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Senate panel reviews bill to expand and better pay New Hampshire public guardianship services
Summary
SB 127 would increase funding and contracts for the Office of Public Guardian (OPG) to reduce hospital discharge delays and raise reimbursement; OPG and hospital officials told the committee the change would clear hospital beds, while state staff flagged drafting fixes to ensure hospitalized, unknown adults gain access to guardianship slots.
Sen. Kevin Avard, prime sponsor of Senate Bill 127, told the Health and Human Services Committee the bill is intended to expand capacity and raise pay for professional public guardians so people who lack family or friends can get guardianship services needed to leave hospitals and to obtain long‑term supports.
Lisa Brits Silksky Stevens, chief executive officer of the Office of Public Guardian, said OPG serves about 1,400 Granite Staters and employs nearly 60 people who provide guardianship, fiduciary and trust services to adults with intellectual or developmental disabilities, severe mental illness, traumatic brain injury or dementia. She told the committee that the department's current contracted rate of $9.91 per day does not cover the actual cost of providing 24/7 guardianship services, which she estimated closer to $13 per day, and that the office has been operating with a structural deficit.
"Seventy percent of OPG's current cases are paid by DHHS contracts, though those contracts only make up 51 percent of our revenue," Lisa Stevens said. She described long hospital stays caused when patients need guardianship to participate in discharge planning but do not qualify for the department's existing adult protective services (APS) pathway.
Stevens and other witnesses described data collected by the Foundation for Healthy Communities and hospitals showing unnecessary inpatient bed days tied to guardianship gaps; the foundation's analysis cited about 1,726 unnecessary hospital days in calendar 2024 and more than $5 million in uncompensated care related to delays in securing guardianship and placement.
Melissa Nemeth of DHHS said the department supports additional funding but raised drafting and implementation questions. DHHS staff noted the bill creates 100 new contract "slots" but left unclear whether the new slots were intended for the Office of Public Guardian only or shared among the state's two contracted public guardianship agencies (OPG and Tri-County CAP Guardianship services). Nemeth said the department had interpreted the bill as potentially creating additional slots on top of the department's prioritized budget request; the sponsor clarified the intent was to mirror the DHHS prioritized need rather than add to it.
Representatives of the hospital and long-term care communities — including Ben Bradley of the New Hampshire Hospital Association and Jessica Ryan of Dartmouth Health — supported the bill, saying the lack of guardianship capacity blocks hospital throughput and causes patients to accumulate costly, unnecessary inpatient days. Jessica Ryan described 12 current patients in her health system awaiting guardianship (about 24 slots) and said those patients accounted for roughly 480 bed days and about $1.5 million in estimated costs at the time of testimony.
Several witnesses and committee members focused on statutory drafting: DHHS staff and a Bureau of Aging and Adult Services representative said SB 127 introduces language to RSA 161‑F‑52 (and related sections) but does not change the underlying statutory definition of "protective services" in RSA 161‑F‑43; as written, the new language could be interpreted to authorize guardianship only for adults already known to APS. Committee counsel and the sponsor discussed working with OPG and the department on language changes so hospitalized adults who are unknown to APS but need guardianship would be eligible for contracted guardianship services.
Opposition testimony included an extended personal account from an individual who said her sister was placed into state guardianship and described serious alleged mistreatment. Committee members asked the witness to provide details to the chair so the allegation could be reviewed; the committee did not take action on the claim at the hearing.
Why it matters: Committee witnesses said SB 127 aims to prevent hospital discharge delays that result when adults with incapacity have no one to act as guardian and do not qualify under existing APS‑funded contract pathways. Proponents argue modest increases in ongoing guardianship funding would reduce unnecessary inpatient days, improve patient outcomes and ultimately reduce uncompensated hospital costs. DHHS staff supported the idea but asked for clarifications to statutory cross‑references and contract slot accounting before the committee advances the bill.
Next steps: Sponsors and agency staff agreed to work on statutory language clarifications (especially links between the bill's new hospital‑discharge language and the definition of protective services in RSA 161‑F‑43) and to reconcile whether the 100 contract slots are an addition to or a mirror of the department's prioritized budget request.
