Senate committee hears bill to create uncompensated mental‑health assessment for community providers

CONCORD, N.H. — Lawmakers heard testimony Jan. 20 on Senate Bill 136, a proposal to establish an uncompensated mental‑health care assessment fund and a committee within the New Hampshire Department of Insurance to allocate money to community mental health centers.

Senator Deborah Altschiller, sponsor of SB 136, told the Senate Health and Human Services Committee the bill would create an assessment targeted only at uncompensated mental‑health care and administered by the insurance department. “This bill is only about mental health care,” she said, asking the committee to amend wording and to consider adding the words “mental health” where missing in the draft.

Supporters — including leaders of the state’s 10 community mental health centers and the New Hampshire Community Behavioral Health Association — said uncompensated costs have climbed sharply in recent years and threaten the centers’ ability to deliver outpatient services, prevention and the state’s Mission 0 objective to eliminate psychiatric boarding in emergency departments.

Dr. Cynthia Whitaker, president and CEO of Greater Nashua Mental Health, said her center’s uncompensated care rose to $2.5 million in the last year after remaining about $1 million annually for years. “Our philanthropy can’t take that,” Whitaker said. She described centers as statutorily required safety‑net providers that must serve patients regardless of ability to pay and said uncompensated costs are forcing delays or cancellations of planned capital projects and may impair staffing.

Roland Lamy, executive director of the New Hampshire Community Behavioral Health Association, outlined provider data showing aggregate uncompensated care across the 10 centers and a decline in Medicaid revenue that, together, produced operating losses of roughly $20 million system‑wide in fiscal 2024. Lamy said his spreadsheet shows uncompensated care drivers include Medicaid “spend down” patients who move in and out of eligibility, unpaid cost‑sharing and services private insurers do not cover.

Under the draft bill, the assessment would be levied against commercial covered lives to create a pooled fund to offset uncompensated mental‑health costs at designated centers. Lamy and other witnesses said the model is similar in structure to prior state assessments used for the state reinsurance pool and other programs.

Insurers and trade representatives warned that an assessment is effectively a tax on carriers and could raise premiums or otherwise destabilize insurance markets. Andrew Hosmer of Harvard Pilgrim Health Care said the department of insurance’s fiscal note language left the definition of “uncompensated care” ambiguous and that an assessment “is ultimately a tax” that could lead to higher deductibles or premiums for members. He cited an original fiscal worksheet that calculated a high per‑member figure before the sponsors clarified the bill’s mental‑health‑only scope.

Insurance Commissioner D.J. Betancourt testified that the department writes fiscal notes strictly on how a bill is drafted and said the department is willing to work with sponsors to refine definitions and guardrails. “I am not a huge fan of assessments,” Betancourt said, explaining assessments often create upward pressure on premiums and can have retaliatory revenue effects from out‑of‑state market actions. Michelle Heaton, director of the department’s life and health division, added that payment mechanics are complex for self‑funded groups and noted the bill’s current language that would bar carriers from passing the assessment to employers or individuals may be difficult to enforce.

Several federally qualified health centers (FQHCs) and other safety‑net providers testified that uncompensated care is already large and growing. Christine Stoddard of the Bi‑State Primary Care Association said the 10 community health centers reported about $14.5 million of uncompensated care in 2023 and urged a definition of “safety‑net providers” that would include both community mental health centers and FQHCs because of integrated, overlapping services.

Department of Health and Human Services staff told the committee the department awarded $5 million in stabilization funding to CMHCs in August 2024 and placed a $5 million prioritized need request in the budget, but centers’ uncompensated costs exceed that amount. Jennie O’Higgins, DHHS legislative liaison for behavioral health, told senators the department’s worksheet estimated the incremental commercial share of uncompensated FastForward‑type costs differently (note: FastForward discussion was part of the subsequent bill), and offered to provide more detailed fiscal figures on request.

Supporters asked the committee to recommend SB 136 ought to pass to preserve community mental health capacity; opponents asked for narrower definitions, stronger guardrails and more time to negotiate payment and contracting solutions with carriers. The hearing closed with requests that the Department of Insurance and sponsors refine the fiscal estimates and definitions before further action.