While the state foots the bill for children’s mental health services, advocates and private insurers remain locked in a standoff over who should bear the cost of comprehensive, coordinated care.
New Hampshire’s Families and Systems Together (FAST) Forward is a wraparound program that provides individualized care for children aged 5 to 21, including peer support, crisis planning and family-centered services for critical mental health concerns.
For families who don’t qualify for a Medicaid waiver, the state spends roughly $2 million in taxpayer dollars annually to fill the gap for commercially-insured children.
At Thursdayโs legislative hearing on Senate Bill 498, which aims to close the coverage gap by requiring private insurers to cover wraparound services, Sen. Regina Birdsell said stakeholder talks “broke down last week,” making legislative action the best path forward.
Private insurers cover some services under the program but do so with a piecemeal approach rather than at a bundled rate.
Mental health advocates say the success of the program lies with bundling services, which would allow care teams to provide coordinated care from school counselors and therapists to caregiver respite, individualized plans and any other support a family might need.
Sabrina Dunlap, senior director of government relations at Anthem Blue Cross Blue Shield, said characterizing the negotiations as having broken down is inaccurate.
She said the providers delivering wraparound services fall outside Anthem’s network, meaning they have not been vetted, had their educational backgrounds checked or had their licenses and credentials verified.
โThese things are complicated. They do take time. They should take time,โ she said. โThese safeguards exist to protect our members, and just because the process isn’t happening overnight does not mean we are not making progress.โ
A child enrolled in the FAST Forward program costs between $45,000 and $65,000 per year, but a single night at an inpatient psychiatric facility like Hampstead Hospital runs roughly $1,500. The program is designed to prevent children with complex challenges from reaching that costly level of institutional care.ย
Morissa Henn, deputy commissioner of New Hampshire’s Department of Health and Human Services, said programs like FAST Forward have already reduced the number of children in the state requiring institutionalized or out-of-state care.
She said one year of institutional care for a single child can easily climb to $1 million.
The department is now calling on insurers to step up and share the financial responsibility for a system that has, until now, been carried entirely by the public.
โThe benefits of this program have been acrued and seen by the insurers, as well, who also are responsible for caring for kids when they go to an in psychiatric hospital,โ she said, โSo there’s an element here of just economic good sense about a program like this that’s not just meeting needs, it’s preventing much higher levels of care for kids that otherwise are going to need to go there.โ
