Committee Summary for Senate Health and Human Services (01/08/2026)

Bill/Time	Type	Title	Sponsor
SB543 00:05:41.680 - 8:04:27 AM	Public Hearing	relative to long-term care eligibility and making an appropriation therefor.	Abbas, Daryl(R)[B-]2025
SB610 00:24:11.120 - 8:22:57 AM	Public Hearing	requiring an opportunity for public comment prior to proposed long-term care rate increases under certain circumstances.	Ricciardi, Denise(R)[B]2025
SB614 01:31:08.400 - 9:29:54 AM	Public Hearing	establishing pooled risk management programs for the benefit of child care centers and foster family homes.	Ricciardi, Denise(R)[B]2025
SB611 01:55:37.920 - 9:54:23 AM	Public Hearing	relative to rate setting parity for Medicaid state plan case management services.	Avard, Kevin(R)[B]2025
SB612 02:30:08.960 - 10:28:54 AM	Public Hearing	relative to clinical eligibility criteria for nursing facility and home and community based care.	Avard, Kevin(R)[B]2025

SB543: Grant Bossy, Deputy Chief of Staff, NH Senate Information Only00:05:41.680 - 8:04:27 AM; Grant Bossy introduced the bill on behalf of Senator Daryl Abbas, explaining it as a reintroduction of last year's SB 131, which passed unanimously but was not funded due to budget constraints. The bill addresses delays in Medicaid approvals for nursing home admissions by providing state bridge financing for 90 days to 18 months, repaid upon approval. It includes two new positions and a $1.5 million appropriation, with a fiscal note pending but identical to last year.
SB543: Brendan Williams, President, New Hampshire Healthcare Association Support00:07:57.759 - 8:06:43 AM; Brendan Williams expressed strong support for the bill, noting the association represents most NH nursing homes. He highlighted the financial strain from Medicaid pending claims, providing examples of large amounts owed to facilities like Salem Haven ($700,000+) and Coos County Nursing Home. He appreciated recent legislative efforts to address backlogs but emphasized the need for provisional payments to provide certainty. The bill would create a revolving fund replenished by federal matches, with rare denials requiring repayment. He urged passing the policy despite the modest initial funding.
SB543: Henry Litman, Medicaid Director, NH DHHS Support00:12:11.440 - 8:10:57 AM; Henry Litman supported the bill, describing collaboration with the Healthcare Association to structure it. He noted the need for two administrative positions and that $1.5 million is modest but the revolving fund concept is sound, with safeguards like contracts to protect the state, especially given risks like provider bankruptcies. The original request was $30 million, intended as temporary advanced funding before federal reimbursement.
SB543: Melissa Hardy, Division Director for Long-Term Supports and Services, NH DHHS Support00:13:07.040 - 8:11:53 AM; Melissa Hardy endorsed the bill, stating it complements DHHS efforts to streamline Medicaid eligibility and reduce backlogs through a new contractor. She confirmed close work with nursing facilities and the Healthcare Association to develop this solution for timely application processing.
SB543: Senator Bertzel, Committee Member Information Only00:14:12.880 - 8:12:58 AM; Senator Bertzel inquired about the two new positions in the bill (page 2, line 12-13) and whether discussions occurred with the governor regarding her hiring freeze, expressing concern about implementation timeliness.
SB543: Henry Litman (response) Information Only00:15:32.720 - 8:14:18 AM; In response to Senator Bertzel, Henry Litman noted no direct discussion with the governor on the hiring freeze, which could impact execution, but DHHS has bandwidth for setup like contracts, especially at the $1.5 million level versus the original $30 million request for revolving funds.
SB543: Kate Horgan, New Hampshire Association of Counties Support00:16:55.600 - 8:15:41 AM; Kate Horgan briefly supported the bill, noting it includes protections on page 2, line 7, ensuring counties are not responsible for providing funds and maintaining the existing cap, thus safeguarding county taxpayers.
SB543: Henry Beeu, Crotch Mountain Foundation Information Only00:17:41.360 - 8:16:27 AM; Henry Beeu, a board member of Crotch Mountain Foundation, provides housekeeping information regarding the bill. He notes that the Crutch Mountain Rehab Center referenced on page two, line nine, has been shut down years ago and is no longer in operation. He suggests deleting that reference from the statute. The foundation now operates Crotch Mountain community care for case management and CMF kids, which works with school districts and special education.
SB543: Courtney Tanner, Dartmouth Health Support00:19:33.120 - 8:18:19 AM; Courtney Tanner, senior director of government relations at Dartmouth Health, expresses strong support for SB 543-FN. She thanks Senator Abbis for introducing the bill and highlights the issue of 50 to 80 patients daily at Dartmouth Hitchcock Medical Center who are clinically ready for discharge but cannot transition from acute hospital care to the community. While long-term care facilities are not suitable for all, they are essential for those who need that level of care. She views this legislation as a key piece in addressing broader discharge barriers, building on prior efforts, and praises it as a strong public-private partnership.
SB543: Ben Bradley, New Hampshire Hospital Association Support00:20:21.039 - 8:19:07 AM; Ben Bradley from the New Hampshire Hospital Association provides context supporting SB 543-FN, representing 26 hospitals and five specialty hospitals. He references a June report showing 80 patients daily medically cleared for discharge but facing barriers, including 36 awaiting long-term care Medicaid determinations (45%). Recent data shows this has risen to 147 patients, implying about 66 awaiting Medicaid approvals. He notes median unnecessary hospital days of 64 per patient, leading to over two months of waiting. Additional complexities like guardianship, specialized beds, and dialysis needs exacerbate the issue. The association strongly supports the bill to facilitate transitions and reduce unnecessary hospital stays.
SB610: Senator Denise Rashardi, District 9 Support00:24:11.120 - 8:22:57 AM; Senator Denise Rashardi introduces SB 610, prompted by the New Hampshire chapter of the National Association of Insurance and Financial Advisors and constituents facing affordability challenges with long-term care policies. The bill modernizes New Hampshire's long-term care insurance laws to reflect current realities while maintaining consumer protections and regulatory accountability. It covers services not included in health insurance or Medicare, aiding retirement planning and asset preservation to avoid Medicaid reliance. Key provisions include clarifying regulatory authority on standards and disclosures, reinforcing protections against unfair forms, allowing innovation under strict standards, and permitting public hearings for transparency without mandating them. Initial drafts considered required public comment periods for rate increases, but the introduced version uses 'may.' The bill requires no new spending and strengthens oversight. She compliments the Department of Insurance for their collaboration.
SB610: DJ Bettencourt, NH Insurance Commissioner Support00:29:55.919 - 8:28:41 AM; DJ Bettencourt, NH Insurance Commissioner, joined by general counsel Rooney Carnis, thanks Senator Rashardi for her leadership on SB 610. The bill updates the long-term care insurance framework based on decades of lessons, focusing on market realism, consumer protection, and regulatory restraint. He explains the market's history: prominent in the 1980s-1990s with flawed assumptions on interest rates, longevity, and lapse rates modeled after life insurance, leading to mispricing and current premium increases as policyholders need benefits. Carriers face solvency challenges, balancing consumer impacts with company viability to avoid bankruptcy and limited payouts via guarantee funds. The bill enshrines existing standards in statute, allows innovation for new products, and authorizes (but does not require) public hearings on forms or rates while protecting proprietary information. He notes potential for mandating hearings but highlights workload implications, suggesting it could apply broadly or be modeled after other states. The goal is clear rules, innovation, and prioritizing NH consumers.
SB610: Rooney Carnis, NH Insurance Department General Counsel Support00:30:57.840 - 8:29:43 AM; Rooney Carnis supports the commissioner's summary and is available for technical questions. During Q&A, she clarifies that the bill does not change existing rate approval structures or retroactively affect contracts. She explains standards like 'not contrary to the best interest of the public' (from existing statutes and rules) involve reviewing for unfair practices, illusory benefits, and actuarial soundness. For public hearings, she notes confidentiality of filings until approval, with discretion to balance transparency and proprietary protections, potentially disclosing non-sensitive information while vetting thoroughly against insurance statutes.
SB610: Hal Sullivan, Financial Advisor Support00:55:33.280 - 8:54:19 AM; Hal Sullivan, a certified financial planner with over 50 years experience, including certifications in long-term care and senior living, supports SB 610, drawing from his own 88% premium increase over four years on a MetLife policy. He thanks Senator Rashardi and details long-term care history: sold from the early 1980s by smaller firms, then majors like GE Capital, with aggressive marketing and state-endorsed partnership programs requiring rich benefits. Around 2010, major carriers (now stock companies) stopped active sales due to unprofitable claims, halting new premium inflows that subsidize older policies, leading to substantial rate hikes. He criticizes carriers' actuarial assumptions and incentives for lapses, impacting seniors on fixed incomes, potentially driving them to Medicaid via strategies like annuities, burdening state budgets. Sullivan advocates mandating public hearings or 60-day comment periods for rate increases specific to long-term care (not all lines), notes NH subsidizes lax states, and highlights carriers' vast assets ($617B-$1.375T), arguing they face no hardship. He provides documents on rate calculations, emphasizing impacts on policyholders and the state.
SB610: Ron Evans, Manchester Oppose01:11:17.920 - 9:10:03 AM; Ron Evans, a Manchester resident and adjunct professor, testified about his experience with long-term care insurance purchased from Metropolitan Life in 2001. He and his wife intended it as a safety net for future care needs while protecting their assets. Premiums have doubled from $4,324 annually to $8,734 over 24 years, a 102% increase. He criticized insurance companies for ceasing sales in New Hampshire, which harms the risk pool and burdens existing policyholders. Companies like MetLife, with $72 billion in revenue and $4.8 billion net income, treat long-term care as a separate book of business, leading to unfair increases that force cancellations or benefit reductions. They've invested over $120,000, and further hikes could push them onto Medicaid, increasing state costs. He urged collaboration with the Insurance Department to hold companies accountable using full business performance, require public hearings before increases, and protect policyholders.
SB610: Carrie Grant, Manchester Oppose01:19:37.120 - 9:18:23 AM; Carrie Grant, a retired school psychologist from Manchester, testified as a policyholder who purchased long-term care insurance from John Hancock in 2003 on advice from financial planners and legal counsel. The policy aimed to cover home-based care in senior years, avoiding nursing facilities and protecting assets to prevent reliance on Medicaid. However, the Insurance Commission has approved exorbitant rate increases without policyholder input, threatening affordability at age 78. Original premium was $4,916 with unchanged benefits until 2016. After John Hancock discontinued sales around 2010, increases began: In 2017, benefits reduced (inflation guard from 5% to 2.7%, premium cut by $800); 2020, premium up $1,100 to $5,280, benefits cut from 6 to 4 years; 2023, up $1,042 to $6,250; 2024, up $792 (13%) to $7,042; 2026, up $1,480 to $8,522. A 2027 increase of $1,691 will raise it to $10,213, far exceeding the original contract despite reduced benefits.
SB610: Carrie Grant, Manchester Support01:24:11.280 - 9:22:57 AM; Carrie Grant continues her testimony on the challenges with long-term care insurance premiums. She explains that to avoid a $1691 premium increase in 2027, policyholders would need to reduce benefits significantly. Over 10 years from 2017 to 2027, premiums have increased by $6,040 or 147% from the initial premium. She criticizes John Hancock for stopping sales due to flawed actuarial assumptions and the insurance commission for bailing out insurers at consumers' expense. At 78 years old, she and her husband worry about affording premiums as they near the time they might need the coverage. Social Security and pension increases do not cover the 20% annual premium hikes allowed by the commission. She questions why consumers must pay for insurers' miscalculations and fears being forced out of their policies. She urges keeping the protection despite the costs, as advised by financial planners and lawyers.
SB614: Senator Denise Rashardi, District 9 Support01:31:08.400 - 9:29:54 AM; Senator Rashardi introduces SB 614, which allows child care centers and foster family homes to form risk pools for casualty and property insurance to reduce costs. She shares constituent concerns about waitlists for child care preventing workforce participation. Many centers face insolvency due to unaffordable liability insurance. The bill requires at least 10 participants, oversight by the Secretary of State, annual audits, actuarial reviews, and notice for rate increases. It aims to lower costs and improve stability without lowering standards. She notes collaboration with the Department of Insurance and Secretary of State, acknowledging the bill needs refinement.
SB614: Pete N., Deputy Commissioner, NH Insurance Department Information Only01:35:20.719 - 9:34:06 AM; Pete N. provides information on the insurance market challenges for child care and foster care providers, describing a hard market for liability insurance. He supports exploring risk pooling but notes New Hampshire's small size may not provide sufficient volume for economies of scale with only 10 entities. Suggests expanding to regional pools, like New England or Northeast states, citing issues in Pennsylvania and nationwide problems. Emphasizes the need for more entities to achieve affordability. Accompanied by Jennifer Smith and James Fox for questions.
SB614: Karen Benfield, Staywork Play Support01:39:40.000 - 9:38:26 AM; Karen Benfield offers perspective from young people and working families. Staywork Play's 2025 quality of life survey shows child care as the second most challenging issue, with 85% of young people viewing access and affordability as worse in New Hampshire. A third prefer community-based centers. Families need more supply fitting real schedules and costs. Employers struggle to attract talent due to child care gaps, leading parents to reduce hours or leave work. Centers operate on thin margins with rising costs, including insurance, causing delays in expansion and higher fees. SB 614 reduces overhead via risk pooling, stabilizing child care without new spending or lowered standards, supporting workforce retention.
SB614: N. Grace, BIA Statewide Chamber of Commerce Support01:42:43.199 - 9:41:29 AM; N. Grace supports SB 614, anticipating an amendment with input from the Secretary of State and Insurance Department. Nationwide, liability insurance costs for child care have risen sharply, passed to parents. The chamber focuses on child care affordability for attracting 20-40 year old talent with young children. Without care options, they cannot work. Insurance costs are reaching a crisis, with few providers available. The bill offers a solution for affordable insurance amid rising premiums, and the chamber will work with stakeholders for a good outcome.
SB614: Jennifer Smith, NH Insurance Department Support01:45:46.000 - 9:44:32 AM; Jennifer Smith clarifies the department's support for SB 614, modeled after Texas statute. Child care centers, nonprofits, and foster care face unaffordable liability insurance in a hard market. The bill aims to pool risks to lower costs, with discussions on regional expansion due to low volume in NH. Providers settle claims privately to avoid premium hikes or coverage loss, e.g., paying out-of-pocket for a child's playground injury. The department supports the senator's efforts, working with stakeholders, HHS, and centers on solutions including legal reforms like claim caps. High costs stem from uncapped damages, large-scale misconduct cases (e.g., YDC, Boy Scouts), and routine child injuries lumped together, pressuring the market. They are close to targeted solutions but need a few more weeks of stakeholder talks.
SB611: Senator Kevin Avar, District 12 Support01:55:37.920 - 9:54:23 AM; Senator Avar introduces SB 611, directing the Department of Health and Human Services to annually set equal rates for identical Medicaid state plan case management services: mental health and choice for independent case management, both under code T1016. It corrects disparities using consistent federally compliant methodology, aligning with federal rules requiring equal reimbursement. A 2024 rate study improperly benchmarked rates. Legislative committees since 2018 recommended parity. The bill ensures fairness, compliance, and integrity without expanding services. Non-compliance risks federal funding losses, emphasizing the importance of parity for providers and overall Medicaid compliance.
SB611: Henry Litman, State Medicaid Director, and Melissa Hardy, Division Director for Long-Term Supports and Services Information Only02:00:33.920 - 9:59:19 AM; Henry Litman and Melissa Hardy provide departmental perspectives on SB 611, agreeing with concerns about compliance risks in areas like SNAP and eligibility. They highlight past appropriations for rate increases, such as for CFI, which were compromised but could be revisited. They discuss challenges in rate setting, noting willingness to adopt a cost-based methodology similar to that used for the DD population, though it requires time and CMS approval via state plan amendments. They emphasize that current rates have been approved and suggest an appropriation for quick action, with cost-based rates ensuring fairness and transparency. They address compliance, explaining that different providers can use the same code with varying rates, as seen in mental health and FQHCs, and that cost-based approaches align with federal requirements without guaranteeing 100% cost coverage.
SB611: Heidi Kroll, Jay Grimbleis Strategic Solutions, representing Life Coping Support02:09:06.719 - 10:07:52 AM; Heidi Kroll supports SB 611, aligning with Senator Avard's comprehensive remarks on compliance and fairness. She notes the bill's language mirrors sections 520-522 of the Senate-passed HB 2 from the past session, which included a $2.3 million appropriation removed in conference. She advocates for rate parity across providers, particularly for CFI serving individuals eligible for nursing home care but preferring home-based services to maintain safety and free up institutional beds. She references prior efforts like PAR language in 2023 HB 2, study committees chaired by Senators Gaida and Rosenwald, indicating the issue's persistence and openness to working with the department for resolution.
SB611: Carolyn Virtue, Legislative Solutions, representing Granite Case Management Support02:13:25.199 - 10:12:11 AM; Carolyn Virtue introduces her grandson and family, thanking the legislature for homeschooling support and crediting Senator Roachford's advice. She then shares personal experience with her late mother and schizophrenic sister Lorine, who uses Riverbend Mental Health Center, making her intimately familiar with mental health case management. She offers to answer questions privately on the topic, implying support for equitable case management rates in the context of SB 611.
SB611: Carolyn Virtue, Legislative Solutions, representing Granite Case Management Support02:16:32.240 - 10:15:18 AM; The speaker disagrees with the department's assertion that the proposed case management is very different from CFI case management, noting that CFI requirements are more extensive than mental health ones. Lorine's visits are about 15 minutes, while CFI visits are 45 minutes to an hour and a half. She emphasizes the importance of remembering the department's comparisons.
SB611: Carolyn Virtue, Legislative Solutions, representing Granite Case Management Support02:17:33.599 - 10:16:19 AM; The speaker argues that comparing to DD is apples to oranges, as case management is defined and coded similarly to behavioral health case management. She questions the department's comparison to CFI and DD, noting CFI is a state plan service and DD is a waiver service with agreed differences during last year's Senate finance portion, leading to an agreement on rate setting that was unfortunately cut in the committee of conference.
SB611: Carolyn Virtue, Legislative Solutions, representing Granite Case Management Support02:18:31.439 - 10:17:17 AM; The speaker thanks the committee and Senator for their work. She mentions a CMS-approved methodology for rate setting that the department has not met. The department's July 2024 rate study benchmarked the CFI rate against itself, which does not meet good benchmarking practices, and failed to consider the identical behavioral health case management rate.
SB611: Carolyn Virtue, Legislative Solutions, representing Granite Case Management Support02:20:21.040 - 10:19:07 AM; The speaker criticizes the Department of Health and Human Services for randomly adding duties to case management via memoranda, such as home delivered meals, and offers to provide an example.
SB611: Carolyn Virtue, Legislative Solutions, representing Granite Case Management Support02:21:11.359 - 10:19:57 AM; The speaker references the New Hampshire drafting and procedure manual for administrative rules, noting that internal memoranda setting policy only for department employees should not apply duties to case management or private providers. She emphasizes that the manual requires the department to describe costs to citizens and benefits to independently owned businesses like her LLC. She criticizes the department for making changes without going through the joint legislative committee on administrative rules, leading to arbitrary decisions. In closing, she advocates for simple math in rate setting per state and federal regulations, directing the department to comply with guidance and methodologies. She suggests that if a cost-based methodology is used for CFI case management, it should be based on or include behavioral health case management, not DD services.
SB612: Senator Kevin Avar, Prime Sponsor Information Only02:30:08.960 - 10:28:54 AM; Senator Avar introduced SB 612FN, which modifies long-term care eligibility by adding mobility to the activities of daily living list. The bill requires the Department of Health and Human Services to obtain determinations of applicants' needs from the applicant, primary care physician, physician associate, advanced practice registered nurse, or other health care providers. He noted past issues with wrongful drops from CFI coverage due to flawed medical eligibility assessments (MEAs), but recent changes have reduced such incidents. However, new problems include drops due to failure to schedule or reapply for MEAs, with case managers uncompensated for scheduling assistance.
SB612: Melissa Hardy, Division Director for Long-Term Supports and Services, and Henry Litman, State Medicaid Director, Department of Health and Human Services Information Only02:32:55.680 - 10:31:41 AM; Melissa Hardy and Henry Litman provided an update on improvements to the MEA process following a stakeholder group that met seven times in 2025. They reduced the MEA form from 14 pages to 3 pages by removing repetitive and care-planning elements unrelated to medical eligibility under HM 802, including addressing mobility under ADL criteria. For annual redeterminations, they are seeking CMS approval for case manager attestations instead of full MEAs to reduce administrative burden and scheduling issues. They discussed a new solicitation for an MEA and PASRR vendor closing soon, with implementation targeted for July 1, including IT enhancements for automation and integration. Since last year, only 26 denials occurred, with safeguards like outreach to case managers and bridging services. They agreed to consult on a potential moratorium on discontinuing eligibility until July 1 to avoid disruptions.
SB612: Amy Moore, Vice President of External Relations at Easterseals, Board President at Granite State Home Health and Hospice Association Support02:44:34.479 - 10:43:20 AM; Amy Moore supported SB 612, highlighting how administrative delays in MEAs have led to 69 medically frail individuals losing Medicaid-funded services since 2024, with over 20 cases unresolved and waits up to a year. This burdens home care agencies with unbillable hours and threatens closures amid rising costs. She shared examples of vulnerable clients suffering, emphasizing that systemic failures cause harm, including deaths, and that each departmental change creates costs for vulnerable people. While acknowledging the department's progress and her participation in the stakeholder group, she stressed the need for interim safeguards to prevent shutdowns until changes are fully implemented in July, and better oversight of contractors.
SB612: Cheryl Steinberg, Director of Justice and Aging Project, New Hampshire Legal Assistance Support02:49:24.560 - 10:48:10 AM; Cheryl Steinberg supported SB 612, reiterating her testimony from last year. Despite positive departmental efforts like form reductions and stakeholder input, she advocated for a wait-and-see approach, especially with the upcoming vendor hiring and online MEA algorithm development, urging inclusion of consumer and advocate perspectives. She described ongoing issues as a roller coaster or whack-a-mole, with new closure problems from unscheduled appointments replacing old eligibility issues. She referenced a 2024 departmental pause on terminations during the unwind process and called for similar action now, citing examples like language barriers leading to terminations. She raised concerns about ADA compliance, guardian notifications, insufficient notices for appointments and terminations, and the need for more detailed appeal guidance in notices.

Rochefort, David(Chairman)(R)[B-]2025	Avard, Kevin(V Chairman)(R)[B]2025	Birdsell, Regina(R)[B-]2025
Prentiss, Suzanne(D)[F]2025	Long, Pat(D)[F]2025