New Hampshire’s 26 hospitals stand to lose millions in state payments for uncompensated care with the collapse Thursday of negotiations between the governor, lawmakers, and the hospitals. With a deadline fast approaching and a legislative fix seemingly off the table, a frustrated Gov. Chris Sununu has ordered the Department of Health and Human Services to arrange even deeper cuts to the hospitals than he initially offered.
By one estimate, the loss to hospitals could reach $35 million a year.
Steve Ahnen, president of the New Hampshire Hospital Association, called Sununu’s plan a “direct threat” to the hospitals.
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“The governor scuttled a bipartisan solution on (Medicaid tax payments) in favor of massive, arbitrary and punitive cuts to hospitals,” he said in a statement Thursday evening. “In doing so, the governor is effectively raising the tax paid by hospitals, driving costs up for patients, and destabilizing our entire health care system.”
Ahnen did not say how hospitals intend to respond or whether they will take the state to court as they have twice before.
Senate President Jeb Bradley, who shepherded the now-failed compromise through the Senate, warned the same. “The viability of hospitals is at stake,” he told his House counterparts Thursday. “At the end of the day, our health care system, I think, is at stake.”
At issue is the nearly $320 million hospitals pay the state in Medicaid Enhancement Taxes (MET) annually. The state receives a federal match on that money and returns 91 percent of it to hospitals to help them cover primarily uncompensated medical care costs. This money is separate from the Medicaid reimbursements they get that cover part of their treatment costs.
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The current arrangement, which was reached in 2018 as part of a lawsuit filed by the hospitals, expires at the end of June. Hoping to avoid another lawsuit from the hospitals, Bradley began negotiating late last year with hospitals, the governor, and other stakeholders on a legislative fix. Those negotiations took far longer than expected, Bradley said, so much so that the Senate passed its legislation just two weeks ago without time to let the House review it and hold its own public hearing.
Had that legislation succeeded, it appeared unlikely Sununu would have signed it.
Sununu said he was willing to continue returning 91 percent of the MET revenue to hospitals but wanted to distribute it differently. Those changes would have allowed the state to get a more generous match from the federal government, money Sununu wanted to give to non-hospital providers who care for Medicaid patients but do not pay the tax, including community mental health centers and substance use disorder clinics.
But Sununu’s plan would have left some hospitals with more money and some with less. For example, under one proposal, Lakes Regional General Hospital would have lost $2.5 million a year while Elliot Hospital would have gained nearly $2.9 million.
The hospitals objected to Sununu’s proposal and reached a compromise with the Senate. Under that deal, they would continue getting the 91 percent and an additional $14.3 million to make up for the lost revenue. About $5.7 million of that would have been state dollars, the rest federal.
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Sununu said in a statement this week he was “fundamentally opposed” to using state money to boost the hospitals’ payments.
That deal fell apart Thursday when House and Senate negotiators decided they could not reach an agreement before they meet a final time next week. For House members, it was largely because the Senate’s legislation, tacked onto House Bill 1593, reached them so late.
“Everybody knew this deadline was coming,” Deputy House Speaker Steve Smith, a Charlestown Republican, said Thursday during negotiations. “Why didn’t you start working earlier so that it could have gone through the proper process and maybe I’d be sitting here with a smile and a yes today. But that’s not what happened.”
Like Sununu, Smith said the House could support much of the bill but not the measure giving hospitals an additional $5.7 million in state money.
Bradley acknowledged Smith’s complaint about the late hour but implored his House counterparts to sign on, warning them it would cost the state far more if the hospitals take it back to court.
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“It’s really nobody’s fault that we are here on June 6 at the deadline (for negotiations),” Bradley said. “This is complicated. It’s contentious. It’s been subject to litigation. A lot of money is at stake.”
Sununu weighed in on the Senate’s proposal indirectly Wednesday in a letter to DHHS Commissioner Lori Weaver, which he shared publicly. He directed Weaver to tell federal Medicaid officials that the state would be returning only 80 percent of the MET revenue to hospitals.
He did so, he wrote, in anticipation of legislation failing. And as he has done consistently, Sununu blamed the hospitals for insisting on a deal that he said would prevent the state from giving non-hospital providers Medicaid funding and leveraging a higher financial match from the federal government.
“The hospitals have remained insistent upon an arrangement which crowds out other providers and greatly diminishes general fund savings.”
Ahnen responded in a statement late Wednesday.
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“The proposal put forward by the governor results in an effective tax increase to those New Hampshire hospitals losing money over the current agreement, at a time when they are struggling financially,” he said.
This story was originally published by the New Hampshire Bulletin.
CONCORD – While Republican Gov. Kelly Ayotte has said she opposes increasing highway toll rates across the state, the Senate voted Thursday to increase rates for out-of-state license plate holders.
It now goes to the House for consideration.
This would be a $1 increase for those who have out of state plates going through the tolls at Hooksett, Hampton and Bedford for out-of-state plates, a 75 cent hike for those taking Hampton’s Exit 2 and on the Spaulding turnpike at Rochester, and a 50 cent hike for those taking the exit off I-93 to Hooksett.
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An analysis in the bill shows that this would increase toll revenue by $53.3 million in fiscal year 2027 and go up each year to generate $81.4 million a year in 2036.
Senate Bill 627 passed on a voice vote with two Republicans, Senators Regina Birdsell of Hampstead and William Gannon of Sandown opposing.
Senator Mark E. McConkey, R-Freedom, moved to take the bill off the table and offered an amendment. He said the last time there was a systemwide increase to the turnpike toll was 19 years ago.
“I am sure we could all agree the cost of operations…has continued to escalate when revenue is not rising with it,” and he noted that with an enterprise fund, the state can only spend what it takes in.
The state has just completed a 10-year highway plan and there was a $400 million shortfall in projects that could not be paid for under the current income.
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McConkey said the measure would not increase tolls for New Hampshire drivers with a state license plate.
“Why don’t we ask our neighbors,” to pay a toll increase. “We are getting the best of all worlds,” by passing the bill, he said, including “protecting our residents” and having resources for improvements to the turnpike system.
Sen. Gannon, R-Sandown, asked McConkey if there are any studies on impacts near the border on businesses.
If implemented, McConkey said the state will be the 27th lowest in per mile cost still. McConkey said the bill would also increase from seven to 14 days the amount of time for those with NH license plates to pay for a toll adding there are other states that also have different rates for out-of-state users.
The Hampton toll cost would go from $2 to $3, while Hooksett and Bedford would rise from $1 to $2 for out-of-state plates.
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New Hampshire currently has the lowest rate per mile among states with tolls roads. The governor said she does not support a toll increase.
“We are not going to put a burden on drivers for a toll increase,” Ayotte said. “Families are struggling.”
WILTON, N.H. (WHDH) – A woman died in a Wilton, New Hampshire, house fire Wednesday morning, according to the New Hampshire State Fire Marshal’s Office.
At 9:08 a.m., Wilton firefighters responded to Burns Hill Road after a caller said their home was filling up with smoke. When they arrived, a single-family home was on fire and they found out two people were still inside on the second floor.
A man and a woman were both taken out of the house by firefighters and taken to Elliott Hospital. The woman was pronounced dead and the man is in serious condition.
Officials have not released the name of the victim at this time.
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At this time, investigators are looking into the cause of the fire and are trying to determine if a power outage in the area played a factor. The fire is not currently considered suspicious.
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