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HHS divisions adjust to pandemic changes

By Garry Rayno - InDepthNH | May 4, 2021

State Sen. Cindy Rosenwald, D-Nashua, is pictured in this file Twitter photo.

CONCORD — State Health and Human Services programs have had to adapt to shifting uses during the pandemic with some increase in patients and others with fewer than anticipated.

The shifting usage has made budgeting for the next two years difficult to predict and provided the agency an opportunity to consolidate and transform programs.

Divisions within the agency presented their budget proposals and requested changes to the House’s approved $13.67 billion budget Monday before the Senate Finance Committee.

Since the onset of the pandemic, state Medicaid rolls were expected to increase from between 43,000 to 105,000 as federal and state eligibility requirements were loosened, but the state has been on the low end of the prediction, said Harry Lipman, state Medicaid director.

However, the Medicaid rolls did increase 23.7 percent to 219,242 individuals from March 16, 2020, to April 26,2021, with the greatest increase in the Granite Advantage or Medicaid expansion population of low-income adults, which increased 46 percent to 75,010.

Among the eight Medicaid programs, only one program has fewer participants today than it did when the public health state of emergency was declared a year ago, children with disabilities in home care, which dropped from 1,277 to 1,205.

One issue that plagues several divisions is transitional housing for both the Medicaid program and the state mental health system as they seek additional beds and increased provider rates in order to attract bidders.

Medicaid officials seek slightly over $4 million for rate increases in the next biennium.

The mental health system had $5 million to add additional beds, but only 18 were created, 16 by converting the Philbrook Center on the New Hampshire Hospitals grounds, using just over $3 million.

Katja Fox, head of the Mental Health Division, said the nearly $2 million remaining will lapse because the division could not procure additional beds at the state reimbursement rate.

Acute Mobile Units

The Mental Health Division decided to combine both adult and children mobile crisis teams to address acute mental illness across the state. Lawmakers approved separate child and adult units, but currently there are only three adult units operating in Manchester, Nashua and Concord.

Fox said her division is working with the community mental health centers to develop additional units to serve both adults and children.

The mobile units were intended to reduce the number of adults and children in hospital emergency rooms waiting for acute mental illness treatment at the New Hampshire Hospital.

“Instead of coming to emergency rooms and waiting,” Fox said, “our vision is for us to go to them.”

Her division seeks an additional $5.5 million in the proposed 2022-2023 biennial budget for mobile mental health crisis units.

Child Abuse

The Division of Public Health also seeks an additional $1.06 million not in the House budget for several programs seeking to reduce child abuse.

The division’s acting director, Patricia Tilley, said preventing “adverse childhood experiences” impacts a person’s health particularly chronic diseases and “behavioral complexities.”

She said her agency works in conjunction with the Division for Children, Youth and Families to provide the preventive services “so they never have to go near child protection programs.”

Tilley said the pandemic has moved different divisions to work together and for her division to work more closely with Homeland Security and the Division of Safety.

She said her division has focused on the pandemic in many areas from testing and laboratory services to managing millions of pieces of personal protection equipment.

Planned Parenthood

Several senators asked Tilley about the House Bill 2 provision added by House Finance that effectively prevents Planned Parenthood from providing family planning and other health-care services to low-income individuals.

About 17,000 people a year use family planning services, Tilley said, at 15 locations around the state. Of that number, 12,000 low-income, mostly women, receive health-care services through Planned Parenthood, according to the organization.

In the past, when Planned Parenthood services were targeted, federal Title 10 money was sent directly to the organization.

State Sen. Cindy Rosenwald, D-Nashua, said agency officials said it could be six months to a year before the federal money is available.

Public health division director Lisa Morris said the new administration is changing the rules governing the program and has said they will be finalized within the year, although they want to move as rapidly as possible, possibly for the new federal fiscal year which begins Oct. 1.

The agency has requested a “more one-time expenditure” of $400,000 said Kerrin Rounds, the agency’s chief financial officer, to take care of the need until the federal money is available.

Rosenwald asked how the federal Title 10 funds would be impacted by the House Bill 2 provision, and Tilley said they would not be, but could impact some of the providers contracting with the agency.

“We can accept those funds,” she said, “but maybe some of our partners in the communities may not want to accept the requirements of House Bill 2.”

Medicaid Billing

The Division of Medicaid Services seeks additional money to upgrade or reconfigure its Medical Management Information System.

According to Lipman the system needs to come into compliance with changes to the federal system, state law, and be more secure.

The system was first approved in 2005 at an estimated cost of $60 million, and went through a number of starts and stops including the contractor being taken over by Xerox and completed about decade later at a cost approaching $120 million, mostly paid for by federal funds.

The system was plagued early on with many errors including shortchanging hospitals and other health-care providers millions of dollars for services.

The current operating contract costs $7.6 million in general funds annually, while a five-year extension would cost $9.9 million in general funds annually.

The House approved capital budget includes $90 million for “lifecycle management and re-procurement” of the system, $9 million in general fund dollars.

Lipman said the agency has an opportunity to address the system’s shortcomings into the future.

Dental Benefits etc.

The division also would like Senate budget writers to include funding for an adult dental benefit in the second year of the biennium at $1.4 million.

Also, the division would like the Senate to fund the “in and out” program which decreased the money a person would have to “spend down” before qualifying for the medically needy benefit.

The change was made during the pandemic.

The Senate Finance Committee finished hearing state agency budget requests Monday and now begins work crafting its version of the state’s next two-year spending plan.

The Senate has a June 3 deadline to approve a new biennial budget. The House and Senate will have to reconcile their differences and approve a plan before the current biennium ends June 30.

Garry Rayno may be reached at garry.rayno@yahoo.com.

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