Despite strong support from Gov. Kelly Ayotte, New Hampshire lawmakers rejected a bill that would have required private insurers to cover a state-run mental health program for children.
On Thursday, the House of Representatives voted to send Senate Bill 498 to interim study, delaying action on legislation that would have required private insurers to help fund the state’s Families and Systems Together (FAST) Forward program.
It’s a wraparound care model that provides personalized services such as peer support, crisis planning, and family-focused care for patients aged 5 to 21.
Ayotte, in a statement, said she is disappointed to see “elected representatives choose subsidizing insurance companies over kids’ mental health care.”
“I’m not giving up on this, and I’ll continue working to ensure our children — and their families — get the care and support they need,” she said.
The decision leaves the state and taxpayers on the hook to cover roughly $2 million annually for commercially insured children who rely on the program but do not qualify for Medicaid.
After the House voted down the bill, John Hunt, the chair of the House commerce committee, said Republicans agree with Ayotte that children’s mental health coverage is a serious issue, but said the bill is not the right solution and should not be addressed through a “hasty, last-second Hail Mary.”
“We look forward to studying this issue and devising a sensible and measured approach that satisfies all parties and prioritizes patient care and quality,” he wrote in a statement. “I warmly invite Governor Ayotte to join us this fall as we work on the issue. Together, Republicans, Democrats and the corner office have the opportunity to come together and deliver a reasonable solution for the people of New Hampshire.”
The bill was sent to an interim study in a 188-164 vote.
Insurers push back
The FAST Forward program coordinates services tailored to each child’s needs, helping families access mental health care, crisis support, care coordination, and other resources aimed at improving long-term outcomes.
The program’s effectiveness comes from its wraparound approach, which bundles services together.
But private insurers typically cover only some services rather than the full scope of services provided.
Ayotte has directed much of her criticism at Anthem Blue Cross and Blue Shield, which insures the largest share of children enrolled in the FAST Forward program.
Jim Turner, a spokesperson for the insurance company, called Ayotte’s criticisms of the insurance industry on this issue “inaccurate and misleading.”
“Over the past two years, Anthem has taken significant steps to increase access to mental healthcare for children and adults and to reduce barriers to that access – including being the first insurer to eliminate copayments and other forms of cost share for all children and teens for these services,” he wrote in a statement.
For families who do not qualify for a Medicaid waiver, the state spends roughly $2 million annually in taxpayer dollars to cover the program for commercially-insured children.
While opponents of the bill characterized it as a tax on insurance companies, state Rep. Julie Miles pushed back on that framing.
She said the bill is about affordability, healthcare access, and holding large insurance companies responsible for the coverage paid for by their customers.
“If insurance companies collect the premiums, they should help provide the care,” she said.
State’s burden
In recent weeks, there have been negotiations between the insurance companies, particularly Anthem Blue Cross Blue Shield, to address the issue, but no solution has been reached.
“Despite the recent unwarranted attacks, we will continue working in good faith with the state and care providers on this issue.
Mental health advocates view the FAST Forward program as a way to prevent children from deteriorating to the point of requiring costly inpatient psychiatric hospitalization.
Recent data from the state Department of Health and Human Services show that, over a 12-month period, New Hampshire’s general fund paid for wraparound services for about 89 commercially insured children, with Anthem Blue Cross and Blue Shield covering the largest share of children enrolled in the FAST Forward program at 25.
Morissa Henn, deputy commissioner at DHHS, said New Hampshire has spent five years studying the issue and that taxpayers need not continue covering services that should be paid for by private insurers.
“The need is urgent and the status quo is not sustainable,” she said.
Families with commercial insurance coverage cannot keep waiting, and taxpayers cannot continue absorbing the cost of clinically necessary services for our children that should be covered by private insurance.
While the annual cost for a child in FAST Forward ranges from roughly $45,000 to $65,000, an inpatient psychiatric stay, such as at Hampstead Hospital, can cost about $1,500 per night.
Hunt said on the House floor that, although the program is effective, some of its services extend beyond traditional mental health care, including respite care for caregivers and assigning a case worker.
Hunt said he believes the program would be more appropriately funded through Medicaid.
“Personally, I think the FAST Forward program should be funded by Medicaid,” he said. “If it’s good enough for kids who are on Medicaid, it should be good enough for kids who have health insurance.”