Seacoast Online – April 23, 2025
By IAN LENAHAN, Portsmouth Herald
PORTSMOUTH — Proposed cuts to New Hampshire’s Medicaid reimbursement rate for medical providers could lead to the loss of coverage for hundreds, if not thousands, of patients seen by the Seacoast Mental Health Center annually, the clinic’s longtime president warns. The New Hampshire House of Representatives passed its version of the state biennial budget that includes reductions in Medicaid reimbursement rates by 3% across the board the next two years, which is projected to mean nearly $53 million in cuts. Seacoast Mental Health Center President Jay Couture said that cut alone could cost the center about $500,000 in revenue in each of the two budget years.
Seacoast Mental Health Center patients would lose Medicaid coverage for mental health and substance use treatment, and jobs could be lost or restructured if the present budget proposal were signed into law today, Couture added. The local center, which includes community outreach, housing, job support, nutrition and mobile crisis unit staff, currently has 28 job openings. “Medicaid is the largest source of revenue for community mental health centers,” Couture said. “That’s because we are the designated providers for adults with serious, severe, persistent mental illness and kids with serious emotional disorders. Naturally that’s going to lead to more people who have either disability benefits or Medicaid due to being lower income.”
Jay Couture, president and CEO of the Seacoast Mental Health Center, talks about the impact that the proposed biennial state budget will have on mental health services in New Hampshire on Monday, April 14, 2025.
Gov. Ayotte opposes Medicaid reimbursement cut
New Hampshire Gov. Kelly Ayotte is calling upon state budget writers to remove the proposed Medicaid reimbursement cut from the budget before it reaches her desk. “Our state cannot go backward on support of those providing critical services to our most vulnerable citizens, including our community mental health centers. I’m urging the (state) Senate to restore this funding,” Ayotte said Tuesday in a prepared statement.
The state’s biennial spending proposal is now under review by the state Senate Finance Committee, which is expected to restore some of the House-proposed cuts.
State Sen. Sharon Carson, a Londonderry Republican, sits on the Senate Finance Committee. She said the matter, along with other House-proposed cuts, are still under review. “Throughout the budget process, we are taking testimony from all the involved agencies before we make decisions,” Carson said in a statement Tuesday. “We are listening to the agencies and trying to figure out the best paths forward for Medicare, Medicaid, mental health centers, and anything related to healthcare. However, it is too early in the budget process to say where things will end up. We still have a long way to go, and we need to know where the most recent revenue projections stand before figuring out what will happen.”
Other members of the Senate Finance Committee, including state Sen. James Gray, a Republican from Rochester and chairperson of the committee, did not respond to requests for comment Tuesday.
The Portsmouth facility is one of 10 community mental health centers in New Hampshire and treated roughly 6,100 people and families last fiscal year. Since 2002, Couture has been the president of the center, which covers patients from 24 municipalities in the eastern half of Rockingham County. In a given year, Medicaid reimbursement makes up 65% to 75% of revenue at the Seacoast Mental Health Center. At some other state community mental health centers, upwards of 90% of revenue comes from Medicaid reimbursement, Couture said. Seacoast Mental Health Center has roughly 3,500 to 3,800 patients receiving various treatments. Most are covered by Medicaid.
“As a humane society, one would think that we would want to offer the best healthcare options possible. It is health care. We wouldn’t treat someone with a physical illness so poorly the way that our system, at times, does for people living with mental illness,” Couture said. “We don’t say no to people with kidney disease or diabetes. But sometimes that’s what it feels like the government is saying when they’re talking about massive cuts that will end access to care for certain segments of the population.”
Seacoast Mental Health Center lost $1.5 million in fiscal year 2024: Here’s why
The proposed reduction follows recent revenue losses for the Seacoast Mental Health center. In April 2023, New Hampshire began disenrolling Medicaid recipients following the end of a federal, COVID-19-era policy that allowed people to stay on Medicaid after their original program qualification and enrollment. From that alone, Couture said the “uncompensated care” at Seacoast Mental Health Center led to the facility losing almost $1.5 million in revenue in fiscal year 2024. Couture worries more Medicaid money could be lost in the future.
Almost 500 current Seacoast Mental Health Center patients are enrolled in the state’s Granite Advantage Medicaid coverage program for low-income residents. Passed in 2018, a state trigger law calls for the Granite Advantage program to end within six months if the federal government’s funding allocation for the program dips below 90% of the overall total. According to Couture, if the center’s Granite Advantage recipients lose their Medicaid coverage, it would equate to an annual loss of roughly $5 million in revenue for the Portsmouth center.
State mental health leaders: NH House budget doesn’t support ‘Mission Zero’
Additional strain could be felt in New Hampshire hospital emergency rooms under the proposed state Medicaid reimbursement slash, state mental health leaders say. A May 2023 announcement from the state health and human services department outlined a goal of eliminating hospital emergency department psychiatric boarding by 2025. The “Mission Zero” initiative — which only accounts for adults and not children — is a key priority in the state’s 10-year Mental Health Plan, finalized in January 2019.
The New Hampshire Community Behavioral Health Association, which represents all 10 state community mental health facilities, and the state’s National Alliance on Mental Illness (NAMI) chapter spoke to the impacts the proposed Medicaid reimbursement cuts could have on Mission Zero. “This erosion of services will impact important advances — such as Mission Zero — made in recent years by the state and community mental health providers that address hospital boarding issues, provide more appropriate crisis interventions and care, avoid more expensive care, and help to stabilize the workforce,” the New Hampshire Community Behavioral Health Association wrote in an April memo to state community mental health providers after the New Hampshire House vote.
Susan Stearns, executive director of NAMI New Hampshire, sounded the alarm prior to the full House vote that there could be “no end in sight” for emergency hospital department boarding under the proposal. On multiple days in December and in February, there weren’t any New Hampshire adults needing hospital emergency room admission due to a mental health crisis. That, according to Stearns, had not been achieved since the early peak of the COVID-19 pandemic. Stearns stated the House-approved cuts would unravel years of progress. “New Hampshire’s work to recover from past catastrophic cuts has taken years. Mission Zero is a key part of the work to restore what was once considered one of the best mental health systems in the country,” Stearns wrote in an April 8 newsletter. “The proposed House budget has the potential to set us back more than a decade, eroding a critical system of care. Every one of us, every family, is but one crisis away from needing to utilize these services. The cost of these proposed cuts would be borne by Granite Staters and their families when they are at their most vulnerable.”
Couture noted the trickle-down effect an increase in mental health emergency room boarding would have on other patients needing hospital services. “If you eliminate the access to care by eliminating Medicaid, then you’re going to shift those services … and they’ll likely increase the number of people who are in the emergency department,” Couture said. “Then we’ll be right back to having 50 or 70 people who are stuck there. That’s not good for anyone. That doesn’t just harm access for people living with mental illness and substance use disorders. If you have a cardiac issue and you go into a hospital that’s got a dozen behavioral health holds, that’s going to impact your access to care, too.”
Couture: ‘People need to reflect’ on proposed Medicaid cuts
One in four New Hampshire adults experience a mental illness annually, according to Couture. She said existing state mental health funds “weren’t adequate to begin with to meet the needs of the people in our state.” “I think that people need to reflect on how their loved ones, their neighbors, their coworkers will be impacted if the cuts that are proposed are put into place,” Couture said. Nearly 187,000 New Hampshire residents were enrolled in Medicaid — approximately 13% of the state’s population — at the end of February, according to the University of New Hampshire.