The New Hampshire government subsidizes mental health care by funding some outpatient and inpatient mental health services.

The state increased that funding thanks to a 2014 lawsuit, which found that New Hampshire needed to do more to keep mental health patients out of hospitals, instead treating them within a community care setting.

Outpatient Care in NH

Community mental health centers

New Hampshire provides funding for ten not-for-profit community mental health centers. This funding allows the centers to take on any patient in their area who needs help, regardless of his or her ability to pay.

The centers bill patients who have insurance coverage, whether through a private insurer, Medicaid, or Medicare, but can use a sliding fee scale for uninsured or underinsured patients.

Even when these centers can bill an insurer, the rates at which they’re reimbursed for these services don’t completely cover costs. The funding the state provides—using a combination of state money and federal grants—is what enables them to keep their doors open.

Legal troubles and impact on funding

A large part of New Hampshire’s outpatient mental health funding is dictated by the terms of a 2014 settlement agreement. That lawsuit argued that New Hampshire violated federal laws – particularly the Americans with Disabilities Act –  by failing to provide adequate mental health services in a community setting and instead relying too much on housing citizens with mental illness in hospitals.

Under the terms of the 2014 lawsuit settlement, New Hampshire had to provide funding to expand community mental health treatment as follows:

• Develop Assertive Community Treatment (ACT) – teams that can provide regular services out in the community – to serve up to 1,500 individuals with mental illness
• Develop mobile crisis services – teams that can visit a patient in crisis and provide services – in Concord, Manchester, and Nashua
• Expand supported employment opportunities, which help individuals with mental illness find and keep employment
• Expand supported housing, such as group homes and rental subsidies
• Develop transition plans for residents of Glencliff Home and New Hampshire Hospital to move to community settings

As of the end of the 2017 fiscal year, an independent evaluator concluded that New Hampshire was meeting most of these requirements. However, the evaluator noted that ACT teams were understaffed according to the terms of the agreement. The state Department of Health and Human Services disagreed with that claim. 

Inpatient Services

In addition to outpatient, community-based mental health treatment, the state provides inpatient treatment for individuals with severe mental illness at New Hampshire Hospital. There are also some patients living long-term at Glencliff Home, although the state is working to move those individuals back into the community.

Long waitlists

A long waitlist at New Hampshire Hospital was one reason for the 2014 lawsuit against New Hampshire – but so far increasing community-based treatment has not decreased demand for inpatient services. 

At the time of the lawsuit settlement in 2014, on any given day an average of 24 adults were waiting in hospital hallways and emergency rooms for a bed at New Hampshire Hospital.  In 2016 the average was over 30. On August 21, 2017 there were a record 72 people waiting for beds at the state hospital.

Some of this increase is due to private hospitals around the state closing their inpatient mental health facilities. The opioid addiction crisis has also placed more strain on the health care system overall.

Recent state budgets have attemped to address the waitlist issue by funding more mental health beds at hospitals. The state is also moving kids out of New Hampshire Hospital to a new facility, repurposing that space to accomodate more adult patients. 

Patients in prison?

New Hampshire Hospital has also faced criticism for its lack of a secure psychiatric unit. In New Hampshire, an individual with mental illness who “present[s] a serious likelihood of danger to himself or to others” may be committed to the Secure Psychiatric Unit in the state prison without committing a crime. 

New Hampshire broke ground on a new 25-bed secure forensic hospital in 2023. Patients currently housed in the SPU will be moved to this new facility as soon as it is operational.

Insurance coverage for mental health treatment

A state law passed in 1994 requires insurers in New Hampshire to cover mental health treatment. The federal Affordable Care Act also requires any insurer offering a plan on the health insurance exchange to cover mental health services. 

Furthermore, state and federal laws require any insurer that covers mental health services to cover those services and other physical health services in about the same way. For example, insurers cannot require a much higher copay for a visit to a psychologist than for a visit to a primary care physician.

Many insurers offer mental health providers low reimbursement rates. These low reimbursement rates are a financial challenge for mental health professionals, and contribute to a shortage of mental health professionals in the Granite State.  According to the U.S. Department of Health and Human Services, there are shortages of mental health care professionals in every New Hampshire county except Cheshire. New Hampshire lawmakers responded to this problem in 2019 by adding an 8% increase in Medicaid rates for mental health and substance abuse services to the 2020-2021 budget. Those rates took effect in January 2020.