DHHS outlines public‑health history, reorganization and continuing UNH partnerships

Patricia Tilley, associate commissioner of the Department of Health and Human Services, told the House Finance Division II on Monday that the division’s organizational changes and external contracts should inform lawmakers as they consider the governor’s budget.

Tilley opened by placing the division’s authority in historical context, noting the state first legislated a health department in the 1880s and that the current statutory charge—cited during the hearing as RSA 125:9—directs the commissioner to “take cognizance of the interests of the health and life among the people and make invested investigations and inquiries.” She said that history helps explain where some longstanding general‑fund investments now sit in the division.

Tilley summarized five points she planned to cover, including: a brief history of public health authority; where general‑fund investments have been made (not dollars but program areas); the division’s pre‑ and post‑pandemic organizational structures; how prevention and public health interact with behavioral‑health services; and time for committee questions.

She described the division’s pre‑pandemic configuration (FY2018) as six bureaus with roughly 250 full‑time authorized positions. During the pandemic the division reorganized to seven bureaus, chiefly by splitting the former Bureau of Population and Community Health into a Bureau of Family Health and Nutrition and a Bureau of Prevention and Wellness, and by moving an emergency services unit into the Division of Public Health Services and renaming it the Bureau of Emergency Preparedness, Response and Resilience. Tilley said the reorganization did not create a large net increase in full‑time authorized positions but was intended to improve span of control and operational alignment after pandemic deployments.

She highlighted where state general funds historically support core public‑health infrastructure rather than programmatic expansions: the state public‑health laboratory (originating in 1901), limited support for childhood immunization programs within the infectious‑disease bureau, and targeted general‑fund support tied to maternal‑and‑child‑health work that helps meet a Title V maintenance‑of‑effort requirement. "The greatest bolus of general funds are to maintain that laboratory that started in 1901 and is extraordinarily important to this day," Tilley said.

State loan‑repayment program and workforce

Tilley described the state loan‑repayment program as an incentive program that historically targeted physicians in underserved areas but was expanded in recent years before the pandemic to include behavioral‑health providers through the master’s level. The program requires participants to work in designated underserved locations—often federally qualified health centers, rural areas or other medically underserved areas—and typically obligates participants to sign a multi‑year contract in exchange for loan repayment. "We give you three years’ worth of loan repayment, assuming that you stay working for those underserved populations," Tilley said. Committee members pressed for the number of participants; Tilley said exact counts were not available at the hearing and that the department would provide that data in follow‑up. She characterized the current split of providers using the program as roughly 80% behavioral‑health providers and 20% other clinicians, noting the dollar amounts paid per participant are proportionate to typical educational debt levels (higher awards for MD or DMD degrees, smaller amounts for master’s‑level clinicians).

UNH contracts and federal training grants

Tilley told the committee the division maintains multiple contracts with the University of New Hampshire (UNH). Two long‑running, continuing contracts were described in detail: a nearly 20‑year arrangement that provides a PhD‑level maternal‑and‑child‑health epidemiologist to the division to perform sophisticated data analysis, and a federally funded pediatric mental‑health access effort that pays UNH to run Project ECHO cohorts and teleconsultations for pediatricians and primary‑care providers. Tilley said the maternal‑child epidemiologist’s work helped inform policy decisions such as the Medicaid postpartum coverage extension and program targeting. Regarding the pediatric mental‑health access program, she said the funding is federal (CDC) and the project is time‑limited; "we have a five‑year grant," she said.

Committee materials and next steps

Nathan White, DHHS chief financial officer, reminded members the department will deliver full accounting‑unit briefing books and the agency’s internal budget presentations (the committee’s so‑called "coloring books") once the governor’s budget is released. "Within those we go through every bureau and every account in the programs," White said, adding the briefing books include outputs, deliverables and federal requirements for accounts over $1 million.

Why it matters

Committee members repeatedly returned to how organizational changes, federal matches and time‑limited federal grants should shape budget decisions. Tilley and White emphasized the distinction between program authority created by federal statute and programs a state elects to fund by accepting federal grants; Tilley said the department would provide more precise grant‑requirement mappings in the upcoming briefing materials. The UNH data‑analysis and Project ECHO contracts were presented as operationally important supports for state program planning and provider training, but committee members pressed whether time‑limited federal programs should be expected to be sustained with state general funds in future budgets.

The department committed to provide the committee with additional detail — including participant counts for the state loan‑repayment program, copies of mapping between division activities and accounting‑unit descriptions, and examples showing how UNH analysis translated into policy or program changes.

Provenance

topicintro: "Thank you. Thank you so much. So for the record, my name is Patricia Tilley. I'm an associate commissioner here at the Department of Health and Human Services. Thank you for the opportunity to come and talk to you a little bit about public health." (transcript excerpt)

topicfinish: "So so on that, I'm I'm looking down at the bottom, of that of that column, and it says to help the department make data driven decisions to improve health outcomes for mothers and babies." (transcript excerpt)