Committee Summary for Health and Human Services Oversight Committee (04/25/2025)

Bill/Time	Type	Title	Sponsor
Unclear 00:10:59.839 - 12:06:30 PM	General Working Session	Unclear

Unclear: Chair Information Only00:10:59.839 - 12:06:30 PM; The Chair opened the Health and Human Services Oversight Committee meeting on April 25, 2025, and discussed the attendance of committee members, including representatives La, Pearson, McDonald, and Blink. The Chair mentioned the potential use of a Democratic alternate and the presence of a new member aspirant who has not yet been confirmed. The Chair expressed a preference for consensus over voting and decided to hold the minutes until the next meeting.
Unclear: Dry Information Only00:13:06.160 - 12:08:37 PM; Representative Dry introduced themselves and humorously noted their name, Dry, as in the sense of humor.
Unclear: Chair Information Only00:14:44.880 - 12:10:15 PM; The Chair discussed the minutes from the last meeting, noting that they now included pages 2, 4, and 6. The Chair asked for a motion on the minutes, which was moved and seconded, and the minutes passed.
Unclear: Ann Landry, Associate Commissioner Information Only00:15:51.240 - 12:11:22 PM; Ann Landry, Associate Commissioner, presented on behalf of the DHS Commissioner, focusing on the New Hampshire Community Re-Entry Program. She explained that the program is part of an 11:15 waiver, which allows for services not typically covered under traditional Medicaid. The program targets individuals in state prisons and county facilities, aiming to reduce recidivism by providing services like substance use disorder and mental health treatment, as well as connecting them to community resources before release. Landry highlighted the program's phased rollout, starting at state facilities and planning to expand to counties, and discussed early successes and the potential for cost savings.
Unclear: Representative Information Only00:20:29.039 - 12:16:00 PM; A representative asked about the necessity of waivers for Medicaid services and the number of states with similar waivers. Landry explained that most states have some form of 11:15 waiver, and community re-entry is a new area that CMS is allowing.
Unclear: Representative Information Only00:25:32.159 - 12:21:03 PM; A representative inquired about the 30-day supply of medications provided under the program, questioning its realism. Landry responded that the program is a five-year demonstration, and they aim to show cost-effectiveness and budget neutrality.
Unclear: Representative Information Only00:37:42.720 - 12:33:13 PM; A representative asked about the next steps for the program. Landry mentioned that after stabilizing the program at state facilities, they plan to work with counties, potentially starting with two and then expanding, depending on staffing and funding.
Unclear: Representative Information Only00:38:54.680 - 12:34:25 PM; A representative asked about the selection of counties for program expansion, suggesting larger counties like Merrimack or Rockingham. Landry noted that population and readiness are factors, and they might start with one larger and one smaller county.
Unclear: Representative Information Only00:39:56.280 - 12:35:27 PM; A representative asked about the similarities between New Hampshire and California's programs. Landry explained that while the programs differ, both states phased in their rollouts and focused on mental health and substance use disorder.
Unclear: Representative Information Only00:41:01.200 - 12:36:32 PM; Representatives from Sullivan and Cheshire Counties advocated for their counties to be considered for the program, citing unique challenges and successes in their areas. Landry acknowledged their points and mentioned the importance of provider community integration.
Unclear: Representative Information Only00:43:17.440 - 12:38:48 PM; A representative asked about funding challenges for the program. Landry explained that the waiver is self-generating, and they expect cost neutrality or savings by avoiding expensive emergency room visits.
Unclear: Melissa Hardy, Division Director for Long-Term Supports and Services Information Only00:45:11.839 - 12:40:42 PM; Melissa Hardy presented the fiscal year 25 quarter 2 BDS waitlist report. She reported that the department funds 100% of requests for the developmental disabilities waiver, acquired brain disorder waiver, and children's in-home support waiver. Hardy detailed the number of individuals requesting services, those who withdrew, and those who started services, along with reasons for delays such as Medicaid eligibility and family requests.
Unclear: Representative Information Only00:51:52.800 - 12:47:23 PM; A representative asked about the last time there was a waitlist for the developmental disabilities waiver. Hardy responded that it was in 2020.
Unclear: Representative Information Only00:51:52.800 - 12:47:23 PM; A representative inquired about workforce issues affecting service start times. Hardy confirmed that provider capacity is an issue but noted that the specific reasons for delays in the report were Medicaid eligibility and family requests.
Unclear: Representative Information Only00:55:41.680 - 12:51:12 PM; A representative asked about the funding allocation for the in-home supports waiver. Hardy explained that the funding is reserved for individuals waiting for new or enhanced services.
Unclear: Representative Information Only00:56:55.040 - 12:52:26 PM; A representative asked for clarification on what constitutes an acquired brain disorder. Hardy provided examples such as head injuries from accidents, strokes, and substance use-related brain damage.
Unclear: Henry Lipman Information Only00:58:18.160 - 12:53:49 PM; Henry Lipman presented on the Medicaid Care Management 3.0 contract priority areas. He discussed the focus on primary care and prevention, managing medication costs, care management for priority populations, and strengthening the community mental health system. Lipman highlighted the new standard contract for community mental health centers and the emphasis on authentic patient-provider relationships.
Unclear: Representative Information Only01:10:42.000 - 1:06:13 PM; A representative thanked Lipman for a recent 3% increase to family practice medicine and expressed concerns about the increasing costs and potential for physicians to leave the field. Lipman offered to meet with practices to discuss new billing opportunities.
Unclear: Representative Information Only01:11:47.920 - 1:07:18 PM; A representative expressed interest in the criteria for high-cost treatments and requested a future presentation on the topic. Lipman agreed to arrange it.
Unclear: Susan Drown, Director of the Bureau of Program Quality Information Only01:13:48.960 - 1:09:19 PM; Susan Drown, along with Aaron Metaf and Meredith Tuloose, presented on the Medicaid quality strategy and priority areas. They explained the use of quality-oriented activities to drive improvement in the Medicaid Care Management Program, including quality withhold and incentive programs, performance-based auto assignment, liquidated damages, and quality improvement projects. Drown detailed how these financial levers are used to incentivize managed care organizations to meet performance targets.
Unclear: Representative Information Only01:20:02.239 - 1:15:33 PM; Representatives asked for clarification on the concept of 'levers' and how they are used. Drown explained that levers are financial incentives or penalties used to guide the behavior of managed care organizations and providers.
Unclear: Representative Information Only01:35:10.520 - 1:30:41 PM; A representative expressed concerns about the corporatization of medicine and the dehumanization of patient care due to data entry requirements. Drown acknowledged the issue and emphasized the priority of creating authentic provider-patient relationships in the new contract.
Unclear: Representative Information Only01:37:05.920 - 1:32:36 PM; A representative highlighted the decreasing number of primary care physicians and the potential impact on Medicaid services. They stressed the need for action to prevent further loss of healthcare providers.
Unclear: Chair Information Only01:39:16.080 - 1:34:47 PM; The Chair opened the floor for any comments or questions following the previous discussion. There were no further comments from the attendees. The Chair then addressed the scheduling of the next meeting due to the upcoming Memorial Day holiday, proposing either May 16th or May 30th. The consensus was to schedule the next meeting for May 16th.
Unclear: Danielle Hernandez, Administrator of the Health Professions Data Center, Division of Public Health Services Information Only01:40:32.600 - 1:36:03 PM; Danielle Hernandez presented the 2024 report on the New Hampshire healthcare workforce and data collection, reflecting data from state fiscal year 2022. She highlighted key statistics and trends in the workforce, including net supply changes, practice status, demographics, and geographic distribution. Hernandez discussed the implementation of a license renewal requirement in 2020 to collect data, which aids in policy decision-making and supports various state objectives like federal shortage designation, recruitment and retention initiatives, and emergency preparedness. She emphasized the role of the Health Professions Data Center as a central repository for advanced practice healthcare workforce data, providing year-round workforce supply and demand figures. Hernandez also announced the development of a comprehensive dashboard for all surveyed providers and years of data, set to be released at the beginning of state fiscal year 2026. She detailed the growth in APRNs, the decline in primary care physicians, especially in rural areas, and the concerning loss of dentists. Hernandez concluded by discussing strategies to strengthen the primary care workforce, such as instate exposure to practice, education, and training, and the importance of pipeline programs despite limited funding. She also shared a testimonial from a dentist in the north country highlighting the importance of programs like the State Loan Repayment Program (SLRP) for retaining providers in rural areas.
Unclear: Representative Information Only01:45:56.560 - 1:41:27 PM; The Representative sought clarification on the significant increase in APRN numbers, questioning if it was possible to have such a high graduation rate in one year. Hernandez explained that the increase was part of a trend starting before the pandemic, facilitated by reduced barriers to licensure and clinical practice, including telemedicine expansion.
Unclear: Representative Information Only01:48:11.400 - 1:43:42 PM; The Representative inquired about the number of APRN programs in the state. Hernandez mentioned several popular programs like UNH, Rivier, and St. Anselm's College, and promised to provide more detailed information later.
Unclear: Representative Wood Information Only01:49:25.679 - 1:44:56 PM; Representative Wood asked about the demographics of the new APRNs, specifically their practice status. Hernandez noted that while the survey captures full-time and part-time clinical practice rates, it does not cover the first two years of practice, and trends show higher clinical practice rates for APRNs compared to physicians.
Unclear: Representative Information Only01:51:46.080 - 1:47:17 PM; The Representative sought clarification on the 80% figure mentioned by Hernandez, which was explained as the percentage of APRNs in full-time or part-time clinical practice in New Hampshire.
Unclear: Representative Information Only01:53:43.880 - 1:49:14 PM; The Representative asked about the location of family practice residency programs in New Hampshire. Hernandez listed several locations including Dartmouth in Lebanon and Concord, Portsmouth Regional, the Coos Health Teaching Health Center in Berlin, and Cheshire in Keene, associated with Dartmouth Medical.
Unclear: Representative Information Only01:55:41.040 - 1:51:12 PM; The Representative inquired about the anticipated supply indicators for primary care physicians, particularly the concerning trend of 15% planning to leave clinical practice in five years. Hernandez confirmed the statistics and highlighted the lower new patient acceptance rates and longer wait times for primary care physicians, especially in rural areas.
Unclear: Representative Information Only01:57:43.000 - 1:53:14 PM; The Representative sought clarification on the data presented in tables 6.1 and 6.2, which compare provider rates and percentages of physician practice across public health regions. Hernandez explained the differences and the importance of APRNs and PAs in rural areas.
Unclear: Representative Dry Information Only02:03:26.560 - 1:58:57 PM; Representative Dry, from Sullivan County, sought clarification on the data's relevance to the county, particularly the difference between the upper valley and greater Sullivan County. Hernandez explained the use of public health regions and the potential for different geographic breakdowns in future analyses.
Unclear: Chair Information Only02:06:32.079 - 2:02:03 PM; The Chair requested a five-minute wrap-up from Hernandez and suggested a follow-up meeting with more prepared questions. Hernandez agreed to return and offered to provide data in different geographic breakdowns if needed.