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Committee approves amendment and advances SB 249 on uncompensated care and Medicaid funding
Summary
The Ways and Means Committee voted to approve an amendment to Senate Bill 249 and passed the bill as amended (OTP as amended) after testimony from the state Medicaid director and hospital association representatives; the amendment incorporates terms from a negotiated agreement and preserves the Medicaid enhancement tax at 5.4%.
The Ways and Means Committee voted to support Senate Bill 249 as amended, approving a house amendment and then advancing the bill as "ought to pass as amended." Representative Buellery offered House Amendment 2025-2465H (dated 05/09); Representative Olmi seconded the amendment.
Henry Littman, the state's Medicaid director, summarized the agreement incorporated by the amendment. Littman said the amendment seeks to reflect terms of a negotiated agreement between the state and hospitals that covers state fiscal years 2025 (noted as outside the legislation), 2026 and 2027. He said the numbers in HB1 as passed by the House remain unchanged for the Medicaid enhancement tax payments and that the governor's proposal uses a lower percentage (87.5%) compared with an earlier figure of 91% while using a higher dollar amount to attract a larger federal match, resulting in higher total payments to hospitals without increasing state general fund spending.
Littman explained that the approach relies on directed payments rather than the prior disproportionate share payments model. Directed payments tie higher federal matching rates to eligibility status (for example, CHIP-eligible children receive a higher match than the 50% that applied to traditional disproportionate share payments). He also said adjustments in the agreement account for border hospitals, naming Dartmouth-Hitchcock as an example of a hospital involved in the discussions.
Representative Bolton and others asked about effects on critical access hospitals. Littman said critical access hospitals have received directed payments since 2021 and that under the prior agreement they are entitled to 75% of their uncompensated care through a global pool.
Representative Schamberg raised concerns about potential federal changes and whether that could require later adjustments. Littman said the legislation contemplated current federal rules and that the agreement includes a provision requiring parties to reconvene if there is a substantial change in law.
Steve Onan, president of the New Hampshire Hospital Association, told the committee the association supports the amendment and the bill as amended, saying the settlement provides additional revenue and stability for Medicaid and hospitals.
The committee voted on the amendment (2025-2465H) and the amendment passed by roll call, 18-0 with two members absent. The committee then voted "ought to pass as amended" on SB 249 by roll call, 18 votes in favor with two absent. The chair noted that SB 249 could not be placed on consent because it carries a fiscal note.
