Every year, we recognize May as Mental Health Awareness Month. In my role, I always appreciate this month not only as a chance to increase awareness of mental health conditions, but also as an opportunity to take a step back and celebrate what we’ve accomplished.
Over the past several years, New Hampshire has worked hard to strengthen its mental health system. The state, in partnership with the 10 Community Mental Health Centers, implemented a comprehensive behavioral health crisis system, made meaningful progress in reducing emergency department psychiatric boarding and strengthened the Children’s System of Care. We’ve worked on policy changes to strengthen our workforce and improve access to care. Though there is still plenty left to do, our community mental health system continues to rise to meet the needs of Granite Staters, connect them with lifesaving care and avoid costly and tragic outcomes.
There’s a lot to celebrate. But this year, with changes to Medicaid Expansion looming, it’s hard to do anything other than worry about our system and the people it serves.
New state and federal laws have made significant changes to Medicaid Expansion affordability and eligibility, including new work requirements and cost sharing. These policies threaten not just the health of the over 60,000 Granite Staters enrolled in the program, but the stability of the entire system.
When Medicaid Expansion was implemented in New Hampshire in 2014, it fundamentally changed how our community mental health system functioned. Before Expansion, thousands of Granite Staters struggled to access the care they needed. Many low-income individuals and families couldn’t afford to pay for the services they needed but also didn’t meet the criteria for coverage under traditional Medicaid. This created significant access gaps, with few options or alternatives. For too many, lack of access contributed to tragic outcomes, including hospitalization, homelessness, incarceration and even death.
As safety net providers, this challenge created instability for community mental health programs. Community providers were treating people in crisis, who had been unable to access care, and still had no way to pay — putting stress not only on service capacity, but also taking a heavy financial toll in the form of uncompensated care.
Medicaid Expansion has served as a critical, stabilizing foundation for community mental health services. By extending coverage to low-income individuals and families, this program has helped people get treatment earlier, reduce utilization of emergency services and crisis care and avoid tragic outcomes. In 2024, one in three adults covered by Medicaid Expansion accessed mental health care — that’s over 25,000 people. More coverage also means that providers more often got reimbursed for what would have otherwise been uncompensated care. These changes have helped the state build a comprehensive mental health system, close access gaps and improve mental health throughout the state.
Medicaid Expansion is not a fix-all. Community providers still face uncompensated care and workforce challenges. What the program has given us, however, is progress, the very progress we celebrate during Mental Health Awareness Month.
Policy changes related to Medicaid eligibility force us to question if that progress will be lost. New cost-sharing policies may force people to delay care until they are in crisis. Work requirements jeopardize ongoing coverage for every enrollee. Challenges with reporting hours, verifying exemptions or understanding specific policies will cause stress and confusion that may lead people to lose their coverage, even if they are already working.
For many, Medicaid Expansion lets them and their loved ones stay healthy and engage with their communities. Without this coverage, more people won’t get the help they need until they end up in crisis. Access gaps will widen. Uncompensated care will put an even greater burden on the system, sending us backwards.
This Mental Health Awareness Month, we can’t just celebrate our progress. We need to protect it. Follow NH Medicaid Matters to stay informed as changes to the Medicaid program come to New Hampshire.
Patricia Carty is CEO of the Mental Health Center of Greater Manchester. She lives in Manchester.