Advocacy and legislative alerts and news from prior years:

April 15, 2019: SAVE THE DATES! Tuesday, May 7 and Wednesday, May 8, 2019 in Concord and Manchester -- click here for details.

March 28, 2019: Public Hearing Scheduled for HB692 (dental care) set for Tuesday, April 2 at 2:15 p.m.

A public hearing has just been scheduled for HB692 relative to oral health care for Medicaid recipients. This bill has been referred to the Health and Human Services committee and is scheduled for Tuesday, April 2nd at 2:15 p.m. at the Legislative Office Building in Room 101 in Concord. Click here to find more information related to the bill at the NH general court website.

March 23, 2019: Legislative Liaison Update: NH Budget Hearing in Concord on March 18, 2019

For the very first time I was sitting in our state’s Hall of Representatives. I was in seat #30. As I sat there waiting for the proceedings to start, I wondered about all the men and women, over decades, who have sat in this seat. The history, the drama, the consequences of their actions!  Read more...

March 22, 2019: Bills in NH Legislature Being Followed by CSNI

In addition to the biennial budget, there are a number of bills currently in the New Hampshire legislature that CSNI is following. Read more...

March 1, 2019: Public Hearings for NH Budget (HB) Scheduled for March 11 in Milford, March 18 in Concord

March 11 (in Milford and Laconia) and March 18 (Concord) are very important dates coming up for the House state budget hearings, which determine where and how monies will be allocated. The budget determines how much the DD community will receive for services, including rate increases for staff (to help reduce the number of open positions and decrease staff turnover) as well as the possibility of dental care for Medicaid adults.

March 11, 5 p.m. in Milford
Milford Boys and Girls Club, 56 Mt. Vernon St.

March 11, 5 p.m. in Laconia
Lakes Region Community College, 379 Belmont Rd. (Rt 106)

March 18, 1 p.m. in Concord
Representatives' Hall, State House, 107 N. Main St.

This is the time for your legislators to hear from YOU. They need to hear your voice, receive your letters and to know that there are real people who depend on the decisions they make which affect your lives.

Talking Points and Tips for Budget Hearing

Tips on Giving Budget Testimony

Please help support these bills. The more who can contact their legislators, the more likely they will be to pass legislation affecting you.

Marylouise Alther, MDS Legislative Liaison is attending the Concord hearing on March 18 and is happy to offer a ride to three individuals.
Call Marylouise at 603-313-8693.

2018 Archives

Hot Topics Fall 2018 (click on topic below to download pdf)

NH Values and the NH Advantage Related to Our Support System for Citizens with Developmental Disabilities

Rate Increase for BDS Services

The Wait List: What It Really Means for People with Disabilities and Their Families

Employment for People with Disabilities

Special Education: A Tradition of Education Excellence and Opportunity for ALL

Meeting the Needs of Children & Adults with Complex Medical Diagnoses

Chapter RSA 171-A: The Law at the Root of Rights for Citizens with Developmental Disabilities and Their Families


2015-2017 Archives

August 17, 2017 - DD, ABD and IHS Will Not Be Incorporated into Managed Care in the Near Future, per Commissioner Meyers

July 30, 2017 - Wait List Worries Continue - From the Desk of Alan Greene

June 27, 2017 - Action Alert: U.S. Senate to Vote in July on Revamped Healthcare Bill with Deep Cuts to Medicaid

June 23, 2017 - HB 620 (Threatening Special Education Rights) Is Voted Down -- Budget Passes House and Senate

June 1, 2017 - State Budget Passes Senate, But Work Continues on Companion Bill

April 17, 2017 - State Budget Deliberations Move to the NH Senate – Public Hearing Expected in Early May

April 14, 2017 - Join 20-Minute Webinar (Phone & Online) on How To Create Great Testimony on Wednesday, April 19th at 3 p.m.

April 4, 2017 -  ACTION ALERT: Ask Your State Representatives to Support Amendment 2017-1213h to HB1, Providing Additional DD Funds

March 31, 2017 -  Senate Votes on Medicaid Managed Care Implementation, Postponing DD, IHS and ABD Waivers Until At Least July 1, 2019

March 10, 2017 - NH House Narrowly Votes Down HB 387 to Provide Rate Increase for Care Workers

March 1, 2017 - ACTION ALERT: Families' Testimony Needed for March 13th Public Hearing on State Budget in Concord

February 27, 2017 - ACTION ALERT: Update on HB 620 (Endangers Education Rights for NH Children with Disabilities)

February 22, 2017 - CSNI List of Bills to Watch for 2017 NH Legislative Session

February 14, 2017 - HB 620 Could Endanger Education Rights and Protections for NH Children with Disabilities

February 9, 2017 - SB 153 to Fund Early Childhood Intervention Services Passes 5-0 by Senate HHS Committee

January 9, 2017 - ACTION ALERT: Letter Writing Campaign to Governor During January 2017

January 4, 2017 - Legislative Advocacy Training 101 at MDS Keene on Wednesday, January 11 - 3 p.m. or 5:30 p.m.

July 31, 2016 - Forging an Era of Greater Collaboration (Written by Alan Greene, Summer 2016 Clipboard)

July 13, 2016 - CSNI Makes Recommendations to Governor's Managed Care Commission for Final Report

June 20, 2016 - Gov. Hassan Signs SB 553 Re: Medicaid Managed Care Step 2 Implementation Plan

April 20, 2016 - NCD Report Shows People with Disabilities Lose Services in Managed Care

April 4, 2016 - ACTION ALERT: Show Your Support at April 14 Public Hearing Re: SB 553 (Step 2 Managed Care)

March 28, 2016 - Senate Passes SB 553 Re: Step 2 Managed Care Delay

March 17, 2016 - Senate Health & Human Services Committee Holds Public Hearing on SB 553 Re: Step 2 Managed Care on March 15th

February 18, 2016 - State of NH Performance Audit Shows Ineffectiveness in BDS Delivery System (Message from Alan Greene)

January 4, 2016 -

December 30, 2015 - Governor Hassan to Nominate Jeffrey Meyers of Concord as Commissioner of the Department of Health and Human Services

November 30, 2015 - Step 2 Medicaid Managed Care: Opportunities to Meet the MCM Health Plan Representatives in Manchester and/or Laconia

October 8, 2015 - NH DHHS Announces Enrollment of Remaining Populations in Medicaid Care Management

September 25, 2015 - Information to Help in Choosing a Health Plan for Medicaid Managed Care (MCM) Enrollment

September 17, 2015 - Governor Hassan Signs "Fiscally Responsible, Bi-Partisan, Compromise" Budget Agreement

August 12, 2015 - Budget Update: Dave Solomon’s State House Dome: State budget hangs in summer doldrums (Union Leader via CSNI)

July 27, 2015 - Closing of NH's Lakeview NeuroRehabilitation Center Sends Ripples Nationwide - coverage from

July 24, 2015 - Governor Hassan Proposes "Fiscally Responsible" Budget Compromise to Legislature, Including Business Tax Cuts and Cigarette Tax Hike

July 23, 2015 - State Officials Propose Changes to Medicaid Managed Care Program - article in Union Leader by Garry Rayno

July 15, 2015 - From the Desk of Alan Greene: The Budget Lapse and Its Consequences (Summer 2015 Clipboard)

July 10, 2015 - Budget Update: No Progress Expected in Budget Resolution Until September

June 30, 2015 - Governor Hassan has vetoed the House/Senate budget. Read her 6/25/2015 veto message...

June 8, 2015 - Budget Update: NH Senate Approves Finance Committee's Budget - Governor Hassan Expected to Veto

May 21, 2015 - Legislative Update: Senate Finance Committee Restores Many House Budget Cuts

May 1, 2015 - INFO ALERT: Analysis of Impact of House Budget Cuts on Disabilities Services

April 23, 2015 - ACTION ALERT: Plan to attend Tuesday, May 5th Public Hearing on Senate's Budget Version

April 10, 2015 - MDS family member Kathleen Washburn's Letter to Editor re: budget cuts, published in Keene Sentinel, Ledger-Transcript and several New Hampshire newspapers:
“New Hampshire, the seventh wealthiest state in the union, has slashed $53 million dollars in funding for developmental disabilities services, including in-home supports, which allow people to receive help to care for their loved ones at home instead of in a nursing home…”  Click here to read full letter.

April 4, 2015 - CSNI provides links to a number of media reports on the April 1st budget vote at the State House - click here to access these links.

April 1, 2015 - Floor Amendment 1168H to Restore Disability Budget Cuts Defeated in Narrow House Vote

March 27, 2015 - ACTION ALERT: Now is the time to speak out about budget cuts! Call your representative by March 31. House votes on Wednesday morning, April 1.

March 25, 2015 - Gov. Hassan Responds to Budget Put Forth by House Finance Committee

March 23, 2015 - From Concord Monitor, 3/22/15:  Proposed Health & Human Services Cuts Create Uncertainty Across New Hampshire

March 18, 2015 - House Finance Dramatically Reduces Bureau of Developmental Services (BDS) Budget

March 3, 2015 - Action Alert! House Budget Hearing in Concord Thursday, March 5 from 4-7 p.m. Click here for details.

March 1, 2015 - Public Notice (2/25/15) DHHS Re: Medicaid Care Management Step 2: Mandatory Enrollment and Choices for Independence Waiver Services. Click here to read notice and find out more.

February 23, 2015 - Legislative Alert: Governor Hassan's proposed budget for FY 2016-17; Further delays in Step 2 Medicaid Managed Care rollout; Call to action from ABLE NH to provide details of any issues or problems with the Medicaid Managed Care transition. Click here for details.

2014 Posts

December 19, 2014 - Update on Amended Complaint Filed in NH Court Re: Step 2 Managed Care: Ruling Expected February/March 2015. Click here to read amended complaint document.

December 19, 2014 - ABLE Act Signed Into Law, Allowing People with Disabilities to Set Up Special Savings Accounts

November 10, 2014 - New Target Date of July 1, 2015 Set for Signups for Medicaid Managed Care

October 30, 2014 - Live Streaming of November 6 Medicaid Commission Meeting Allows Greater Access by the Public

October 3, 2014 - DHHS Comm. Toumpas Announces Indefinite Delay In Step 2 Medicaid Managed Care Implementation

August 12, 2014 - MDS Stakeholder Forums in Keene & Peterborough on September 15: NOW is the time to make your voice heard!

July 24, 2014 - Action Alert! Important Stakeholder Forums in August & September on Step 2 Managed Care

June 25, 2014 - Amended Complaint Filed With Court for Summary Judgment Re: Step 2 Managed Care

June 20, 2014 - Gov. Hassan Outlines Revised Managed Care Step 2 Implementation Schedule

June 9, 2014 - Medicaid Care Commission’s June 5th Meeting Weighs Effects of Meridian Health Withdrawal

June 4, 2014 - Meridian Health Plans to Withdraw from NH Medicaid Managed Care This Summer

April 8, 2014 - Judge to Decide if Long Term Care Services for Developmentally Disabled Will Be Included in Managed Care

April 4, 2014 - Gov. Hassan Announces Delay in Step 2 Managed Care Implementation

March 4, 2014 - Advocacy Alert! Public hearing scheduled on Senate Bill 396 - relative to Restraint & Seclusion in schools. Click here for details.

February 18, 2014 -  Commissioner Toumpas provides Medicaid managed care update at mid-February Governor's Executive Council meeting.

February 11, 2014 -  Have you had challenges or issues with the new Medicaid Managed Care system? Governor's Commissioners ask that you share your experiences.

2013 Posts

December 31, 2013 - Medicaid Managed Care Commission Meets in Keene on January 9 from 1-4 p.m. at HCS - Families, Stakeholders Encouraged to Attend

December 9, 2013 - Attorneys File Final Motion for Summary Judgment Re: Step 2 Managed Care

December 5, 2013 - Families, Individuals, Agencies Speak Out at Medicaid Managed Care Commission December Meeting in Nashua

November 14, 2013—Court Rules that Declaratory Judgment Action Will Proceed, Dismissal Not Granted

Hillsborough Superior Court North Judge Gillian Abramson ruled this morning that the Declaratory Judgment action filed by plaintiffs, including the Area Agency developmental services system and individuals with developmental disabilities and their families, will proceed. Judge Abramson denied the state’s motion to dismiss and allowed the plaintiffs’ request to file a summary judgment motion by December 6. This decision is important since it gives the plaintiffs legal standing to challenge whether they are subject to Medicaid managed care for their long-term care services as the state moves forward with its plan. Click here to read full update on the CSNI website.

November 12, 2013: Summary of November 7th Medicaid Managed Care Commission Meeting from CSNI

November 4, 2013: Action Alert! Hearing Set for Thursday, November 14 on Declaratory Judgment for Complaint Filed Against Step 2 at Hillsborough County Superior Court North.

October 31, 2013: Action Alert! DHHS Commission Toumpas To Present Plan on Step 2 of Medicaid Managed Care Thursday, Nov 7, 1:00-4:00 p.m.

October 3, 2013:  It's Time to Pick a Health Plan for Medicaid Managed Care

October 1, 2013: DHHS Announces Medicaid Care Management Sessions for Clients in Keene on Thursday, October 17, 9:30-11:30 a.m. at Cheshire Medical Center

August 27, 2013:  Medicaid Care Management Step 1 starts December 1: What does that mean for MDS individuals and families?

August 22, 2013: Article in Monadnock Ledger-Transcript: Clarification sought on care for the disabled. Click here to access online article.

August 15, 2013:  Complaint Filed Against State of NH -- Families Lead Effort to Clarify Care Management for People with Developmental Disabilities and Acquired Brain Disorders

August 15, 2013: My Turn article in Concord Monitor: Capitalism Isn't the Answer to Care for those with Developmental Disabilities

August 14, 2013:  Medicaid Care Management Step 1 Start Date Set for December 1, 2013

June 15, 2013: NH Challenge article: "NHOfficials Looking to Improve Relations with Area Agencies" from CSNI website

June 7, 2013: CSNI Releases Design Brief to Assist in DD System Reform Under Managed Care

May 30, 2013: Senate Finance Committee Submits HB1 and 2 to Senate Floor For June 6 Vote

May 25, 2013: CSNI Legislative Update Recaps Senate Finance Committee Work This Week

May 13, 2013: Legislative Update:Senate Budget Hearing, Medicaid Managed Care Progress

April 30, 2013: Senate Budget Hearing Scheduled for Thursday, May 9th from 3-8pm in Concord

April 12, 2013: Gov. Hassan Creates Commission on Medicaid Care Management

March 12, 2013: Action Alert – Budget Meeting on Monday, March 18 from 5-8pm in Claremont

March 1, 2013: An Alternative Proposal for Medicaid Managed Care for Medicaid Managed Care for DD and other Long Term Services

February 18, 2013: What does the Governor’s proposed budget mean for people and services?

January 15, 2013: DHHS provides an updateon Medicaid Managed Care as of January 2013

Click here to access previous Advocacy updates.

November 12, 2013: Summary of November 7th Medicaid Managed Care Commission Meeting from CSNI

The Medicaid Managed Care Commission met on Thursday November 7th. Governor Hassan participated in the first portion of the meeting. She spoke as a mother and leader of the State of New Hampshire. She expressed that Managed Care brings incredible opportunities and challenges to the state and lauded it as an opportunity to coordinate care and save money that can be reinvested in the people it serves. Read more...


October 31, 2013: Action Alert! DHHS Commission Toumpas To Present Plan on Step 2 of Medicaid Managed Care Thursday, Nov 7, 1:00-4:00 p.m.

Health and Human Services Commissioner Nicholas Toumpas will lay out his road map for Step 2* of the Medicaid Managed Care program to Governor Maggie Hassan and her Commission on Medicaid Care Management. This meeting will take place in Concord on Thursday, November 7 at 1:00 p.m. in the Legislative Office building (click here for map).

Governor Hassan formed the Governor’s Commission on Medicaid Care Management in April 2013 to ensure providers and patients are protected as New Hampshire moves to a managed care model for the state’s Medicaid program.

It is hoped that at least 10 people from the Monadnock region will attend this public meeting to show support to and for the Area Agencies to the Commissioner and Governor.

If you are able to attend, or have any questions, please contact Chris Coates either via email at: This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at: 313-9002.

*Step 2 currently includes developmental disabilities services and long-term care, and is slated to begin one year from the start of Step 1 (acute health care services).


October 1, 2013: DHHS Announces Medicaid Care Management Sessions for Clients in Keene on Thursday, October 17, 9:30-11:30 a.m. at Cheshire Medical Center 

The New Hampshire Department of Health and Human Services (DHHS) announces information sessions about NH’s Medicaid Care Management (MCM) program. The sessions are for Medicaid clients who are eligible to participate in MCM when it begins on December 1st. Enrollment materials were mailed to eligible clients earlier this month. MCM Open Enrollment (the period of time during which clients pick their health plan) is now underway in preparation of the December 1 start date.

“We are reaching out to our Medicaid clients,” said DHHS Associate Commissioner Mary Ann Cooney, “and offering these information sessions so that our clients can come and learn about MCM, how to enroll in a Health Plan, and what they can expect beginning December 1. This is an opportunity for our Medicaid clients to get their questions answered by members of our own enrollment and eligibility staff, and there will also be representatives from each of the 3 Health Plans at these meetings.”

There will be four information sessions held during October. Seating is limited so DHHS is asking anyone planning to attend to RSVP by email to Teri Jones at This email address is being protected from spambots. You need JavaScript enabled to view it. or by calling Teri at 603-271-9404. Please indicate any needs such as ASL, Large Print or alternative formats when you RSVP.

The schedule is as follows:

Session 1: October 15, 2013 - Seacoast
RSVP by October 10
9:00 am – 11:00 am
Families First of the Seacoast, 100 Campus Road, Portsmouth, NH

Session 2: October 17, 2013 - Monadnock Region
RSVP by October 14

9:30 am – 11:30 am
Cheshire Medical Center
Court Street
Keene, NH

Session 3: October 18, 2013 - Manchester
RSVP by October 15

9:00 am – 11:00 am
Manchester Health Department, 1528 Elm Street (please use back entrance), Manchester, NH

Session 4: October 22, 2013 - North Country
RSVP by October 17

9:00 am – 11:00 am
North Country Health Consortium, 262 Cottage Street, Littleton, NH


August 27, 2013: Medicaid Care Management Step 1 starts December 1: What does that mean for MDS individuals and families?

DHHS has announced a December. 1, 2013 start date for MCM Step 1, the Acute Care portion of the Medicaid managed care program. Medicaid recipients should have received an informational letter from DHHS Commissioner Toumpas last week, alerting them that enrollment will begin soon, but that no action is yet required. In coming weeks you will be required to choose from one of three plans to cover PCP and other healthcare costs. (Please note this is Step 1 only, not Step 2 which covers DD services). Click here to read a copy of the DHHS letter.

We want to keep everyone as updated as possible. At this point, we don't have much detailed information for you, but we are keeping a close eye on things and will keep you posted. Here is what we do know:

1. Detailed information and instructions are not yet available on options and actions items. You should receive materials and instructions in the mail from DHHS. In coming weeks you will be required to choose from one of three plans to cover PCP and other healthcare costs. Please know that as soon as this information does become available (hopefully in the next few weeks), we will pass along what we know to you. We also plan to hold information sessions as needed. You should also visit the new DHHS Medicaid Care Management site to read their updates.

2. DHHS is heavily marketing their NH EASY online account system, and encouraging folks to create an account on line. These accounts are easily manageable and convenient, so you might want to consider using this option. Click here to visit the NH EASY website. If you have any questions or need help to sign up for NH EASY, please call or email Sandra Metivier, MDS Benefits Specialist, who will be more than happy to assist you in this process.

3. Step 2 of the Managed Care program, which includes disabilities services and long-term care, will not start until at least December 1, 2014, with specific plans not yet determined. Meanwhile, a group of NH families and the Area Agencies have filed a complaint in the NH State Court asking for a ruling that could exclude all waivered services (which is what most DD services are) from the Managed Care program. See below to learn more about this complaint or visit the CSNI website.

As information becomes available, we will post to our website and pass it along to you. If you have any questions, contact your MDS Service Coordinator or andra Metivier at 352-1304 ext 290, This email address is being protected from spambots. You need JavaScript enabled to view it..



November 4, 2013: Hearing Set for Thursday, November 14 re: DHHS Request for Dismissal of Complaint

A judge in Hillsborough County Superior Court will conduct a hearing and rule on DHHS’s request for dismissal of the complaint filed by individuals and families re: Step 2 of Medicaid managed care. The hearing is scheduled for Thursday, November 14 starting at 9:00 a.m. at the Hillsborough County Superior Court North, at 300 Chesnut Street in Manchester. Click here for map.

Stu Wallace, one of the plaintiffs who is a family member and guardian explains the complaint filed: “When managed care was introduced as an option by the legislature, I didn’t think that DD would be in any way affected. The law seemed to be about acute health care for those using Medicaid. The current DD care system was put together by families and individuals, and this is not what the bill was about. We feel the commissioner and the state have exceeded their authority by including DD in this current plan, as Step 2. They have expanded the law beyond its original intent – which is NOT something that state agencies should to – that belongs with courts and legislators. It’s not a question of wrong or right. It is a question of an agency or commission exceeding its authority.”

At last month’s Statewide Video Conference, plaintiffs and attorneys gathered with more than 100 families from across the state for an update on the complaint. At that meeting, attorneys told the group that the Attorney General’s office replied in September with a request for dismissal saying: “Until it is known what the State has decided to do about DD/ABD/long-term care, interpretation of the statute is not ripe for judicial review.” At the November 14th hearing, the judge will hear from both sides and decide whether to further consider the original complaint against DHHS.

A solid representation from families and individuals at the hearing would help show the Judge the impact of including people with developmental disabilities and acquired brain disorders in managed care. The hearing takes place on Thursday, November 14 starting at 9:00 a.m. at the Hillsborough County Superior Court North, at 300 Chesnut Street in Manchester.

August 20, 2013: Further Explanation of the Complaint Filed on August 15 from the NH Fiscal Policy Institute

Deborah Fournier, an analyst at the NH Fiscal Policy Institute explains:  “The primary argument in the complaint is that the state law underlying the managed care initiative only specifies that mandatory Medicaid services be required to be provided in a managed care context. Mandatory services are distinct from optional services and presumably from waivered services. In fact, some mandatory services are long-term care services (like skilled nursing facility care or home health care for people entitled to skilled nursing facility care).

“The argument in the complaint is that waivered services for those with developmental disabilities or acquired brain disorder are not mandatory services and therefore the State doesn’t have the authority to mandate those specific long-term care services be included in the managed care initiative. The complaint actually requests that the court rule on whether the law allows DHHS to mandate the inclusion of long-term care services for these two populations in the Medicaid managed care program.”

Fournier explains further: “The complaint is not so broad as to ask whether or not the State had the authority to mandate any waivered or optional service be included in the managed care initiative or to attempt to carve out waivered or optional services all together for any and all populations. The complaint does not seek any injunctive relief either; i.e., it doesn’t ask the court to stop the state from moving forward. It does ask the court to declare as a matter of law what the right answer is on this question.”

August 15, 2013: Complaint Filed Against the State of New Hampshire - Families Lead Effort to Clarify Care Management for People with Developmental Disabilities and Acquired Brain Disorders

Led by families, the law firm of Devine Millimet and Concord attorney John Macintosh today filed a declaratory judgment action in the Hillsborough County Superior Court seeking a ruling that Senate Bill 147, Laws of 2011, requiring the Department of Health and Human Services (DHHS) to develop a managed care program for administering the state’s Medicaid services, does not include long term care services for people with developmental disabilities or acquired brain disorders served by New Hampshire’s developmental services system. A declaratory judgment is the legal determination by a court as to the legal position of plaintiffs in cases where there is doubt as to their position in law. Click here to access the Complaint Document.

The complaint also seeks a judicial determination that none of the individual plaintiffs are required to participate in managed care programs for these services and that none of the Area Agencies are required to enter into contracts for the provision of long-term managed care services to their Medicaid populations with the three separate managed care organizations that the State Department of Health and Human Services has contracted with to put the Medicaid managed care program into effect.

The first phase of the State’s Medicaid managed care program for acute care services was supposed to be operating by July 1, 2012. NH’s Medicaid Care Management Operations team confirmed this week that Step 1 of the Medicaid Care Management (MCM) program will commence implementation on December 1, 2013. Medicaid managed care for long term care services is the second phase of the program and cannot start for at least one year after the start of the first phase. Because of this delay, the plaintiffs have sought a declaratory judgment rather than an injunction. If successful, however, this complaint will have the same effect as an injunction against the State.

For more information, contact CSNI’s Dotty Treisner at This email address is being protected from spambots. You need JavaScript enabled to view it. or 603-229-1982. Click here to read the Complaint Document.


August 14, 2013: Medicaid Care Management Step 1 Start Date Set for December 1, 2013

Now that all hospitals have either signed agreements or signed in principle with the Medicaid Managed Care companies, and mental health centers have come on board, Commissioner Nick Toumpas has announced a December 1, 2013 start date for Step 1 of the Medicaid Care Management (MCM).  Details to come. From  DHHS:

Aug 14'03 - Concord, NH - Department of Health and Human Services Commissioner Nick Toumpas announces today that the State’s three Medicaid Care Management Organizations have demonstrated that their provider networks are now substantially developed. Simply stated, the Department has confidence that the networks are sufficient to meet the needs of Medicaid beneficiaries with minimal disruption from what they have experienced on the fee-for-service program. As such, Toumpas is setting the program start date for “Step 1” of the State’s Medicaid Care Management (MCM) initiative. “Step 1” of the MCM initiative will commence on December 1, 2013. This is the first day that coverage of current NH Medicaid beneficiaries will be provided by one of the three MCM vendors: Meridian Health Plan, New Hampshire Healthy Families or Well Sense Health Plan.

“Medicaid care management is a critical part of our state’s efforts to strengthen our health care system, helping to reduce costs and improve the quality of care for patients,” Governor Maggie Hassan said. “I thank Commissioner Toumpas and the Department of Health and Human Services for their hard work, as well as New Hampshire's providers—our hospitals, medical professionals, community health and mental health centers, home health providers, and many more—for coming to the table and working together to move forward with meaningful health care innovations that will benefit thousands of Granite Staters.”

Many activities must occur between now and December 1st. These activities include but are not limited to: outreach to current Medicaid beneficiaries to assist them in selecting a care management plan for their coverage; outreach to current Medicaid providers about how to make the most of their relationship with the care management plans; and the State’s assessment of the plans’ readiness to handle member enrollment, complex care coordination, provider payment, and other essential functions in compliance with the State’s contract.

In 2011, the State Legislature directed DHHS to administer Medicaid in a managed care model. Progress in network development was initially slower than anticipated delaying the program start. However, in recent months contracting activity has increased markedly. Toumpas stated, “We are extremely pleased with the progress of the provider community and the MCM organizations in coming together to meet the needs of New Hampshire’s Medicaid beneficiaries. We are excited about moving the program forward and realizing the many benefits of the MCM program.”

Current Medicaid beneficiaries can expect mailings in the coming weeks. A new DHHS website dedicated to MCM will launch in the coming days as well. DHHS will also have an expanded call center ready to answer questions regarding care management and assist beneficiaries in selecting a care management plan when open enrollment starts in September. Providers can access information via the provider portal of the MCM website,

June 7, 2013: CSNI Releases Design Brief to Assist in DD System Reform Under Managed Care

CSNI, on behalf of area agencies, families, individuals and other stakeholders, has released a Developmental Disability Design Brief. This brief describes points of agreement, what needs to be included, and what is causing concerns in current planning for DD system reform under Managed Care. The DD Design Brief is intended to inform the efforts, currently underway at Executive, Legislative, and Departmental levels, and to be sure stakeholders in the DD/ABD community have a voice to ensure continued quality services and local control.
Click here to read the DD Design Brief on the CSNI website.

May 30, 2013: Senate Finance Committee Submits HB1 and 2 to Senate Floor For June 6 Vote

On Tuesday, May 28, by a party line vote of 4-2 the Senate Finance Committee sent HB 1 and HB 2 to the Senate floor for a June 6 vote, but this is not the end for the Senate process. It is anticipated that additional floor amendments will be introduced, when the budget is debated on the Senate floor next week, making various changes to the committee’s recommendations.

Who spent more, House or Senate?

Both chambers of the Legislature, the Governor, and political parties have issued press releases taking differing positions about budget expenses. Based on Legislative Budget Office information, the Senate budget “spends less than the House.” However, the “spend less” definition is of “total funds” (i.e. funds from all sources: State, Federal, County and others such as fees.) In terms of General Fund or state spending, the Senate actually spends more than the House.

No new taxes

The Senate removed four tax/fee increases from the budget as proposed by the House. There were two fee increases, one to the Salt Water Fishing License and one to the Marriage License; both were deleted. In addition, the committee removed tobacco and gasoline tax increases. The Senate did predict that the State of NH will bring in over $100 million in additional revenue from existing fees and taxes based on economic growth. This growth in revenue allowed for increased spending.

What about the DHHS budget?

When looking at DHHS, the Senate spends more than the House (nearly $24 million more). However, the DHHS Commissioner has said that because of low budget estimates for caseloads and other “back of the budget cuts” made by the Senate, the DHHS budget has a $40 million deficit. There was never an official amendment drafted to cut many of the programs that are in jeopardy because of this “deficit.” The Commissioner verbally told the committee that the following programs are at risk with the Senate’s version of the budget: DD/ABD waitlists, CHINS, mental health, community health centers, family planning clinics and payments to counties. At this point in the budget process, the “deficit” in DHHS remains and will be discussed during the June House/Senate Committee of Conference on the budget.

Medicaid Expansion Update

The Senate Finance committee removed Medicaid expansion from HB 1 and HB 2 in favor of studying the issue. It is interesting to note that DHHS contracted with the Lewin Group several months ago to provide the state with an analysis that would assist with informed decision making. The Lewin study reached many conclusions that strongly favor NH choosing Medicaid expansion, but the Senate has elected to further continue study of this issue.

Innovation in Medicaid Delivery – I-MD Commission

HB 2 now calls for an “Innovation in Medicaid Delivery” or an “I-MD” Commission. This commission will work to create a new Medicaid waiver application, an 1115 Medicaid waiver. According to the proposal, the waiver’s goal is to “Obtain federal matching funds for so-called costs not otherwise match-able to improve access and quality of care for Medicaid-dependent patients.”

Consumer Assistance Grant

The Senate Finance committee did not include any federal funding for the Health Benefit Marketplace that will soon be created as part of the Affordable Care Act. NH has been approved for a federal grant to set up a consumer assistance program. There was a proposal by Senator Larsen to accept $5 million in federal funds in HB 1; this did not happen. The money would be used for training to assist people — many of whom have never had insurance coverage — in navigating the new marketplace. With the grant New Hampshire will be able to launch a program designed in NH. Without the grant, NH would cede control of this to the Federal government.

The House has now responded to the Senate’s inaction on this issue by tacking on the federal funding for this program on to another bill, SB 129, relative to court-ordered placements in shelter care facilities and at the Sununu Youth Services Center, relative to the children in need of services (CHINS) program, and establishing a committee to study programs for children in need. That bill, like the budget, will likely end up in a Committee of Conference.

What’s next?

All this isn’t over yet. There is still a month to go in this budget process. Steps to come are:

  • the full Senate vote on Thursday, June 6;
  • the appointment of the Committee of Conference, by Thursday, June 13;
  • votes in both houses to accept their report;
  • action by the Governor;
  • then back to the House and Senate if it does not get her approval, for another try by June 30th deadline.

Stay tuned for further developments.


May 25, 2013: CSNI Legislative Update recaps Senate Finance Committee work this week, including:

  • Toumpas: $40 Million Hole for DHHS
  • Senate Finance Committee Rejects Medicaid Expansion
  • Senate Finance Committee to Hospitals: Sign up for Medicaid Managed Care Or No Charity Reimbursement

Click here to read the update on the CSNI website.


May 13, 2013: Legislative Update from CSNI: Senate Budget Hearing, Medicaid Managed Care Progress

Senate Budget Hearing: On Thursday afternoon and evening, May 9, the Senate Finance committee conducted a six-hour public hearing on HB 1 and HB 2 (State budget). Developmental Services was once again the most advocated program, followed by Domestic Violence Prevention and Substance Abuse Treatment. Many others spoke about various human services programs for children, the elderly and those with mental illness. Following additional committee work, the Senate will vote on its budget on June 6. Commissioner Toumpas will back again before Senate Finance this week on Monday, May 13th at 10:00 a.m.

Step 1 Medicaid Managed Care Gaining Speed?  At the May Health and Human Services Oversight committee last week Commissioner Toumpas provided some new information relative to Step 1 Medicaid managed care. First, there is one MCO that claims to have achieved providers in 80% of the state. It was unclear if this was network adequacy in 80% of the state, or simply a presence in 80% of the state. DHHS continues to suggest that two MCOs are moving ahead with network progress with the third seemingly behind the first two. DHHS has said they will proceed when two are ready.

DHHS has created new capitated rates for year 2 of Step 1 (It appears that, the current year 1 Step 1 rates have not and will never be used). These new rates are higher paying than the current rates and seem to be acceptable to Step 1 providers, including hospitals and community mental health centers. The new rates would be incorporated into a contract amendment.

In addition, there is a new supplemental rate for three categories of individuals with severe mental health diagnosis. These supplemental rates will allow the MCOs to send additional money to not only the community mental health centers, but also other Step 1 providers such as pharmacists. Step 3 rates are being planned and worked on with the department’s vendor.

In terms of Step 2, this week, Commissioner Toumpas, Nancy Rollins and Jose Montero are traveling to CMS in Baltimore to discuss the SIM program with other states and CMS. Finally, the Commissioner reported that he has made phone personal phone calls to CEOs of hospitals, especially the “suing hospitals” to encourage them to sign on to Medicaid managed care. Toumpas said that he was very encouraged by most of the responses from the CEOs and he said many of the hospitals are close to signing agreements with MCOs.

The Commissioner strongly indicated that he envisions Step 1 commencing toward the end of calendar year 2013.

Media coverage links:


April 30, 2013: Senate Budget Hearing Scheduled for Thursday, May 9th from 3-8pm in Concord

The Senate Finance Committee will conduct a public hearing on HB 1 and HB 2 (bills for the State budget) on Thursday, May 9th from 3:00-5:00 p.m. and 6:00-8:00 p.m. in the Representatives' Hall of the State House in Concord. This is a chance for MDS families to deliver the message that the restoration of recent budget cuts is a top priority for New Hampshire families. The Senate has had the House’s version of budget bill before them for several weeks, and its Finance Committee has been meeting with House members and various state agency heads to understand what the House budget means for those groups. Since this hearing is about the entire budget, there will be many groups represented. Click here to access DHHS FY14-15 budget documents on their website.

It is important that Senate Finance hear testimony from families. Testimony should be limited to one page. Please plan to contact your Senator about the budget if you are not able to make the trip that day. Please send us a copy of your testimony so that we can prepare packets for all the members of the committee.

Contacting your Senator:
Senate districts have changed recently – we have five different Senators representing individual towns of the Monadnock Region.

District 8
Bob O’Dell (R-Lempster)
State House, Room 302
107 North Main Street, Concord, NH03301
(603) 271-2609
This email address is being protected from spambots. You need JavaScript enabled to view it.
Towns: Acworth, Antrim, Bennington, Francestown, Hillsborough, Langdon, Lempster, Marlow, Stoddard,Washington, and Weare.

District 9
Andy Sanborn (R, Bedford)
State House, Room 302, 107 North Main Street, Concord, NH 03301
(603) 271-2609
This email address is being protected from spambots. You need JavaScript enabled to view it.

Towns: Dublin, Fitzwilliam, Greenfield, Hancock, Jaffrey, Lyndeborough, Mont Vernon, New Boston, Peterborough, Richmond, Sharon, Temple and Troy

District 10
Molly Kelly (D, Keene)
State House, Room 120, 107 North Main Street, Concord, NH 03301
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Towns: Alstead, Chesterfield, Gilsum, Harrisville, Hinsdale, Keene, Marlborough, Nelson, Roxbury, Sullivan, Surry, Swanzey, Walpole, Westmoreland, and Winchester.

District 11
Peter Bragdon (R, Milford)
State House, Room 302, 107 North Main Street, Concord, NH 03301
(603) 271-2111
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Towns: Amherst, Milford and Wilton

District 12
Peggy Gilmour (D, Hollis)
State House, Room 105-A, 107 North Main Street, Concord, NH 03301
(603) 271-4151
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Towns: Brookline, Greenville, Hollis, Mason, New Ipswich, Rindge

Updates on other bills of interest:

SB 152 (Casino Gambling)
Right now, the House is focusing on SB 152 (Casino Gambling). The “super committee” of joint Finance and Ways & Means has broken up into sub-committees (Revenue, Regulation and Community Impact). It isn’t yet clear what these committees will recommend to the full House. What does seem clear is that the Senate will NOT include gaming revenue in its budget recommendation unless the House passes SB 152.

SB 193 (Oral Health Care Expansion)
The Oral Health Care Expansion bill (SB 193) was recently held for a year of study in the State Senate. This bill specifically mentions that part of its purpose is to expand dental care access to people with developmental disabilities. Specifically, this bill authorizes licensure of dental therapists who may perform dental services under the supervision of a currently licensed dentist. The bill’s statement of purpose reads: "The general court recognizes that access to oral health care services for New Hampshire’s children, elderly, minority populations, low income adults, and people with developmental disabilities and special medical needs remains sporadic and unreliable, particularly in sparsely populated areas of our state".

Also under review:

HB 528, a bill that allows the court to initiate or continue child support beyond the age of 18 for children with disabilities, provided that the order does not continue after the child reaches age 21.

SB 87, a bill that clarifies the patients’ bill of rights as it applies to home health care providers. The bill also establishes parameters for discharge or transfer from home health care.


April 12, 2013:
Governor Hassan Issues Executive Order Creating Commission on Medicaid Care Management. 

In order to ensure providers and patients are protected as New Hampshire moves to a managed care model for the state’s Medicaid program, Governor Maggie Hassan issued an Executive Order today creating the Governor’s Commission on Medicaid Care Management. The Commission, which will review and advise the Governor on the implementation of the Medicaid Managed Care program, includes two Monadnock area professionals: Donald Shumway of CMRI and Yvonne Goldsberry of CMC-DH-Keene.

The Governor’s commission will bring together members of the public representing a broad range of experience in health care issues to review and advise on the implementation of an efficient, fair and high-quality Medicaid care management system.

“With new tools and federal funding available, New Hampshire has an opportunity to greatly strengthen our health care system. Moving forward with implementing Medicaid managed care is critical to ensuring that we are able to effectively expand Medicaid coverage and maximize our health care dollars,” Governor Hassan said. “I also recognize the concerns and challenges surrounding managed care implementation. Members of the commission will leverage their significant experience to review implementation and provide insight to ensure we are protecting both patients and health care providers.”

The Governor’s Commission on Medicaid Care Management includes members with expertise in managed care and payment reform models of care, Medicaid public policy, elderly affairs, children’s health, public health, mental health, developmental disabilities and adult health care services.

Mary Vallier-Kaplan, former vice president of the New Hampshire Endowment for Health, will chair the panel and Donald Shumway, former commissioner of the Department of Health and Human Services and president and CEO of Crotched Mountain Rehabilitation Center, will serve as vice-chair. The Commission’s members are Thomas Bunnell, policy consultant for NH Voices for Health; Sue Fox, project director at the UNH Institute on Disability and a parent of a child with developmental disabilities; Wendy Gladstone, MD, a pediatrician at Dartmouth-Hitchcock Medical Center’s Child Advocacy and Protection Program; Yvonne Goldsberry, Ph.D, MPH, vice president of Population Health and Clinical Integration at Cheshire Medical Center/ Dartmouth-Hitchcock- Keene; Catherine McDowell, founder of Coos Family Health and currently running McDowell Project Management; Douglas McNutt, Associate State Director for Advocacy, AARP NH; Gustavo Moral, President of Independent Services Network; Kenneth Norton, executive director of NAMI New Hampshire; and Jo Porter, MPH, deputy director of the NH Institute for Health Policy and Practice.

The Medicaid care management program, as enacted in 2011, is intended to improve the value, quality and efficiency of services provided through Medicaid, stimulate innovation and generate savings for New Hampshire. The program is to be implemented in three phases through contracts entered into between the Department of Health and Human Services and certain Managed Care Organizations who are responsible for providing health care services to members enrolled in the New Hampshire Medicaid Program.

The chair of the commission will call its first meeting within 30 days.

The full text of the Governor’s Executive Order can be found at:

March 12, 2013: Action Alert – Budget Meeting on Monday, March 18 from 5-8pm in Claremont.

Please attend a Budget Meeting to voice your support for the Governor’s budget on Monday, March 18 from 5:00 p.m. to 8:00 p.m. at the Sugar River Valley Technical Center in Claremont

Who should attend? Staff, board members, individuals on waitlists or who just received funding and other family or friends who wish to support the budget. You don’t need to give testimony to have an effect – your presence will be just as important.

If you wish to give testimony, here are guidelines:

  • Keep to 1 page or 2 minutes

  • Print on hot pink paper as this is the color recognized as supporting our cause.

  • Make 24 copies of each testimony for other supporters in attendance, in hot pink.

  • Click here for tips on giving testimony.

If you cannot attend, please consider sending your comments or testimony by email so that we can include your thoughts. You can send them to Mary Burton at This email address is being protected from spambots. You need JavaScript enabled to view it..

CSNI's position (and ours) is to support the Governor's budget. Please note that the budget does include a cigarette tax and proposed expanded gaming in order to cover these services – it is believed that without these services will not be covered.

Despite distance and short notice, we hope that as many of you as possible can attend. This is an opportunity to voice our strong support of the budget submitted by Governor Hassan before it goes on to the House and Senate for voting.

March 1, 2013:  Agency, Family and Board Representatives Propose Alternative to Medicaid Managed Care for DD and Long-Term Services
A team of representatives from Area Agencies – Executive Directors, staff, Board members, and families – in conjunction with outside expert consultants has developed a transformational proposal for an innovative care management system that would serve as an alternative to commercial Managed Care for people with developmental disabilities and acquired brain disorders (DD and ABD). This proposal was presented in late January to Governor Maggie Hassan, DHHS Commissioner Nick Toumpas and BDS Director Matthew Ertas.

The proposal recommends that, instead of contracting with out-of-state Managed Care Organizations, New Hampshire establish the existing Area Agencies (AAs) as Coordinated Care Organizations (CCOs) for people with DD/ABD. As such, the Area Agency system will evolve into CCOs and be responsible for integration and coordination of the physical, mental health, and long term services and supports for people with DD/ABD. The CCOs would replace the three MCOs in providing DD/ABD services, which are currently slated for Step 2 of the Managed Care transition.

These CCOs will continue the Area Agencies’ 30-year commitment to providing quality-driven care and achieving cost savings. They will draw on and expand the AA’s nationally respected best practices. The Agency tradition of providing person-centered, quality care will be expanded to achieve holistic, healthy outcomes.

Many of us have had deep concerns about outsourcing DD long term care services to out-of-state commercial organizations. This plan would be an alternative that preserves our core values. “Nothing about us without us” was the principle decades ago behind the development of our current community-based service system. Appropriately, this principle is still the driving force behind this 21st century proposal to evolve Area Agencies into CCOs.

An additional part of the proposal states that if the State of New Hampshire funds the Wait List at 90% of the budget submitted by BDS, the Area Agencies/CCOs will work with BDS to support 100% of those planned for within that budget to enter into services. Although it seems odd to request less than what DHHS submitted, the Area Agencies would be able to support 100% of those in need of services at 90% of what DHHS proposes for costs. How can that happen? The Area Agencies are committed to moving into a Participant Directed & Managed Services model of care to expand choice and also drive down cost of care for those needing services in Fiscal Year 2014/15.

The CCO proposal has been in development for months, under the direction of the Community Support Network, Inc.(CSNI) Future Systems Group, in collaboration with representatives from families, Area Agency Boards and staff. This plan builds on the community-based system foundation established by our system’s most invested and valued stakeholders — the individuals we serve and their families.

We anticipate continued discussion and refinement on the items outlined in the proposal’s Executive Summary, which is available on the CSNI website, at We will keep you posted on progress for the adoption of this proposal by the State of New Hampshire.

February 18, 2013: What does the Governor’s proposed budget mean for people and services?
Governor Maggie Hassan presented her proposed state budget to the Legislature on February 14. This second phase is part of a nearly yearlong five-step process:

1. DHHS Phase – Aug-Oct 2012

2. Governor’s Phase – Nov 2012-Feb 2013

3. House Phase – Feb-Apr 2013

4. Senate Phase – Apr-May 2013

5. Committee of Conference – Jun 2013

CSNI has provided an overview and preliminary analysis of the Governor’s budget, which is her recommendation to the Legislature. The Legislature will likely change the budget, and Gov. Hassan said to the Legislature in her budget address: “I am ready to work with you to develop a final budget plan.”

What do the budget numbers really mean to people and programs? It is critical to keep in mind that the specific impacts of any changes to the State budget may not be fully known for months.

When are the public hearings? House Bill 1 (HB 1) is like any other piece of legislation in NH: it MUST have a public hearing. The House Finance committee will conduct public hearings in the following communities over the next several weeks: Whitefield, Nashua, Rochester, Claremont and Concord. The exact dates and times are unknown as of this printing.

What is House Bill 2? HB 2 is the “trailer bill” and it contains the policy changes implementing the state budget. This bill has not been released.

What about Medicaid Managed Care? The Governor said she recommends the state continue to implement Medicaid Managed Care. However, there was no mention specifically of Step 2, which includes DD services and other long-term care. In addition, Gov. Hassan said she will soon name a Commission to review the entire program.

What about Medicaid expansion? The Governor’s budget assumes Medicaid expansion will move forward in NH in January 2014.

Based on CSNI’s preliminary reading of the Governor’s Budget, it appears that the following items are included in Governor Hassan’s Budget:

  • Current Services: All currently funded services are continued.

  • Rate Increase for Developmental

  • Services: The Governor did not include the DHHS recommended rate increases.

  • DD/ABD Waitlists: Both of these adult waiver waitlists are funded in the Governor’s budget at a 90% level (as

  • mentioned in “From the Desk of Alan Greene”). Gov. Hassan said: “This budget fully funds the waitlists for services for people with acquired brain disorders and developmental disabilities.”

  • In-Home Support Waiver: There is an increase in funding from current levels and it appears the cuts of the previous two years are reversed.

  • Family Support: There is an increase in funding from current levels; it appears the cuts of the previous two years are reversed.

  • Other Programs: We are continuing to examine Early Supports & Services and other BDS programs.

This update provided by CSNI –

January 15, 2013: DHHS provides an update on Medicaid Managed Care as of January 2013

Although no official start date has been announced, the Dept of Health & Human Services has laid out the procedural timeline for expected upcoming Step 1 switchover to Medicaid Managed Care. DHHS outlines details and updates including:

   * Upcoming changes to our Medicaid program

   * How the new program is different from what we have today

   * Timelines for enrollment

Click here to see DHHS Care Management documents, including the January 2013 DHHS update presentation.