[{"_1":2,"_97":-5,"_98":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,86],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6620231,"mediaKeyId","2813048-d5d7ba260f59ccbfeceb3e8f8bbdcae5","parentId",2813048,"title","House Finance Division III advances budget changes, delays and targeted cuts; MCO payment timing and Medicaid rates among major moves","audioSeconds",16691,"startMs",499000,"endMs",17190000,"viewUrl","/Search/View?dp=1&key=2813048-d5d7ba260f59ccbfeceb3e8f8bbdcae5&start=499&end=17190","thumbnailUrl","https://assets.pipeline.soar.com/2813048-d5d7ba260f59ccbfeceb3e8f8bbdcae5/thumbnail_499000.jpg","articleUrl","/articles/6620231/New-Hampshire/House-Finance-Division-III-advances-budget-changes-delays-and-targeted-cuts-MCO-payment-timing-and-Medicaid-rates-among-major-moves","mediaUrl","https://secure.pipeline.soar.com/6620231-7857022159255ac7e37c57b933c63281/orig.mp4?Expires=1771154335&Signature=Zs3phJtVwAtkOb07OLLXoP17WKTkh0O4OtytpGB8ZBaQf28Ocv-k-ThzjDrlVSSm~RM6rnyowJ~kCukDKTkeZMWhkDby1ju1fdupDw4OCMiNbm5TyKwSG9zMb-AHfjg~4luBtleK7fClkePzD8fvo6EIsfuybSS5AYBggQdOwAu7TuneowLxZX5Kme-mIlDY7qVKD51tsCca2-shY3YLtOnIC0ID3orQnQZ~sBVaGo6T8ABqTDFU2H2BDth9cJ9nRiR~VWn7TXsxv7WK2Boj~qLZf9cplSiQLQ0JDn9NSl2EXRR~ASSutnekfQUc18EA-K0OQXJSPpGFJslgCg0-cQ__&Key-Pair-Id=KUT5TJCACFTXG","author","New Hampshire Legislature","date","2025-03-28T22:41:15.037Z","article","House Finance Division III convened for a work session to consider a large set of HB 2 amendments and related budget language, approving a package of changes to reduce the committee's biennial budget target and reallocate or delay spending.

Division leaders and members said the votes reflect an effort to meet a required budget reduction and to leave items for further review in the Senate. “We have unlimited wants and limited resources,” the chair said during the session, describing the group’s task as making “tough decisions” under scarcity.

The committee approved several high‑profile procedural and fiscal items. Most notably, members voted to delay the June 2027 managed‑care organization (MCO) capitation payment into the next fiscal biennium — a timing shift that generates temporary budget relief by moving a payment from late June into early July. The committee also approved a 3% across‑the‑board reduction in Medicaid provider rates as part of the division’s contribution to the biennial savings target. Members described those actions as painful but necessary to meet Division III’s assigned reduction target.

Votes at a glance
- Withdrawal of amendment incorporating HB 548FN (membership‑based/direct‑pay health facilities) into HB 2 — withdrawn from HB 2 after discussion and public testimony (roll call as recorded in transcript: outcome withdrawn). Representative McLean’s member bill will remain as a stand‑alone measure in the Senate.
- Amendment 13‑86 H (standing orders / clarify non‑Medicaid use) — adopted by the committee (show of hands; recorded as 9‑0 in the work session).
- Amendment 14‑02 H (managed‑care outpatient cost‑sharing / patient incentives) — adopted (show of hands; recorded as 9‑0).
- Amendment 14‑29 H (transition of Medicaid long‑term supports and services (LTSS) into MCOs) — withdrawn for further work; committee asked for a commission and recommended Senate policy deliberation instead (motion to withdraw approved by show of hands 9‑0).
- Delay of June 2027 MCO capitation payment into FY2028 (amendment 14‑23 H) — approved by roll call, 6‑4.
- 3% Medicaid provider rate decrease (amendment 14‑22 H) — approved (committee recorded vote 6‑4). Committee members and many provider witnesses warned of service and access impacts.
- Developmental services / wait‑list funding: the committee voted to remove the HB2 suspension language that would have changed the statutory wait‑list requirement, and instead adopted reductions to the governor’s requested wait‑list funding levels (general fund reductions reflected in the work session: approx. $8.877 million in FY26 and $22.499 million in FY27). Members emphasized the department retains the ability to return to the fiscal committee if expenditures exceed appropriations.
- WIC / farmers market incentive suspension (amendment 13‑92 H) — adopted (show of hands; recorded as 9‑0) to suspend a startup until the commissioner can identify funding.

Context and committee exchange
Several health‑care provider associations and county officials testified during the session, arguing that rate reductions and cuts to developmental and home‑and‑community services would have downstream impacts: higher uncompensated care at hospitals, increased county tax burdens for nursing home support, and a risk that home care and community providers would exit the market. Ben Bradley of the New Hampshire Hospital Association, David Ross of the New Hampshire Association of Counties, Christine Stoddard of Bi‑State Primary Care Association, Greg White of Lamprey Healthcare, and others described the recent round of rate increases and the fragile state of workforce retention; many urged caution about reversing supports.

Committee members said they understood the provider concerns but emphasized the division’s constrained revenue allocation from Ways and Means and the need to meet a set reduction target. Several members said they preferred to give the Senate and policy committees additional opportunity to refine complex policy changes — for example, the committee withdrew the business‑model direct‑pay facility language from HB 2 to allow the Senate policy process to take the lead.

What’s next
Items carried forward in the work session will appear in the Division III recommendations to the full House Finance Committee and, if approved there, will go to the Senate for further consideration. The committee repeatedly noted that some measures are temporary or deferred to allow more time for deliberation and stakeholder engagement.

Ending note
The committee’s votes reflected a balance between making immediate budget reductions and preserving an opportunity for additional study and amendment in the Senate. Several members and outside witnesses asked the legislature to avoid destabilizing essential services while the Senate and future budget cycles consider longer‑term solutions.

","mediaType","Video","parentTitle","House Finance Division III (03/28/2025)","oneSentenceSummary","House Finance Division III convened for a work session to consider a large set of HB 2 amendments and related budget language, approving a package of changes to reduce the committee's biennial budget target and reallocate or delay spending.","taxTitle","Finance - Division III, House of Representatives, Committees\t, Legislative, New Hampshire","taxId",17752,"location","New Hampshire","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":44,"_45":80,"_47":81,"_49":50,"_51":82,"_53":83,"_55":56,"_57":58,"_59":84,"_61":62,"_63":64,"_65":85,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6620221,"Representative McLean’s direct‑pay facilities bill pulled from HB 2 after extensive testimony; committee seeks further Senate policy work",1041,1540000,"/Search/View?dp=1&key=2813048-d5d7ba260f59ccbfeceb3e8f8bbdcae5&start=499&end=1540","/articles/6620221/New-Hampshire/Representative-McLeans-directpay-facilities-bill-pulled-from-HB-2-after-extensive-testimony-committee-seeks-further-Senate-policy-work","https://secure.pipeline.soar.com/6620221-abc02e8dc55d5a055b43f886efc5257a/orig.mp4?Expires=1771154335&Signature=dD900OjtvHmkN72VCftYMQIUJGHbOcqczubwrvyH9ruKXKN4nBF2MMv-jjLD3PngKI5vuby1WzCAxGbNzYIiSx5b-LGJfxErHtzcKqNntLuOwa~7e208wSnPRQWud3S7PtW6IRgRfdg-85oeFHyZ1YrwaOSKmeCnZUTgefC0QeE7CPGV1c8ZAutNp9knEWlBGsXbA1IyVCQ76N4GKWBVrMZvDYduhKerf0nftDvHp7PUJS1V2J9qrQZkh6FGvMKj131IuhUKuxtWpoqbT6FZPBIyxybVhbAJdqtEnTd2gCBh0ZECGjHj6SEjiSoyoe5Upwl~cgivqBQz1K1A-8PoHg__&Key-Pair-Id=KUT5TJCACFTXG","Members of House Finance Division III heard substantial testimony and robust committee discussion on an amendment replicating HB 548 FN (membership‑based / direct‑pay health facilities), a policy that seeks to extend direct‑pay models to outpatient and facility settings.

Representative John (Joe) McLean (Manchester) (first reference in transcript as Representative McLean, sponsor) described the measure as aiming to “open up competition” in health care by allowing facility‑level direct‑pay or membership models similar to direct primary care. He framed it as a modest experiment — pointing to a long‑running example in Oklahoma — and said the bill includes a study provision to track impacts.

Opponents raised economic and structural concerns. David Ross, administrator of Hillsborough County Nursing Home and representing the New Hampshire Association of Counties, testified that the bill would remove a moratorium on nursing‑home beds for self‑pay facilities and could shift privately‑paying patients away from existing facilities that counties and Medicaid rely on to balance operational revenues. Ben Bradley of the New Hampshire Hospital Association testified that the bill may create a separate regulatory framework and bill of rights for some facilities, and he warned about potential loss of CMS conditions of participation and patient safeguards.

Committee discussion
Members probed the potential impact on critical access hospitals, Medicaid funding flows and tax assessments (MET/NFQA). Some members questioned the Oklahoma example’s applicability to New Hampshire geography and payer mixes. Representative Stringham asked about tax implications and whether new facilities would pay existing health facility taxes; Representative Priess asked whether other states have adopted the model (the witnesses and sponsor indicated Oklahoma is the principal real‑world example). Several members said the policy deserved more deliberative policy committee time than the HB 2 budget process allowed.

Outcome
After extended testimony and committee questioning the chair offered a procedural path: because HB 548 is a policy bill moving through the Senate, amending HB 2 to include it was not necessary. The committee voted to withdraw the amendment from HB 2; the sponsor acknowledged the concerns and confirmed the bill remains available for further Senate consideration. The roll call to withdraw was recorded by committee staff (withdrawal approved as recorded in transcript).

Why it matters
Supporters said the bill could spur innovation and offer more options to consumers; opponents warned it could destabilize existing facilities, shift profitable procedures away from safety‑net providers, and create regulatory and patient‑safety concerns. The committee’s action preserved the sponsor’s right to pursue the bill while removing it from the budget vehicle so the Senate policy committees can vet the policy more fully.

Ending
Representative McLean thanked the committee; members asked the sponsor and stakeholders to continue engagement as the bill proceeds through policy committee channels.

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Why it mattered
Committee members framed the combination of actions as necessary to meet an assigned reduction target for Division III. “We have to hit a number,” the chair said, urging members to balance priorities. The measures together were intended to shrink a large back‑of‑the‑budget cut and leave the Department of Health and Human Services with a smaller operating reduction to manage.

Provider testimony and concerns
Multiple witnesses told the committee the measures would materially affect care access and the ability of providers to retain staff.
- Ben Bradley, vice president of state government relations for the New Hampshire Hospital Association, urged caution and asked the committee to consider exempting hospitals from a general 3% reduction; hospitals had previously asked to redirect increases into community services and had accepted prior adjustments.
- Greg White, CEO of Lamprey Healthcare, said primary care and behavioral health services operate on narrow margins and estimated the reduction could produce a six‑figure impact to an individual health center.
- Kelly Ann Totten, representing home‑health and hospice providers, said home and community‑based programs were still stabilizing after prior rate increases; she warned a cut would accelerate workforce loss and drive patients into more expensive institutional settings.

Committee action and vote
The committee approved the MCO payment timing shift (amendment 14‑23 H) on a roll call; the recorded vote was 6‑4 in favor. The committee also approved amendment 14‑22 H, the 3% Medicaid rate reduction, by the same margin (6‑4 as reflected in Division III proceedings). Members voting in favor said the measures were necessary to meet the division’s fiscal target; members opposed urged the legislature to seek revenue options and expressed concern about service destabilization.

What the department may do next
Committee discussion noted the Department of Health and Human Services can return to the fiscal committee if actual expenditures exceed appropriations. Several members urged the department and the MCOs to work together to limit service disruption. Chair and staff directed OLS and fiscal staff to prepare formal amendment language and detailed change sheets for the full finance committee and the Senate.

Ending
Lawmakers described the action as difficult but framed it as the division’s contribution to meeting Ways and Means’ revenue allocation. Provider groups signaled they will press the Senate and budget conferees to restore funding or limit the distribution of reductions to reduce service and workforce impacts.

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Article not found

House Finance Division III advances budget changes, delays and targeted cuts; MCO payment timing and Medicaid rates among major moves

Representative McLean’s direct‑pay facilities bill pulled from HB 2 after extensive testimony; committee seeks further Senate policy work

Division III approves 3% Medicaid rate reduction and delays June 2027 MCO capitation payment to ease near‑term budget gap