In various aspects of life, we witness the undeniable power of partnerships – be it in business, personal relationships like marriages and engagements, or grassroots community action groups. The strength of the community mental health system in New Hampshire depends not only on the work and dedication of its ten non-profit community mental health centers, their directors, staff, and boards – but also on the partnering relationships we have with NH hospitals. The work and the mission of the mental health centers and the hospitals in our state are well aligned and can often be seen in their mission statements. At our core is the goal we share in our commitment to improve peoples’ overall health, inclusive of their behavioral health needs, in the communities we serve.
The collaboration between New Hampshire’s mental health centers and hospitals runs deep, encompassing shared regions, historical ties, interconnected networks, and in some cases, even staff and board members. Further, the NH Community Behavioral Health Association, which represents the centers, and the NH Hospital Association, representing all 26 hospitals, share many of the same public policy goals. For many years we have worked collaboratively to ensure quality and timely access to care, in an effort to eliminate the emergency room waitlist, through increased funding for behavioral health services and legislation to strengthen the NH healthcare workforce.
The strength of our partnerships was clearly demonstrated earlier this year when the hospitals chose to defer a Medicaid reimbursement increase in the state budget so that providers of mental health services and long-term care could benefit instead from a historic bump in rates. Directing funds to these providers will likely lessen the load that hospitals bear when individuals who can’t access mental health services in the community wind up in emergency rooms; or when hospital beds are unavailable because there are no lower-acuity beds in the community to which patients may be discharged.
We owe a debt of gratitude to the hospitals for recognizing that both these problems should be addressed at the source; for putting the needs of the community and our shared patients above their own interests; and for acknowledging that we are all partners in the same system.
While the workforce shortage in health care and in mental health has not subsided, with both hospitals and mental health centers losing many employees both during and since Covid, this significant rate increase will hopefully make a difference. In our advocacy and in meetings with our local legislators, we have collectively and individually reminded policymakers on a regular basis that New Hampshire has one of the lowest Medicaid reimbursement rates in the nation. Increases in the state budget for Medicaid have been slow and quite frankly few and far between. However, the work of a broad group of stakeholders this year moved the ball forward. CBHA and NHHA were leaders in the advocacy at the statehouse, demonstrating their strong partnerships.
Mental health centers rely on Medicaid for 80 to 90 percent of their revenue, unlike other healthcare providers who have other sources of income available to them, so the rate increase is particularly important to us. Recruiting and retaining staff still remains a challenge for all ten community mental health centers. As an example, as of June 2023, there are a total of 378 staff vacancies in the ten centers, 339 of which are clinical positions.
And for hospitals, there are also challenges to hiring staff in areas such as behavioral health, post-acute care, and long-term care. The resulting workforce shortages mean that there are rising costs and negative impacts on patients, in particular, those needing inpatient care. Many could be treated in lower-acuity community beds if there were adequate funding and staffing available. There are pipeline issues that we hope the 2024 Legislature will address that will help to mitigate these problems.
We are thankful to the House and Senate leadership, budget writers, and members for listening to our testimony, considering the facts, and voting to make the Medicaid rate reimbursement increase a reality this year. NHCBHA wants to express its thanks to our partners especially the state’s hospitals and the NHHA, who played such a critical role, there is still much work to do but the power of our partnerships will strengthen our efforts and lighten the load.
Maggie Pritchard is Executive Director of Lakes Region Mental Health Center and President of the NH Community Behavioral Health Association. She lives in Boscawen.