Health and Human Services outlines roadmap, cites staffing gains and ‘Mission 0’ for psychiatric boarding

Lori Weaver, commissioner of the Department of Health and Human Services, told the Senate Health and Human Services Committee that the department is using a roadmap focused on “culture, community and customer service” to guide priorities including workforce retention, behavioral health and services for older adults.

The roadmap, Weaver said, is designed to prioritize who the department serves and how it works. “Our long game is pretty much what our vision statement says, optimal health and well-being for everyone,” Commissioner Weaver said, laying out a four-topic focus the department chose to discuss with the committee: eliminating emergency-department boarding for people needing inpatient psychiatric care (Mission 0); healthy mothers and babies; successful transitions for people after incarceration; and a system of care for healthy aging.

Why it matters: HHS accounts for a large share of the state budget and services. Weaver told senators that HHS comprises roughly one-quarter of state employees and receives about 53% of the state’s general-fund budget, and that progress on hiring and retention affects the department’s capacity to deliver services.

Key details

- Workforce and budget: Weaver said HHS has about 32,100 authorized positions and roughly 27,100 filled positions, and cited a legislative cap of 3,000 hires. She said the department’s vacancy rate fell from about 22% in 2022 to about 14.7% now after recruitment and retention efforts, including state-level hiring tools and pay increases that assisted retention.

- Mission 0 (behavioral health): Katya Fox, director of the Division for Behavioral Health, described Mission 0 as “a laser focus on achieving 0 individuals waiting in emergency departments around the state for inpatient psychiatric care.” Fox said the department has reduced wait times by expanding alternatives: certified community behavioral health clinics in Manchester and Nashua (with West Central Behavioral Health provisionally certified), mobile crisis services and community-based crisis stabilization centers in locations including Laconia, Plymouth and Derry. She also described “care traffic control,” a coordination effort led by New Hampshire Hospital to route adults to available designated receiving facilities (DRFs). Dartmouth is expected to add five DRF beds soon, and HCA’s acquisition of CMC includes a required 10-bed DRF expansion, Fox said.

- Transitions and housing: Fox said the department is working on step-up/step-down transitional beds and landlord incentives, and named Granite United Way and NFI North as partners that help match individuals leaving hospitals with landlords and provide case management and damage or vacancy protections to landlords.

- Healthy mothers and babies: Henry Littman, state Medicaid director, described efforts to increase early prenatal and postpartum care and noted that Medicaid births account for about a quarter of births but for more than half of maternal deaths in New Hampshire; he cited the 2023 change extending postpartum Medicaid coverage to 12 months as important to addressing behavioral-health–related maternal deaths. Littman also outlined a Medicaid-funded reentry benefit (an 1115 waiver feature) allowing some services to be provided to sentenced individuals up to 45 days pre-release, and a federally required youth reentry benefit providing pre-release screenings and 30 days of intensive case management following release.

- System of care for healthy aging: Melissa Hardy, division director for long-term supports and services, reviewed work from HB 2 (2023) including completion of a rate study for the Choices for Independence waiver, financial-eligibility changes (spousal impoverishment rules, an increased resource disregard to $7,000 and a shortened Medicaid look-back from five years to three in routine cases), expansion of who may be paid as a personal care provider, investments in Aging and Disability Resource Centers (ServiceLinks), and IT improvements to the NH Easy portal. Hardy said the department plans a public-facing dashboard to show home- and community-based services and aims to publish the system-of-care plan and an online service portal by June of next year.

Department operations and next steps

Associate Commissioner Andrea (identified in testimony as an associate commissioner) described customer-service initiatives aimed at reducing administrative burden for community providers, improving contracting and payment processes and expanding provider training and coordination with the nonprofit sector.

The department told senators it would provide the roadmap and work with the committee on questions about regional bed availability, transitional-housing placements, and the mechanics of landlord incentives.

Ending

Committee members asked follow-up questions about recruitment tools, salary increases, regional placement for DRF beds, landlord-incentive specifics and IT and staffing needs for new programs. Weaver and division directors said they would continue to coordinate with hospitals, providers and the committee as the department refines budget requests and implements the roadmap.