Senate Finance Committee advances bill to revise Medicaid enhancement tax distribution, prompting debate over hospital losses and federal match

The New Hampshire Senate Finance Committee voted 4-1 in executive session to advance Senate Bill 249, a measure that changes how Medicaid enhancement tax (MET) revenues and DISH (disproportionate share hospital) payments are distributed and establishes directed payments to hospitals.

The bill, as amended in committee, moves the share paid back to hospitals from 80% to 91% beginning in state fiscal year 2026 and leaves room for an additional supplemental payment (an “adder”) that proponents say could reduce projected losses for several large hospitals. Committee members agreed to send the bill to the Senate floor so negotiators can continue talks with the governor’s office before crossover.

Supporters told the committee the revised distribution would allow the state to draw more federal matching funds while preserving a longstanding partnership between hospitals and the state. “We wanna continue the partnership that has existed on this issue for over a decade,” Steve Onan, president of the New Hampshire Hospital Association, said during the executive session. Onan and hospital leaders described the proposal they had shared with the governor as mirroring last summer’s approach but including changes to capture enhanced federal matching dollars.

Onan told senators the proposal would generate roughly $80,000,000 more state revenue than the prior agreement while still leaving larger hospitals with aggregate losses.…