Bradley: Senate Bill 498 Will Improve Children's Mental Health Services

By Jeb Bradley, NH Journal

Mental health services, especially for New Hampshire’s youth, have seen notable progress over the past few years. Only five years ago, there were often nearly 50 children languishing in hospital emergency rooms waiting for a bed and services in a psychiatric facility. Why? Because too often, community-based and in-home services were not available for those most vulnerable.

Today, the number of children in hospital emergency rooms has been almost completely eliminated due to the expansion of community-based and in-home services called the FAST Forward Program.

In 2022, I co-sponsored legislation SB-70 to expand New Hampshire’s system of community-based mental health care for children. The evidence was and is clear: these intensive wraparound services keep kids stable, keep families together, and the services cost a fraction of what is spent on inpatient psychiatric care.

How does FAST Forward operate? When a child has a serious mental health need — not a bad week, but a persistent psychiatric issue — FAST Forward sends a multidisciplinary team directly into the home. They work with the child, the family, and the school to stabilize the crisis in the community before it worsens. FAST Forward ranges in cost from $45,000 to $65,000 per child per year. But those costs pale in comparison to $180,000 for three months of inpatient hospitalization per child. On an annual basis, that is a 90 percent cost savings.

But more important than cost is the child’s well-being. Community-based and in-home care that allows a child to remain with family, friends, and in school is, in most circumstances, far more effective.

In 2021, New Hampshire closed the Sununu Youth Services Center, our juvenile detention facility. That decision was grounded in the evidence that community-based interventions like FAST Forward had reduced the need for institutional placements. We don’t keep expensive institutions and less effective treatments operating when community care produces better outcomes at lower cost.

However, today, too often the cost of those inpatient services is picked up by taxpayers even when these children are covered by their parents’ private insurance.

New Hampshire taxpayers are spending more than $2 million a year to subsidize private insurance carriers that refuse to pay for FAST Forward. Families and business owners pay high costs for private insurance plans. But when their child reaches a crisis, the carrier denies the FAST Forward bundle of services. For some children, their condition continues to deteriorate, and they eventually qualify for inpatient hospitalization and for a Medicaid waiver that transfers the costs of that child’s care to the state. Taxpayers pick up that cost, too.

Senate Bill 498, sponsored by Sen. Birdsell, would fix this inequity. SB-498 would implement an assessment on insurance carriers that spreads this cost across all privately insured people in New Hampshire. If SB-498 passes, it will end the dynamic where insurance carriers collect premiums and then shift their costs to the state and taxpayers. SB-498 will also ensure that the FAST Forward program will have the necessary funding to help at-risk New Hampshire children.

This is why the testimony in favor of SB-498 was overwhelmingly supportive. The only opposition was from insurance company lobbyists. According to the public hearing report, Insurance Commissioner Bettencourt supports the legislation’s underlying objectives, describing it as both sound public policy and a practical necessity. To his credit, the insurance commissioner has spent years trying to advance non-legislative solutions to fix this known issue, but without success. Given that background, the full Senate passed SB-498 without objection.

Some legislators may nevertheless still be skeptical of new assessments to fund FAST Forward. But taxpayers are currently paying $2 million for FAST Forward, when insurance carriers should be covering these costs, especially in light of federal law requiring mental health parity.

Ken Norton, the past president of the National Alliance on Mental Illness of New Hampshire, recently estimated the cost would be about 20 cents per covered individual per month, or $2.40 per year. This is a small, targeted assessment. And, as the Insurance Department highlighted during public testimony, the costs are fully contained in a manner that is more than reasonable for carriers; this is a very manageable cost given the prevalence of mental health issues impacting New Hampshire youth.

The same arguments were used in 2015 when insurance carriers opposed legislation I sponsored to require insurance coverage for oral chemotherapy medication. Imagine having cancer and being unable to tolerate intravenous chemotherapy. Oral chemotherapy may be a cancer patient’s only option. Someone may have faithfully paid their insurance premiums for years, only to be told by their insurer that it does not cover oral chemotherapy. The estimated cost for that legislation was less than 10 cents per person per month, or $1.20 per year.

The legislature rejected the arguments of insurance carriers regarding oral chemotherapy in 2015 and should do so again by passing SB-498. The mental health of children is a top health care priority and should be covered when families have private health insurance.

Sen. Jeb Bradley (R-Wolfeboro) served as President of the New Hampshire state Senate.

This story was originally published by the NH Journal, an online news publication dedicated to providing fair, unbiased reporting on, and analysis of, political news of interest to New Hampshire. For more stories from the NH Journal, visit NHJournal.com.