an 1115 Medicaid waiver, to obtain federal matching funds to improve access and quality of care for Medicaid recipients. DHHS will probably work on its own to create an 1115 Waiver.
• A number of DHHS Study Commissions were included in HB 2:
Commission to study the expansion of Medicaid eligibility in New Hampshire. Although there are already many studies that show the fiscal, economic, and health benefits of expanded Medicaid, a study committee will be taking another look. Their reporting deadline is October 15th. After the committee shares their findings, there may be a special session of the legislature called to hold a vote on Medicaid Expansion.
Medicaid Enhancement Tax (MET) Study Commission.
Commission to review and analyze the costs and future funding of Medicaid long-term care services for the elderly, either in licensed facilities or under the Medicaid waiver in New Hampshire.
• Uncompensated Care Fund: The committee agreed to the Senate’s position, which was to reduce the House’s spending on uncompensated care payments to hospitals.
• Certificate of Need: The repeal of the Certificate of Need Board for new hospital construction was repealed and new reforms for the Board were adopted.
• Step 1 Medicaid Managed Care: NH Hospitals must “participate” in Medicaid managed care in order to receive payments for uncompensated care.
Both the House & Senate will vote on the budget Wednesday, June 26.
Due to the large number of folks I have heard from who will not be able to come to the NH CARES meeting tomorrow (6/21/13) because of the HHS Oversight Meeting, or much better than that, days off or vacation, there will be no NH CARES meeting tomorrow.
A notice will go out next week regarding a new meeting date, but for the sake of your planning it probably cannot be on Friday 6/28/13 because the room here at GSIL, and yours truly, are tied up giving an advocacy presentation that morning. Although, if others want to meet then, have space available, and are willing to sit in for me I guess it could happen then. Please let me know if you are interested in doing that.
That is all for now. Be on the lookout next week for an announcement of the next CARES meeting and a collection of analyses of the state budget agreed upon today in the Committee of Conference.
Have a wonderful weekend!
Jeff Dickinson – GSIL
The Senate Finance Committee is done. On Tuesday, by a party line vote of 4-2 the Senate Finance committee sent House Bill 1 and House Bill 2 to the Senate floor for a June 6 vote. This is not the end of the Senate process as there will likely be many floor amendments to make various changes to the committee’s recommendations when the budget is debated on the Senate floor next week.
Both chambers of the Legislature, the Governor and the political parties have issued press releases making various accusations about the budget differences. Based on Legislative Budget Office information, the Senate budget “spends less than the House” in “total funds” (i.e. funds from all sources: State, Federal, County and others such as fees.) However, in terms of General Fund or state spending, the Senate actually spends more than the House.
The Senate budget no longer includes additional gambling revenue since the House killed the Senate’s casino bill. The Senate removed four tax/fee increases from the House proposed budget. There were two fee increases, one to the Salt Water Fishing License and one to the Marriage License. Both were deleted. In addition, the committee removed tobacco and gasoline tax increases. The Senate did predict that the State of NH will bring in over $100 million in additional revenue from existing fees and taxes based on economic growth. This growth in revenue allowed for increased spending.
When looking at the Department of Health and Human Services the Senate spends nearly $24 million more than the House. However, the Commissioner has said that because of low budget estimates for caseloads and other “back of the budget cuts” made by the Senate, the DHHS budget still has a $40 million deficit. The Commissioner told the committee that the following programs are at risk with the Senate’s version of the budget: DD/ABD waitlists, CHINS, mental health, community health centers, family planning clinics and payments to counties. Surely this will all be debated when both houses of the legislature meet in Conference Committee in June.
Here’s what’s ahead for the State Budget:
•On Thursday, June 6, the Senate Finance Committee’s recommendation on HB 1 and 2 will go to the floor of the Senate for a vote by the full chamber.
•By Thursday, June 13, a Committee of Conference (C of C) on HB 1 and 2 will be appointed by the House Speaker and Senate President.
•No later than noon on Thursday, June 20, the C of C will vote on / report out and sign off on its HB 1 and 2 recommendations to the full House and Senate.
•By Thursday, June 27, the full House and Senate will vote on the C of C’s recommendation.
Complete State Budget documents can be found here:
At the 4/12/13 NH CARES meeting members identified the following NH General Court bills of interest:
SB87 – Prime Sponsor – Peggy Gilmour – Bill clarifies that general patients’ bill of rights doesn’t apply to home health care. Specific home health care version applies. Bill also allows Homecare agencies to discharge a client with little and in some cases notice.
House Health, Human Services and Elderly Affairs Committee
Public Hearing: 4/16/2013 1:00 PM LOB 205
Executive Session: 4/23/2013 10:00 AM LOB 205
SB138 – Prime Sponsor – Jeanie Forrester – This bill allows an assisted living facility or nursing home facility in certain circumstances to pursue recovery of costs of care rendered to a client from entities or certain other persons.
House Health, Human Services and Elderly Affairs Committee
Public Hearing: 4/16/2013 2:00 PM LOB 205
Executive Session: 4/30/2013 10:00 AM LOB 205
SB152 – Prime Sponsor – Lou D’Allesandro – Allows video lottery machines and table games at one gaming location in the state pursuant to a competitive application process.
Joint House Committee of Finance and Ways and Means
Public Hearing: 4/16/2013 10:15 AM Representatives Hall
Bill Walk Through and Presentations: 4/17/2013 9:30 AM LOB 210-211
SB100 – Prime Sponsor – Jeb Bradley – Deletes the requirement that an employer who pays wages by electronic fund transfer offer employees the option of being paid by check. Also permits an employer to pay wages with a payroll card after offering employees the option of being paid by direct deposit.
House Labor, Industrial and Rehabilitative Services Committee
Public Hearing: 4/23/2013 11:00 AM LOB 307
Executive Session: 4/24/2013 1:00 PM LOB 303
SB24 – Prime Sponsor – John Reagan – This bill repeals the law requiring the department of health and human services to review and report relative to Medicaid reimbursement rates.
House Executive Departments and Administration Committee
Public Hearing: 4/17/2013 2:00 PM LOB 205
SB193 – Prime Sponsor – Peggy Gilmour – This bill authorizes licensure of dental therapists who may perform dental services under the supervision of a currently licensed dentist.
Re-referred to Senate Health, Education & Human Services Committee
Click the following links for materials from this NH CARES meeting:
NHFPI has assembled a number of reports, fact sheets and other information about Medicaid and the proposal to extend Medicaid to low-income adults.
The NHFPI Resource Page now features both parts of the Lewin Group report, their own analysis, basic facts about Medicaid and other materials. They also provide links to other organizations involved in the debate.
Bookmark their Medicaid resource page and you will have easy access to information about Medicaid and the ongoing discussion about extending Medicaid in New Hampshire.