Committee Summary for House Finance Division III (01/30/2025)

Bill/Time	Type	Title	Sponsor
Unclear 00:03:02.840 - 12:01:58 PM	General Working Session	Unclear

Unclear: Representative Walner Information Only00:03:02.840 - 12:01:58 PM; Representative Walner discussed the scheduling of a visit to Waypoint, a shelter in Manchester, suggesting it could be scheduled for the afternoon of February 5th. They mentioned having other commitments in the morning related to introducing bills but were flexible with the timing of the visit.
Unclear: Representative Seaworth Information Only00:05:10.039 - 12:04:06 PM; Representative Seaworth recalled that Waypoint had welcomed a visit anytime after a specific date, which they confirmed to be the 5th. They discussed the need to coordinate the visit and mentioned the possibility of mileage reimbursement for members traveling from distant areas like the North Country.
Unclear: Representative Stringham Information Only00:05:56.240 - 12:04:52 PM; Representative Stringham raised concerns about mileage reimbursement for travel to the Waypoint visit, noting the long drive from the North Country. They were unsure about the process for requesting reimbursement and suggested discussing it with the speaker's office.
Unclear: Representative Edwards Information Only00:06:42.120 - 12:05:38 PM; Representative Edwards discussed the scheduling of the Waypoint visit, suggesting it could be done in the afternoon. They also mentioned having bills to introduce but were open to adjusting the timing to accommodate the visit.
Unclear: Trish Tilly, Associate Commissioner, Department of Health and Human Services Information Only00:08:31.360 - 12:07:27 PM; Trish Tilly provided an overview of the Department of Health and Human Services' focus areas, including children's behavioral health, DCF (Division for Children, Youth, and Families), and adult mental health. She emphasized the integrated approach to serving youth and the importance of community-based services. Tilly discussed the challenges and strategies related to residential care, the new YDC (Youth Development Center) build in Hamstead, and the need for a data system upgrade called Granite Families. She also addressed questions about funding, foster care recruitment, and the collaboration with Dartmouth Health for the Hamstead hospital project.
Unclear: Representative Daniels Information Only00:55:30.039 - 12:54:26 PM; Representative Daniels inquired about the federal funding for the Granite Families data system and expressed concerns about the sustainability of federal funding given the national debt. They also questioned Dartmouth Health's policies on vaccinations and whether they would comply with state laws.
Unclear: Representative Mooney Information Only00:58:30.559 - 12:57:26 PM; Representative Mooney asked about the availability and recruitment of foster parents, as well as the marketing strategies used to attract more foster families. They also inquired about the rates and additional support provided to foster parents.
Unclear: Marissa Hen, Deputy Commissioner Information Only01:11:00.360 - 1:09:56 PM; Marissa Hen clarified the funding situation for the covered walkway between the new YDC facility and Hamstead hospital, noting that it was not currently included in the budget due to restrictions on using General funds under HB 49. They also reassured that Dartmouth Health would comply with all state laws as part of their contract.
Unclear: Representative Torki Information Only01:12:36.960 - 1:11:32 PM; Representative Torki sought clarification on the bed count for the new YDC facility, confirming that the goal was to serve 12 youth with a surge capacity up to 18. They were reassured that there was no intention to exceed the 18-bed ceiling.
Unclear: Unknown Speaker Information Only01:17:10.239 - 1:16:06 PM; The speaker raised a concern about the costly searching machine appropriated for the new YDC facility during the last term, emphasizing the need to ensure its inclusion in the construction plans due to its size and placement requirements. The discussion then shifted to workforce considerations at YDC, noting a mix of state and contracted positions for running the new center. The speaker also mentioned ongoing conversations about security, which is not yet budgeted, highlighting the need for an integrated security approach rather than it being an afterthought.
Unclear: Unknown Speaker Information Only01:17:56.239 - 1:16:52 PM; The speaker continued the discussion on the workforce at YDC, emphasizing the need for an integrated security approach rather than treating it as an add-on. They mentioned that the budget was prepared months ago without finalized security issues, which are being addressed in ongoing discussions with the committee and others. The speaker highlighted the importance of transparency regarding the budget's current status concerning security.
Unclear: Unknown Speaker Information Only01:20:14.440 - 1:19:10 PM; The speaker transitioned to discussing the adult community mental health system, noting that New Hampshire has 10 Community Mental Health centers designated to serve primarily low-income populations, Medicaid recipients, and individuals with severe mental health conditions. They emphasized the importance of keeping individuals supported within their communities to be productive, mentioning the large number of constituents served by these centers and the growth in services despite some centers undergoing electronic health record conversions.
Unclear: Unknown Speaker Information Only01:21:00.159 - 1:19:56 PM; The speaker discussed the financial impact on Community Mental Health Centers due to the Medicaid unwind at the end of the pandemic, noting that centers continued to serve individuals even after Medicaid coverage ended. They highlighted initiatives like rapid response to meet mental health needs in the community, away from hospital emergency rooms, and the growth in these services since 2021. The speaker also mentioned operational losses reported by eight out of ten centers due to uncompensated care, increasing workforce costs, and operational expenses.
Unclear: Unknown Speaker Information Only01:24:54.840 - 1:23:50 PM; The speaker elaborated on the operational losses faced by Community Mental Health Centers, emphasizing the dual challenge of attracting and retaining staff, which impacts the ability to generate income through Medicaid billable hours. They mentioned a $5 million ARPA contract to support these centers and the ongoing quarterly financial monitoring. The speaker also discussed the sustainability of the current model and the need for centers to develop recommendations for managing their finances.
Unclear: Unknown Speaker Information Only01:26:34.840 - 1:25:30 PM; The speaker responded to a question about the limitations faced by Community Mental Health Centers due to staffing shortages and lack of billable hours. They noted that some centers might need to implement waiting lists to manage patient intake and discussed a shift to the Certified Community Behavioral Health Clinic model, which integrates physical and mental health wellness. The speaker highlighted the ongoing work to adapt to declining resources and the critical role of these centers in the state's safety net.
Unclear: Unknown Speaker Information Only01:28:54.400 - 1:27:50 PM; The speaker discussed Mission Zero, a strategy to reduce emergency room boarding for adults to zero, emphasizing the complexity of the issue and the need for coordinated efforts at the front and back doors of hospital emergency departments. They mentioned various initiatives, including expanding community behavioral health clinics, crisis stabilization locations, and care traffic control to match resources with needs. The speaker also noted the importance of having safe places for individuals to transition out of acute care.
Unclear: Unknown Speaker Information Only01:31:14.719 - 1:30:10 PM; The speaker responded to questions about the effectiveness of Mission Zero, highlighting the legal obligation to address emergency room boarding and the focus on clearing out New Hampshire Hospital by ensuring places for discharged patients to go. They discussed the budgetary impact of these efforts and the use of various funding sources, including landlord incentives to provide stable housing for individuals transitioning out of acute care.
Unclear: Unknown Speaker Information Only01:35:53.840 - 1:34:49 PM; The speaker provided an update on Mission Zero's progress, noting a reduction in the average number of individuals waiting in hospital emergency rooms from 44 to less than 20, with occasional days reaching zero. They highlighted improvements in wait times from an average of four days to about a day and a half, emphasizing the importance of these reductions for individuals in mental health crises. The speaker also mentioned the collaborative efforts of various partners in achieving this progress.
Unclear: Unknown Speaker Information Only01:39:47.360 - 1:38:43 PM; The speaker discussed the progress of the department's roadmap, including the establishment of Certified Community Behavioral Health Clinics and crisis stabilization locations to reduce the need for emergency room visits. They mentioned the increase in inpatient care beds at New Hampshire Hospital and the upcoming addition of five more beds by Dartmouth Health. The speaker also responded to questions about the hospital's capacity and staffing, clarifying that the current capacity is 185 beds, with efforts to improve staffing.
Unclear: Unknown Speaker Information Only01:42:54.080 - 1:41:50 PM; The speaker addressed the broader context of the mental health crisis, mentioning the multifactoral reasons behind it and the importance of community connections and early recognition of mental health conditions. They discussed the role of prevention in reducing the need for treatment and the various community-based initiatives aimed at supporting families and children. The speaker also noted the challenges in scaling prevention programs and the need for ongoing evaluation of their effectiveness.
Unclear: Unknown Speaker Information Only01:49:47.760 - 1:48:43 PM; The speaker responded to a question about the overlap between mental health and substance abuse issues, acknowledging the significant crossover but not providing specific numbers. They emphasized the need for safe recovery facilities post-treatment and the department's efforts to address substance misuse, which were not covered in detail during the session.
Unclear: Unknown Speaker Information Only01:53:44.760 - 1:52:40 PM; The speaker concluded the session by reiterating the importance of scaling resources appropriately for both acute and preventive needs, and ensuring that individuals receive the right programs in the right settings. They emphasized the goal of serving people close to home, whether children or adults, and appreciated the investments made to support these efforts. The speaker also mentioned upcoming presentations on Public Health, Developmental Services, Elderly and Adult Services, and a focus on the transition to the new Youth Development Center.