No one will feel the effects of the two-year budget passed by the New Hampshire House more, if it is enacted, than New Hampshire low-income residents who need help paying for, and accessing, health care.

The $15.36 billion FY 2026-27 budget passed by the House Thursday, April 10, cuts Gov. Kelly Ayotte’s $16 billion proposal by $643 million. It takes its deepest cut from the state Department of Health and Human Services — $269 million less than what was proposed by Ayotte in February. That includes $46 million in “back-of-budget” cuts, which aren’t specified in the state budget, but up to the agency head to come up with.

Many of those cuts are to Medicaid-related services; programs that provide health care support; resources and aid for the elderly, people with disabilities and those with low incomes. It eliminates programs designed to reduce health care costs overall in the state, and raises fees and costs for low-income people who receive Medicaid.

Ayotte said this week she hopes to work with the New Hampshire Senate, which has until June 5 to amend the House proposal, including cuts to mental health and disability services. Any disagreements between the House and Senate are worked out in a committee of conference, and the two-year budget goes into effect July 1.

The DHHS budget represents a massive share of the services the state provides to residents. It was $6.58 billion in the current fiscal biennium, representing 44% of the states’ expenditures.

House Republican budget leaders say the deep DHHS cuts from what Ayotte proposed are necessary to help close an $800,000 gap in their revenue projections as compared to the governor’s.

But those who opposed the budget said it goes too far, particularly when it comes to the state’s low-income residents.

“This budget will have devastating and long-lasting effects on the neediest in our state,” Rep. Mary Jane Wallner, D-Concord, said during the House Ways and Means approval process. Thursday’s vote was along party lines, with Democrats, in the minority, attempting to amend some of the cuts or fee increases. Most of those efforts were unsuccessful.

“If enacted, these proposed cuts will certainly have an impact on the lives, dignity, and futures of Granite Staters,” Kate Frey, vice president of advocacy at New Futures, said in an online statement Thursday. New Futures is a nonprofit that provides data and research on the health of New Hampshire children and families.

“The people who will feel these cuts the hardest are families struggling to make ends meet, older adults dependent on critical support services, people accessing treatment and recovery for substance use, health care providers reliant on state investment, and working individuals who rely on basic health care and economic opportunities,” Frey said.

Many of the biggest cuts, as well as fee hikes, are for families who receive Medicaid, which provides health care to people with low incomes, disabilities and the elderly. More than 182,000 New Hampshire residents, 13.4% of the state’s population, receive Medicaid, including 30.1% of children in the state and 64% of residents living in nursing homes, according to federal statistics. An additional 60,000 are included in the Granite Advantage Medicaid expansion program for residents between 19 and 64 who have a household income at or below 138% of the federal poverty guideline, which would be $21,597 for an individual.

Most Medicaid programs in New Hampshire are overseen by DHHS.

Among the House budget provisions affecting health care for low-income state residents:

• A required premium of 5% of income premium for Medicaid recipients above the federal poverty guideline. The premium would apply to households with no children that earn 100% or more of the federal poverty guideline ($15,650 for an individual, modified annual gross income, which includes all income, not just wages) and 255% or more of the federal poverty guideline for families with children (for instance, $67,957 of modified annual gross income for a three-member family). Those who oppose the premium characterize it as an income tax on those who can least afford it.
• An increase to the copay for prescription drugs for Medicaid recipients to $4 from the $1 and $2 most recipients paid. Those who oppose it say that it may seem like a small amount, but isn’t for many families who struggle to buy food or heat their house. Rep. Ken Weyler, R-Kingston, the chair of the House Finance Committee, said the increase will deter people who take advantage of the system by getting medication they don’t need.
• Cuts the Medicaid reimbursement rate by 3%, which means $52.5 million less to providers over the next two years, which will cause reductions in services and some health care providers shutting down, critics of the move have said.
• A $31.4 million reduction in funding for developmental disability services over two years, which would also reduce federal Medicaid matching funds, for a $62.8 million (6.4%) cut that would affect the developmental disability services waitlist for anyone needing increased aid, children aging out of school-based services and individuals with disabilities moving into the state.
• Suspends the WIC farmers market nutrition program, which provided $30 a month to WIC recipients to buy produce at farmers markets.
• Suspends congregate housing services for elderly residents who are eligible for Medicaid, but also increases the amount counties must contribute for long-term care for the elderly, from 2% to 3%, capped at a statewide total of $135.8 million in FY 2026 and $139.9 million in SFY 2027.
• Cuts $37.8 million over two years for community mental health, which would mean cuts in service or elimination of community mental health centers, the Rapid Response Team, and other initiatives to better serve people with mental health challenges, including to Mission Zero, a program that aims to provide mental health services that free up emergency room space used to board people suffering from mental illness.
• Changes to how the Alcohol Abuse Prevention and Treatment Fund is financed that limit the money to opioid-related programs.
• Eliminates the state’s family planning program, a $1.7 million cut, which provides contraception and prenatal services, as well as cancer screening and sexually transmitted disease prevention resources and testing.
• Suspending the State Loan Repayment Program for health care professionals, including dentists, who take jobs in underserved areas for 36 months or more, and in exchange the state pays a portion of their student loans. The program was created to incentivize health care work in areas that don’t have access to providers.
• Eliminating the Tobacco Cessation and Prevention Program, which is designed to reduce the prevalence and consumption of tobacco use, the top cause of preventable death in the state, as well as contributing to a large variety of health issues, including in children who breathe second-hand smoke. According to Quit NH, the state’s initiative to combat the effects of smoking, tobacco use costs New Hampshire $1.5 billion annually both directly and indirectly, including medical costs and lost productivity from illness related to it.
• Eliminating the New Hampshire Commission on Aging, which works to access federal Older American Act funds.
• Eliminating the Prescription Drug Affordability Board, which works to limit prescription drug costs.
• Eliminating four Dept. of Education positions that implement prevention and student wellness programming in schools (these are non-vacant positions).

Ayotte said before the vote that she plans to work with the Senate on getting some of what she proposed back into the budget, including funding for community mental health centers and the waiting list for services for people with developmental disabilities.

Adding to the outlook for Medicaid recipients and health care in New Hampshire is uncertainty about what will happen on the federal level. New Hampshire has a trigger law that, if federal funding for Medicaid drops below 90% of the program’s cost in the state, the Granite Advantage program will be terminated.

Congress is in the midst of considering changes to the Federal Medical Assistance Percentage that would require states to come up with a bigger percentage of their Medicaid share. Some of the proposals in the House budget had that in mind, including a shift to lower-cost medications and services. But the state would still have to come up with millions, which would likely include elimination of Granite Advantage, the expansion that provides Medicaid to more than 60,000 state residents.

A town clerk will pay fines and be stripped of his justice of the peace accreditions, but avoid jail time, after he signed a marriage license for a wedding he didn’t perform, involving a groom who was dead.

Jim Tetreault pleaded guilty in Keene District Court on Thursday to a misdemeanor count of notarial misconduct. He was given a suspended sentence of 90 days in jail, assessed a $1,240 fine, and resigned his justice of the peace and bail commissioner positions.

According to prosecutors, Tetreault signed a marriage license for Wendy Leedberg-Snow and Eric Leedberg. Tetreault originally told investigators that he performed the ceremony in his living room in September 2023. Tetreault would later admit, however, that he didn’t perform the ceremony, and that he was asked by Leedberg-Snow to sign the document some time after Eric Leedberg’s death.

He told authorities that he was friendly with Leedberg-Snow, who changed her legal name shortly before Eric Leedberg’s death. In his obituary, she is described as his “significant other.”

Leedberg’s family alerted authorities after they received his death certificate, which listed Leedberg-Snow as his spouse.

Leedberg-Snow has not yet been charged with any wrongdoing, but the New Hampshire Attorney General’s office confirmed she is under investigation. She previously declined to comment to NHPR.

Tetreault was back in his office as town clerk and tax collector in Winchester by midday Thursday. He declined to comment when reached by NHPR, but through his attorney, said that he “took responsibility for my poor choice in that one moment. I want to thank my family and friends and the townspeople for their support during this time.”

Tetreault was facing felony charges for vital records fraud, but accepted a plea deal on a misdemeanor count. Under the terms of the settlement, he agreed to not seek reappointment as a justice of the peace or notary for two years.

A 39-year-old man who became the victim in a fatal skiing accident near the summit of Black Mountain Ski Area in New Hampshire died “doing what he loved best,” according to his obituary.

Bartlett, New Hampshire, resident Eric Page crashed on a black diamond trail in an unwitnessed accident, Jackson, New Hampshire, police said previously. A passing skier reported the crash shortly after 5:50 p.m. on April 20.

A police sergeant located Page off-trail near the edge of the snow line with “significant” injuries, police said. He was unresponsive as he was taken to the base of the mountain, and paramedics soon declared him dead.

• Read more: Man dies in ski accident near summit of New Hampshire mountain

“Eric came into this world a month early, and he has been late ever since,” his obituary reads. “From a young age, he asked lots of questions (his ski coach would limit him to 2 questions per lift ride), was very artistic, and loved anything to do with the outdoors.”

Page started skiing when he was just two years old, and spent most of his weekends at Attitash Mountain or Ossipee Lake with his family, according to his obituary. Raised in Pelham, New Hampshire, he graduated from Bishop Guertin High School before earning a bachelor’s degree in business from the University of New Hampshire.

“Anywhere Eric went, he made friends and built lasting relationships,” his obituary reads.

After graduating from college, Page selected a range of jobs for the purpose of developing new skills he would need to eventually start his own business, according to his obituary. Before his death, he created a profitable vacation rental business, earned his real estate license and became a skilled craftsman and painter.

“Eric was an avid lover of the outdoors and found joy and peace in nature. He was exceptionally talented at many extreme sports, but his true passion was skiing,” his obituary reads.

Page spent many years racing for the Attitash ski team and made lifelong friendships doing it, according to his obituary. He later became a freestyle coach at the mountain and enjoyed showing off his “jaw-dropping skills” as a freestyle skier.

“His team was so excited to have THE legendary Eric Page all to themselves to show them how it’s done. He enjoyed instilling his love of skiing on the next generation, spending countless hours teaching kids of all ages and abilities how to ski. His nieces couldn’t wait to get on the slopes each weekend with Uncle Eric,” his obituary reads.

“He left a lasting impression and legacy in the Mount Washington Valley ski community with his vibrant personality, generosity, and love for the sport.”

Page is survived by his mother, father, sisters, three nieces and many other beloved friends and relatives, according to his obituary.

“Eric’s warmth, adventurous spirit, and generous heart will be missed deeply by all who knew and loved him,” his obituary reads.

A visitation for Page is set to be held Tuesday, April 29 from 4 to 7 p.m. at Remick & Gendron Funeral Home-Crematory in Hampton. A Mass is scheduled for the following day at 11 a.m. at Our Lady of the Miraculous Medal Church in Hampton.