Committee reviews SB 118: annual nursing-home allowance, Hampstead payouts and Dartmouth match, plus home cultivation language

Members of the Finance Division III work session reviewed Senate Bill 118 (SB 118) on Oct. 26, 2025, examining four distinct components: an annual indexing change to the personal needs allowance for Medicaid nursing-home residents; one-time payments and leave accruals for employees affected by the state’s acquisition and later lease of Hampstead; a dedicated state fund to match Dartmouth’s capital investments up to $3 million; and a set of therapeutic cannabis home-cultivation provisions carried over from House Bill 53.

The personal needs allowance change would require the Department of Health and Human Services to update the allowance annually rather than every five years. Nathan White, chief financial officer for the Department of Health and Human Services, said the current allowance ‘‘is approximately $75 to $80’’ and that moving to an annual adjustment is estimated to increase state expenditures by about $50,000 per year. White also noted that the fiscal-note ranges reflect uncertainty about which Medicaid-eligible residents would be in nursing facilities in any given year.

Proponents and several committee members debated the policy trade-offs. One legislator said the change would tie a recurring cost to Social Security’s annual cost-of-living adjustments and warned it could become a permanent cost driver. White and Brian Clark, an attorney for the Bureau of Adult and Aging Services, clarified that the allowance is set in statute and that the legislature retains discretion to change it in an off year; Clark said the department’s interpretation was that the current statute requires updates at least once every five years.

The bill’s sections addressing Hampstead relate to the state’s purchase of the facility in mid-2022 and a subsequent lease to Dartmouth. White described a set of hiring and contracting transitions and said roughly two dozen executive-level staff became state employees while more than 100 positions moved into state service earlier. He said approximately four employees missed annual bonus payments during the transition and several dozen lost accrued annual leave because of the change in employer. Section 2 of SB 118 would appropriate funds to ‘‘make those employees whole’’; White said that appropriation is about $160,000 and is reflected in the bill’s general-fund figures.

Sections 3–5 would create a dedicated state account to meet a unique lease obligation: when Dartmouth makes capital improvements to the Hampstead facility, the state must match Dartmouth dollar-for-dollar up to $3 million. White said the lease includes a matching provision capped at $3 million and the bill would direct lease revenue and other receipts from the agreement into the dedicated account (listed in the bill as a new entry in RSA 6:12). White said Dartmouth’s first-year lease payment to the state is roughly $1,141,000, with a 3% annual escalator, and that it will take time to accumulate a capital pool large enough to meet the matching cap. He warned there is a risk Dartmouth could undertake improvements before the fund reaches a given threshold, in which case the state would need to identify other general-fund sources to meet the obligation.

Committee members asked about governance and oversight. White said the lease establishes a joint operating committee that includes state representatives (he named Deputy Commissioner Marissa Henn as one appointee), and that disputes over whether an improvement must be matched could ultimately involve federal Medicaid rules; under the current lease language White said Dartmouth would have the final determination in some escalation scenarios. The bill would let the department deposit current-year lease receipts into the dedicated account immediately if the legislature passes the measure; the effective date discussed in the hearing is June 30, 2025.

Attached to SB 118 in the current copy under consideration are provisions from House Bill 53 to allow limited home cultivation for therapeutic cannabis patients. Michael Holt, administrator of the Department of Health and Human Services therapeutic cannabis program, described the carried-over language (sections 6–23) as effectively identical to the House-passed bill. Holt said the department does not take a position on the policy change, that the medical oversight board supports it for anticipated patient benefits (increased access, lower costs, more strain availability), and that the department can operationalize the change without a substantive fiscal impact to the department itself.

Under the cultivation language described by Holt, qualifying patients or a named caregiver could cultivate a small number of plants (Holt said the bill allows three mature plants, three immature plants and 12 seedlings) and the statute would authorize the department to record a cultivation location. The bill would permit the department to disclose patient or location information to state or local law enforcement under existing statutory standards (the department cited RSA 126‑X) when law enforcement submits a sworn affidavit of probable cause or in other statutorily enumerated circumstances. Holt said that historically the program has operated reactively — the program lacks an enforcement or investigatory arm and typically acts on law-enforcement referrals — and that the department expects to make a small data-field change in its registry to record cultivation authorization.

Several legislators raised concerns about privacy, enforcement discretion and the wording of penalties and reporting duties that in the bill use ‘‘may’’ rather than ‘‘shall.’’ Holt said ‘‘may’’ language has been debated over multiple legislative cycles, and that administrative rules would clarify how the department implements discretionary provisions.

No formal committee vote was taken on SB 118 during the work session. The panel adopted a motion to continue the division’s work session to a publicly held meeting after the House session on Thursday to allow members additional time to consult with leadership and to consider possible amendments; the motion carried by voice vote (committee members present responded ‘‘aye’’). The chair said the division would reconvene to coordinate a recommendation for the full Finance Committee.

The record from the hearing documents the fiscal estimates discussed (personal-needs allowance increase of roughly $50,000 annually; an appropriation of about $160,000 in section 2 to cover Hampstead employee bonuses and leave accruals) and the contractual obligation to match Dartmouth capital investments up to $3,000,000. The bill text in the committee packet references an amendment described as ‘‘amendment 20251871h’’ for the House changes; the bill was described in the hearing as ‘‘amended by the House.’’