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Lawmakers weigh options to fund FastForward wraparound services as DHHS warns of budget strain
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Summary
DHHS and advocates told the Senate committee that New Hampshire's FastForward high-fidelity wraparound program is preventing costly institutional care but faces funding strain; insurance carriers and care management entities are negotiating in good faith while the committee considers an assessment model and alternative amendments.
Sen. Regina Burtzel told the Senate Health and Human Services Committee that SB 498 aims to stabilize financing for FastForward, New Hampshire's high-fidelity, team-based wraparound program for children with complex behavioral health needs. The sponsor said the state currently pays roughly $2 million per biennium toward gaps in FastForward coverage and proposed a financing mechanism to preserve the bundled service model.
The Insurance Department read a statement from Commissioner Bettencourt urging collaboration but expressing caution about an assessment on commercial insurers because such costs may flow through to premiums. The statement said, "The current structural and financing arrangements under which this program operates is placing strain on the DHHS Medicaid budget," and that the department was willing to work on alternatives that preserve program objectives while addressing market concerns.
DHHS deputy commissioner Marissa Henn described FastForward as a "game changer" that keeps many children at home and out of inpatient or out-of-state residential placements. She said the program is delivered as a bundled team model (care coordination, peer supports, flexible services and crisis meetings) and that the state is currently using general funds to fill coverage gaps for commercially insured children who cannot access care through their plans. Henn noted the budget pressure is already leading to reductions in service intensity by care management entities.
Care management entities and family advocates urged the committee not to unbundle the FastForward service, arguing the bundle is what makes the model effective. Providers said many CMEs do not bill commercial insurers now and lack billing infrastructure; multiple witnesses urged funding or grants to help CMEs come online to bill insurance.
Anthem's senior director of government relations, Sabrina Dunlap, said Anthem is actively engaging CMEs to explore network participation and preferred a non-legislative contracting solution; she estimated the carrier had roughly 30 members in the program (July'November data). Other carriers reported fewer members tied to the program. Several insurers said contracting and credentialing processes take months because CMEs historically have not participated in commercial networks.
The committee asked DHHS and the Insurance Department to continue discussions and to draft an amendment that seeks data-driven options (including billing, in-network participation, gap grants or a narrowly tailored payment delta) before advancing legislation. No final committee action on SB 498 occurred during the hearing; stakeholders said negotiations were ongoing.
