Though Some Hospitals May Come Up Short, Senate Passes Uncompensated Care Bill

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Sen. Lou D'Allesandro, D-Manchester, Sen. David Watters, D-Dover and Sen. Jeb Bradley, R-Wolfeboro, chat during a break at the state Senate session Thursday.


CONCORD – In a battle between Gov. Chris Sununu and the New Hampshire Hospital Association over uncompensated medical care and how much federal money in the future the hospitals will receive, the Senate passed House Bill 1593 Thursday which gives $6 million more to hospitals than the governor suggested.

The vote was unanimous, 24-0.

The state gets hundreds of millions of dollars a year in federal dollars to help cover those hospital losses and a 2018 deal brokered to distribute that with the state must be renegotiated through legislation now.

The governor said two weeks ago he is looking to change the formula to allow for more money to go to community mental health and substance misuse treatment, diverting those funds from the hospital, while maintaining the hospitals are getting more money than they have in the past, just not as much of a percentage.

Sununu suggested they receive 91 percent of those funds this year instead of 100 percent which the hospitals asked for. The Senate amended that to 93 percent giving about $6 million more than the governor had outlined.

Steve Ahnen, president of the New Hampshire Hospital Association told the Senate Finance Committee May 14 the association is “in strong opposition” and that it threatens to “upend the partnership” the hospital has with the state because it will do them financial harm.

Sununu, who spoke just before Ahnen at that hearing May 14, said the relationship was already frayed but the Hospital Association is taking the state to court over the mental health emergency room boarding crisis, and maintains that they are the ones that are not willing to care for those individuals. 

Sununu also maintained they will still get more money than they did in the past, but that it was better to extend help to community-based care providers.

On Tuesday, Senate President Jeb Bradley, R-Wolfeboro, offered an amendment which would increase the hospital portion to 93 percent.

“This is not a finished product,” he said. “But I think that it moves the ball forward.”

Presuming a committee of conference will be necessary with the House version different, he said, there will be work to “maximize revenues to the state while having the least amount of impact possible to the hospitals.”

“We are moving away from the traditional disproportionate share of hospital payment. There will still be $130 million running through the DISH model but the balance will be to direct payments which is what enables the state to come out with a net positive and some hospitals to come out that way as well, though some hospitals will come out with a net loss,” Bradley said. 

That structure depends on the patient mix that every hospital has, the acuity level of that patient, the number of patients on Medicaid, Medicaid expansion or without insurance. That number changes annually, he said.

On the floor of the Senate Thursday, Bradley explained that the current settlement with the hospitals to get 91 percent of the MET or Medicaid Enhancement Tax is expiring and there needs to be passed a piece of legislation to continue the agreement.

There are budgetary implications facing the next legislature which are significant, Bradley said.

“We are trying to increase revenue to the state by moving away from the disproportionate share of the funding that goes into the formula and moving toward directed payments to take advantage of different percentage matches.”

By moving toward directed payments, Bradley said the state will see enhanced revenue to the state.

The added $6 million by increasing the percentage hospitals get from 91 to 93 percent will help shield some hospitals from harm as it is a fact that some of the hospitals come up a bit short on the new directed payment model.

Another change made was to soften the language that states the Health and Human Services Commissioner has the sole discretion, Bradley said noting that the new language would allow for a negotiated good faith settlement “that everyone could live with.”

Bottom line, he said the goal is to maximize new revenues coming to the state while at the same time, mitigating harm to hospitals, Bradley said.

“The fact that there are winners…and i.e.; some losers, was of major concern to the Finance committee. We all know that more work will need to be done to have a settlement….

“I hope that this will be the last time the Senate has to weigh in,” he said, adding he expects a committee of conference will occur with the House on the bill.

The committee of conference will take a few weeks, he noted.

Sen. Lou D’Allesandro, D-Manchester, supported the amendment. 

He said the bill is “so important” and recognized that “the hospitals are in trouble” and the state faces some daunting bills in the next biennium.

“What we (Senators) bring to the table is the needs of our communities and a message to solve the problem,” he said “That is what it is all about.”


A bill that would eliminate exceptions for the same day voter registration under HB 1569 passed, despite concern it could create loss for the state’s exemption from the federal motor voter laws.

Sununu has argued that he confers with the Secretary of State who does not feel the need for the change.

The vote was 13-11 with all Democrats and Sen. Sharon Carson, R-Londonderry voting in the minority.

Sen. James Gray, R-Rochester, said the bill is important and unamended.

He said he has spoken to the governor’s staff who expressed concern it might impact our motor voter exception.

Gray said HB 1370 “is a better bill” but if they both go to the governor, HB 1569 will likely be set aside.

Sen. Rebecca Perkins Kwoka, D-Portsmouth opposed the bill saying the state has fair and safe elections. “This is a solution looking for a problem,” she said.

Perkins Kwoka noted in 2022 and 2023 there were zero cases of people not being found after filing same day voter affidavits.

“We know our people have been using this tool, these affidavits,” she said and worried they would be disenfranchised.

Sen. Donna Soucy, D-Manchester, noted this bill is coming to the Senate in the same form as it passed in the House. This is effective 60 days after passage. Does that give the Secretary of State enough time, she asked. That is a really big concern.

D’Allesandro said the city clerks are opposed to the legislation. 

“We encourage people to vote, not discourage people,” he said.

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