Committee Summary for Health and Human Services Oversight Committee (03/28/2025)

Bill/Time	Type	Title	Sponsor
Unclear 00:07:52.240 - 12:05:53 PM	General Working Session	Unclear

Unclear: Commissioner Lori Weaver, Department of Health and Human Services (DHHS) Information Only00:07:52.240 - 12:05:53 PM; Commissioner Lori Weaver provided an update on the sudden termination of federal funding, which was unexpected and caused significant disruption. The funding, labeled as 'COVID money,' was used for various purposes including Behavioral Health and public health services. The termination of the funding, effective immediately, left a 15-month gap in funding that was originally planned to last until September 2026. This affected approximately 80 million dollars, with 75 million in public health and 5 million in Behavioral Health. The sudden cut led to immediate impacts, including the termination of contracts and the need to reassign 20 staff members within DHHS to maintain operations. The department is actively working to mitigate the effects and find alternative funding sources.
Unclear: Trish Tilly, DHHS Information Only00:13:11.480 - 12:11:12 PM; Trish Tilly elaborated on the specifics of the funding cuts, focusing on the impact on public health and Behavioral Health services. She detailed the use of the funds for epidemiology, laboratory capacity, and community health workers, which were crucial for disease detection and community support. The sudden termination of the funds has forced the department to expedite plans for alternative funding, such as Medicaid billing for community health workers, and to reassess ongoing projects like data infrastructure and laboratory services. Tilly also mentioned the impact on community partners and the need to quickly process payments to them.
Unclear: Senator Rosenwald Information Only00:18:55.120 - 12:16:56 PM; Senator Rosenwald inquired about the impact of the funding cuts on the 20 staff members and the Public Health Labs. Commissioner Weaver explained that the majority of the staff would remain in their positions with different funding sources, while a few might be reassigned within the department. The impact on the Public Health Labs includes a shortage of staff, particularly in the water lab, which could affect testing capabilities during peak seasons.
Unclear: Representative Weber Information Only00:22:14.200 - 12:20:15 PM; Representative Weber sought clarification on the status of the 20 staff members affected by the funding cuts. Commissioner Weaver assured that no one was being laid off and that all staff members had a job, with some being reassigned to different roles within the department to accommodate the funding changes.
Unclear: Senator Gray Information Only00:24:27.080 - 12:22:28 PM; Senator Gray discussed the broader financial implications of the funding cuts, noting that the state might end the year in a deficit condition. He emphasized the need for quick action to address the funding gap and mentioned upcoming Senate testimony to further discuss the issue. Commissioner Weaver acknowledged the challenge and the need to prioritize and possibly halt some projects due to the funding shortfall.
Unclear: Representative Dr. Woods Information Only00:26:35.399 - 12:24:36 PM; Representative Dr. Woods sought to understand the broader context of the funding cuts, confirming that the funds were expected to end in 15 months but the sudden termination disrupted planning. Commissioner Weaver confirmed this, explaining that the funds were budgeted and contracts were in place, but the federal government abruptly ended the funding.
Unclear: Alison Power, Maternal Child Health Section, Bureau of Family Health and Nutrition, Division of Public Health Information Only00:28:38.960 - 12:26:39 PM; Alison Power, filling in for Erica Tenny, provided an update on maternal mortality in New Hampshire. She discussed the role of the Maternal Mortality Review Committee (MMRC), which has been reviewing maternal deaths and making recommendations to improve outcomes. The MMRC completed a 5-year CDC grant and has been awarded another 5 years of funding, enhancing their ability to review cases and develop actionable recommendations.
Unclear: Caroline Nas, Maternal and Child Health Epidemiologist, Bureau of Family Health and Nutrition, Division of Public Health Services Information Only00:30:05.240 - 12:28:06 PM; Caroline Nas provided an overview of maternal deaths in New Hampshire for the year 2023 and a five-year aggregate. In 2023, there were five pregnancy-associated deaths, defined as all deaths regardless of cause, with three from substance use overdose, two from cardiovascular issues, and one from homicide. Pregnancy-related deaths, which occur during pregnancy or up to one year postpartum and are related to or aggravated by pregnancy, showed a decrease in substance use disorder-related deaths from 62.5% in 2022 to 40% in 2023. Most pregnancy-related deaths were among non-Hispanic white women aged 25-34, with half having a high school diploma or less. Half of the deaths were due to drug overdose, with 62.3% occurring postpartum, and 67% of overdose-related deaths happening between 43 days to one year postpartum. Seventy-three percent of those who died from overdose were Medicaid recipients, with half facing financial and transportation barriers to healthcare. The Maternal Mortality Review Committee (MMRC) determined that 58% of pregnancy-related deaths were primarily due to mental health conditions, with contributing factors including substance use, domestic partner violence, unemployment, lack of transportation, and care coordination. Seventy-nine percent of the five-year aggregate of pregnancy-related deaths were deemed preventable. Caroline also mentioned the impact of Medicaid expansion and the forthcoming report that will include pregnancy-associated deaths.
Unclear: Representative McDonald Information Only00:36:10.319 - 12:34:11 PM; Representative McDonald sought clarification on the reasons behind the decrease in maternal mortality rates from 32.9 in 2021 to 18.6 currently. Caroline explained that the high rate in 2021 was due to the pandemic, and while there has been a decrease, it's not steady due to fluctuating annual case numbers. She attributed the improvement to federal funding and interventions based on MMRC recommendations.
Unclear: Senator Rosenwald Information Only00:39:24.240 - 12:37:25 PM; Senator Rosenwald expressed concerns about the preventability of maternal deaths and questioned whether the responsibility lies with the Department or healthcare providers. Caroline explained that the MMRC includes a diverse group of clinical and non-clinical contributors, and it's designed to gather all relevant parties to discuss maternal care, especially since women may see multiple providers postpartum. She emphasized that the MMRC's determination of preventability is not about assigning blame but understanding circumstances and making recommendations to various agencies, including clinicians, communities, and families.
Unclear: Caroline Nas, Maternal and Child Health Epidemiologist, Bureau of Family Health and Nutrition, Division of Public Health Services Information Only00:44:26.800 - 12:42:27 PM; In response to Senator Rosenwald, Caroline further explained that the preventability of deaths is not about blaming any single entity but about understanding the multifaceted nature of contributing factors, including financial issues, personal choices regarding medication, and systemic inadequacies like insufficient mental health services. She highlighted the challenges faced by Medicaid recipients in accessing timely mental health care and stressed that preventing maternal deaths is a collective responsibility across the healthcare system.
Unclear: Representative Woods Information Only00:45:42.119 - 12:43:43 PM; Representative Woods asked about specific issues related to timely admission or education in medication, focusing on the need for more practitioners and the distinction between availability and accessibility of healthcare services. They referenced page 13 of a document for further details on the recommendations developed by the Maternal Mortality Review Committee (MMRC).
Unclear: Unnamed Speaker Information Only00:47:08.520 - 12:45:09 PM; The speaker discussed the MMRC's approach to addressing mental health issues contributing to deaths, highlighting specific recommendations and actions taken. They mentioned the establishment of a peer Recovery Group at Dartmouth and new clinical guidelines for managing pain during labor for patients with substance use disorders.
Unclear: Unnamed Speaker Information Only00:48:32.119 - 12:46:33 PM; The speaker continued discussing the MMRC's findings, emphasizing the qualitative analysis of contributing factors to deaths between 2019 and 2023. They mentioned specific examples of recommendations, such as clinical guidelines for pain management in patients with substance use disorders.
Unclear: Courtney Keane, Bureau Chief for Family Health and Nutrition Information Only00:51:18.760 - 12:49:19 PM; Courtney Keane introduced the Child Fatality Review Committee's annual report, emphasizing the committee's commitment to understanding child death patterns and circumstances to prevent future tragedies. She highlighted the comprehensive review process and recommendations aimed at preventing further deaths.
Unclear: Mark Clement, Co-Chair of the Child Fatality Review Committee Information Only00:52:19.960 - 12:50:20 PM; Mark Clement provided a historical overview of the Child Fatality Review Committee, established in 1991 and later moved under the Department of Health and Human Services in 2019. He explained the committee's objectives, including identifying trends, risk factors, and service improvements. He detailed the committee's composition and operational principles, emphasizing confidentiality and the non-investigative nature of their work.
Unclear: Joe Porter, Co-Chair of the Child Fatality Review Committee Information Only00:57:40.640 - 12:55:41 PM; Joe Porter discussed the recommendations from the latest annual report of the Child Fatality Review Committee. He outlined the report's structure, highlighting data on child fatalities and recommendations starting on page 12. He emphasized the committee's focus on broad, preventive recommendations rather than detailed investigations of individual cases.
Unclear: Joe Porter, Co-Chair of the Child Fatality Review Committee Information Only00:59:48.640 - 12:57:49 PM; Joe Porter continued discussing specific recommendations from the report, including increased awareness of seat belt use, driver safety messaging, mental health treatment services, suicide prevention, and water safety education. He mentioned tangible changes like the inclusion of the suicide hotline on student ID cards and the expansion of life jacket loaner stations.
Unclear: Unnamed Representative Information Only01:03:42.240 - 1:01:43 PM; The representative expressed concern about the high number of suicides among children and inquired about the breakdown of suicide methods and potential prevention recommendations. They were directed to page nine of the report for details on suicide methods.
Unclear: Joe Porter, Co-Chair of the Child Fatality Review Committee Information Only01:04:33.799 - 1:02:34 PM; Joe Porter responded to the inquiry about suicide methods, pointing out that childhood traumas and the need for improved mental health services are common themes in their reviews. He mentioned the committee's alignment with the state's 10-year Mental Health Plan and the use of the 988 emergency number, though he noted a lack of specific data on its effectiveness.
Unclear: Representative McDonald Information Only01:06:11.039 - 1:04:12 PM; Representative McDonald inquired about the role of bullying in child suicides, following up on concerns raised by Representative Lon. He was interested in understanding how significant bullying is as a factor contributing to suicides among children.
Unclear: Mark Information Only01:07:17.160 - 1:05:18 PM; Mark responded to Representative McDonald's query about bullying and its impact on child suicides. He confirmed that bullying has been a recurring theme in some of the cases reviewed by the Child Fatality Review Committee, though he did not have quantifiable data. He noted that challenges at school were common in multiple cases they reviewed.
Unclear: Representative Woods Information Only01:07:45.760 - 1:05:46 PM; Representative Woods asked about the collection of data on safety belt use in motor vehicle accidents. He referenced his involvement in the safety belt movement in the late 80s and 90s and sought clarification on whether such data is currently required to be reported.
Unclear: Mark Information Only01:09:04.839 - 1:07:05 PM; Mark responded to Representative Woods' question about safety belt data. He explained that while they do collect such data in the cases they review, he was unsure if it was systematically recorded for every death or only during investigations. He noted the involvement of medical examiners and law enforcement in collecting this data.
Unclear: Representative Weber Information Only01:10:11.640 - 1:08:12 PM; Representative Weber shared a personal anecdote about a traffic accident report that included a question about seat belt usage. He then asked about the selection process for cases reviewed by the Child Fatality Review Committee, confirming that not all child fatalities are reviewed due to time constraints.
Unclear: Mark Information Only01:11:34.120 - 1:09:35 PM; Mark clarified that the Child Fatality Review Committee does not review every child fatality case but selects cases based on their potential to generate helpful recommendations. He confirmed that the data presented reflects the total number of deaths, not just the cases reviewed in depth.
Unclear: Joe Porter, Co-Chair of the Child Fatality Review Committee Information Only01:12:37.080 - 1:10:38 PM; Joe Porter acknowledged the retirement of his co-chair, Mark, and thanked him for his service on the committee since its inception. He humorously noted that no committee members were currently wearing seat belts.
Unclear: Dr. Mary Beth Denes, Dartmouth Health, Chair of the New Hampshire Rare Disease Advisory Council Information Only01:13:27.880 - 1:11:28 PM; Dr. Mary Beth Denes introduced herself as a pediatric geneticist at Dartmouth Health and the current chair of the New Hampshire Rare Disease Advisory Council. She provided an overview of the council, noting its role in advising legislators and the Department of Health and Human Services on rare diseases. She highlighted the council's establishment in New Hampshire as the first in New England in 2019.
Unclear: Dr. Mary Beth Denes, Dartmouth Health, Chair of the New Hampshire Rare Disease Advisory Council Information Only01:14:22.840 - 1:12:23 PM; Dr. Denes continued discussing the council's activities, including legislative updates and collaboration with other advisory councils. She emphasized the importance of community outreach and awareness about rare diseases. She mentioned the council's involvement in supporting bills like House Bill 355 for newborn screening and Senator Rosenwald's role in relevant legislation.
Unclear: Dr. Mary Beth Denes, Dartmouth Health, Chair of the New Hampshire Rare Disease Advisory Council Information Only01:17:03.760 - 1:15:04 PM; Dr. Denes discussed the council's composition, which includes patients, family members, healthcare professionals, and legislators. She outlined the council's tasks as per the RSA, focusing on advising on rare disorders, collaboration with other councils, and community outreach. She highlighted the council's role in legislative updates and the importance of telehealth for rare disease patients.
Unclear: Dr. Mary Beth Denes, Dartmouth Health, Chair of the New Hampshire Rare Disease Advisory Council Information Only01:22:16.600 - 1:20:17 PM; Dr. Denes discussed the activities of the New Hampshire Rare Disease Advisory Council, including their participation in a national meeting in Washington DC with representatives from 13 states. She highlighted the council's structure, noting that unlike some states, New Hampshire's council operates through the Department of Health and Human Services without state funding, relying on volunteers. She emphasized the importance of community outreach, mentioning annual meetings with legislators at the capitol, media appearances, and the significance of Rare Disease Awareness Day on February 28th, which includes proclamations from the governor and symbolic illuminations. Dr. Denes also discussed the Sudden Death in the Young Committee, focusing on the need for genetic testing in cases of unexplained deaths in children, which has been funded through a CDC grant. She expressed excitement about the potential for collaboration and the impact of genetic testing on providing closure and diagnosis for affected families.
Unclear: State Representative Dr. David Nagel, Past President of the New Hampshire Rare Disease Advisory Council Information Only01:28:32.239 - 1:26:33 PM; Dr. Nagel shared insights on the success of the Rare Disease Advisory Council, noting that increased recognition of diseases like Ehlers-Danlos could lead to their removal from the council's focus. He raised concerns about the council's mandatory two-term limit of six years, which is set to sunset in September, suggesting an extension to a three-term maximum to retain experienced members. He discussed the challenges faced by the council, including the impact of the 2019 nationwide event and the importance of continuing the council's work despite bureaucratic hurdles.
Unclear: Senator Rosenwald Information Only01:36:50.600 - 1:34:51 PM; Senator Rosenwald clarified the appointment process for the council, noting that members are appointed by the governor or through the New Hampshire Hospital Association and the New Hampshire Medical Society. He emphasized the importance of teamwork and expressed concern about the impact of losing experienced members due to term limits. He suggested exploring the possibility of extending terms or removing term limits to retain valuable members.
Unclear: Representative McDonald Information Only01:38:04.560 - 1:36:05 PM; Representative McDonald discussed the potential benefits of eliminating term limits for council members, arguing that it would be easier to retain experienced individuals on various boards and commissions. He highlighted the difficulty in finding qualified people to serve and suggested that good people should be allowed to stay as long as they are doing a good job.
Unclear: Representative Woods Information Only01:39:34.320 - 1:37:35 PM; Representative Woods expressed willingness to help on the house side regarding the council's term limits issue, given his past involvement with the commission. He emphasized the importance of working with subject matter experts and thanked the members of HHS for their contributions to his learning and work.
Unclear: Representative Weber Information Only01:50:05.280 - 1:48:06 PM; Representative Weber supported the idea of regular updates on lapses from the Department of Health and Human Services, suggesting that quarterly or bi-monthly reports would be prudent and not overly intrusive. He emphasized the importance of monitoring financial aspects to ensure effective oversight.
Unclear: Senator Rosenal Information Only01:52:12.639 - 1:50:13 PM; Senator Rosenal expressed frustration over the lapses in financial information provided by the Department of Health and Human Services (DHHS) through the fiscal committee's monthly dashboard. He noted that while the dashboard provides detailed information about case workers, the financial section is often incomplete. He suggested considering legislation to compel the executive branch to provide more timely and accurate financial information, emphasizing the need for early budget adjustments.
Unclear: Unidentified Speaker Information Only01:53:06.719 - 1:51:07 PM; The speaker highlighted the issue of receiving unrealistic lapse numbers from the department, suggesting that the executive branch might not feel compelled to share accurate information. They proposed that legislation might be necessary to ensure timely and accurate reporting, using the example of their experience with the Family Division of the Circuit Court where cordial relationships led to proactive changes.
Unclear: Unidentified Speaker Information Only01:54:23.320 - 1:52:24 PM; The speaker continued discussing the need for better information from DHHS, suggesting that asking for lapse numbers alone might not be sufficient to compel the executive branch to share necessary data. They shared a positive experience with the Judiciary, suggesting a similar approach might work with DHHS to avoid adversarial legislation.
Unclear: Unidentified Speaker Information Only01:55:16.800 - 1:53:17 PM; The speaker emphasized the importance of having a cordial relationship with DHHS to encourage them to provide helpful information voluntarily. They suggested that this approach could lead to better outcomes than legislation, which might make the relationship adversarial. They also mentioned an upcoming presentation where both sides could work on improving the situation.
Unclear: Mr. Williams Information Only01:56:32.960 - 1:54:33 PM; Mr. Williams shared an example of working with the Water Division on a bill, where initial proposals were adjusted after discussions. He stressed the importance of ongoing discussions about efficiency and oversight, including the need for regular audit reports to understand departmental operations and findings.
Unclear: Representative Weber Information Only01:57:50.000 - 1:55:51 PM; Representative Weber sought clarification on whether the discussion was about audits conducted by the legislative performance audit oversight committee or internal DHHS audits. He emphasized the importance of understanding the department's compliance with statutory requirements.
Unclear: Representative McDonald Information Only01:59:06.119 - 1:57:07 PM; Representative McDonald, with his background in the department, praised the department's efforts given their resources and responsibilities. He appreciated the commissioner's update on the $80 million and stressed the importance of having more insight into the department's financial operations. He highlighted the potential financial implications of bills like the one to eliminate the Office of Health Equity, suggesting that better information could benefit both oversight and advocacy for the department.