So what, exactly, does the New Hampshire Department of Health and Human Services do?

Last modified: 2/8/2015 12:20:06 AM
About half an hour into the Department of Health and Human Services’ presentation to the House Finance Committee last month, Commissioner Nick Toumpas had already explained a handful of the issues before the department.

He went over its big-ticket Medicaid programs, its budget shortfall, its challenges trying to keep up with growing demand for services and with a changing health care landscape at large.

But before Toumpas went any further, Rep. Neal Kurk – a Republican from Weare and the chairman of the finance committee – asked to make a quick observation to his fellow lawmakers.

“If you’re not fully . . .” Kurk began, pausing to search for the right word, “awed by some of the issues in the department, you have not been paying attention.”

“What was the word?” Toumpas responded.

Kurk repeated himself, matter-of-factly. “Awed.” A few others in the chamber chimed in with murmurs and some quiet laughter.

“Okay,” Toumpas replied, unsure what to make of the assessment. “Is that a good awe or a bad awe?”

“It’s a favorable awe,” Kurk clarified. “The department does extraordinary things. They are very complicated. Even though the commissioner is using no acronyms at this point and trying to make things as simple as possible, it is still very complicated – and one can be overwhelmed very easily by this. So if you’re not overwhelmed, and I’m pretty nearly overwhelmed, I think you have not been paying attention.”

The exchange said a lot about the department’s current position.

Toumpas had good reason to question the meaning behind Kurk’s initial assessment. The agency – and the commissioner, as its public face – has drawn plenty of scrutiny from state lawmakers as a major driver of the state’s overall budget shortfall. And since Toumpas presented a plan for reducing the department’s budget hole in part by reducing Medicare payments to nursing homes, that scrutiny has in recent weeks grown even more intense.

But that back-and-forth also hinted at the scope of the tasks – many of them carrying significant cost, both human and financial – that fall to the department. In the months leading up to November, according to a report published by the department, the agency served an average of 174,235 people – a 14 percent increase over the year before.

Activity is spread out across about 15 divisions, which handle everything from monitoring disease outbreaks to handling food safety to distributing food stamps. It manages the New Hampshire Hospital, the state psychiatric institution, and Glencliff Home, the state facility for people requiring long-term care for mental illness or developmental disability. It oversees juvenile justice programs through the John H. Sununu Youth Services Center. It also handles foster care and adoption, licensing for health facilities, substance abuse prevention programs, child support services and, since 2013, the state’s medical marijuana program.

In addition to its headquarters in Concord – which itself is broken up into separate locations on Pleasant Street and Hazen Drive – the agency also operates some 11 district offices scattered throughout the state.

As such, there are hundreds of accounting units across the department.

But just 85 of those units drive more than 95 percent of the department’s general fund spending, according to Toumpas. As the department makes its case to lawmakers about what kind of funding it needs for the next two-year budget cycle, it’s also going to be putting an added emphasis on drawing a link between the money the department spends and the people affected.

Some of the biggest expenses, according to a breakdown presented to lawmakers last month, are expected to go toward long-term support services for seniors, as well as medical services for children and adults.

And as it tries to manage its expanding responsibilities at a time when resources are becoming tighter, the department is finding it harder and harder to please everyone.

Toumpas has a sign hanging in his office that reads: “Worst Job In America.” It’s meant as a joke, but he’ll still admit the job is no cakewalk.

At an earlier presentation to the Senate Finance Committee when Toumpas was talking about the challenges of balancing the agency’s budget while still meeting all of its obligations, Sen. Andy Sanborn put it bluntly: “I don’t envy you, sir.”

(Casey McDermott can be reached at 369-3306 or or on Twitter @caseymcdermott.)

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