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Providers urge lawmakers to address rising uncompensated care for community mental health centers
Summary
Community mental health providers told the House Finance Committee the sector is carrying more uncompensated care and urged predictable rate increases and policy work with commercial insurers to reduce the gap.
Representatives of New Hampshire’s community mental health centers and the Department of Health and Human Services raised the issue of growing uncompensated care during the Division III budget work session on Feb. 27.
Jim Monahan of The DuPont Group, speaking for the Community Behavioral Health Association, told the committee that the 10 community mental health centers provide care for roughly 50,000 people annually and that uncompensated care has grown materially in recent years. He said a department analysis and provider data indicate uncompensated care moved from about 6% of relevant revenue in 2021 to about 12% in 2024 and that the total uncompensated care amount for 2024 was in the low‑ to mid‑millions (the provider spreadsheet circulated to the committee showed an aggregate uncompensated care figure in the millions across centers).
Monahan and the association urged the committee to consider several actions: (1) recurring, modest rate increases for Medicaid‑funded behavioral health services (the association suggested a 3% annual rate increase as a stabilizing step), (2) funding to help shore up uncompensated care in the near term (department and providers noted the governor’s budget included $5 million per fiscal year to offset uncompensated care), and (3) engagement with the Department of Insurance and commercial payers to address coverage gaps and high co‑pays/coinsurance that leave providers with unrecoverable costs.
Division leaders said CCBHC participation carries a federal requirement — CCBHCs must accept all patients and cannot use waiting lists the same way some community mental health centers may temporarily manage demand for uncompensated care. That federal participation requirement complicates local decisions because the state‑level suspension of certain eligibility requirements is not available to CCBHC demonstration sites.
Committee members asked the department to provide further crosswalks showing how children’s residential funding and Medicaid billing interact across agencies and accounts; department staff said they would present more detailed reconciliations to clarify where costs and payments are recorded.
Ending: Providers asked for recurring, predictable rate adjustments rather than ad hoc infusions, and urged the committee to consider both short‑term support for uncompensated care and longer‑term policy fixes to commercial payer coverage policies that contribute to the gap.
