(Opinion) Mental health centers need a ‘meaningful’ rate bump

As crisis and workforce shortage continue, a Medicaid rate hike is essential

New Hampshire’s community mental health centers are requesting that policymakers and budget writers increase Medicaid reimbursement rates in a meaningful way in 2023. The 10 nonprofit centers that make up the community-based mental health system provide critical services to more than 60,000 NH citizens in our state every year. But the shortage in the workforce pipeline has reached a crisis level: We cannot hire the staff we need and retain the dedicated staff we already have, without a significant rate increase this year.


Our mental health centers rely on Medicaid for 80 to 90 percent of our revenue — unlike other healthcare providers who may be similarly challenged with workforce shortages but who have other sources of income available to them. The underlying Medicaid fee schedule has had few rate increases over the years, and New Hampshire has one of the lowest Medicaid reimbursement rates in the nation.

The governor and Legislature have been supportive of our work and our mission, and we very much appreciate the 3.1 percent Medicaid reimbursement rate increases in 2020 and 2021. But costs have gone up, and the number of people in crisis and in need of care has increased considerably. We are reaching the limit of our ability to serve those who need care. Without access to timely outpatient care, more individuals will see their needs escalate, requiring more costly and restrictive intensive outpatient and inpatient services.

I have worked in New Hampshire’s community mental health system since 1986.

With age comes, if not wisdom, institutional memory. I know that recruitment and retention of qualified staff has always been a point of discussion. There was a time when mental health centers felt they could confidently attract staff by talking up the generous benefits offered to offset the low salaries, but over time the benefit packages eroded somewhat as costs rose. Fully paid individual and family health plans made way for staff contributions and higher deductibles and co-pays.

Our salaries still lagged behind the larger healthcare providers who were seeking to hire the same job candidates as the community mental health centers. New Hampshire’s population grew and the numbers of individuals and families needing care increased.

And then along came Covid. We have all seen the reports of increased need for mental and behavioral health services during the pandemic. Community mental health centers were fortunate to receive support from federal and state funds that allowed for continuity of care during this time. The centers have been even more fortunate to have staff who have continued to rise to meet the challenges of increased service needs, all while living through the pandemic themselves.

In 2016, the NH Community Behavioral Health Association began collecting and reporting information about recruitment, retention and vacancy data at the 10 centers. We have seen the number of vacant positions and turnover rates steadily grow ever since. Every center has made intentional decisions to adjust salaries, benefits and workflows in an effort to increase their competitiveness in the hiring market. And as “integrated care” became a common phrase in our healthcare universe, hiring became even more of a challenge.

From 2020 through 2022, the number of patients seen by community mental health centers increased by 8 percent, with emergency services increasing by 15 percent. We managed to serve this larger population while experiencing 12-month turnover rates that averaged close to 25 percent statewide and exceeded 40 percent at times for individual centers.

And while we have made the provision of quality care our primary focus, we have also worked to eliminate the stigma and discrimination related to mental illness.

We have asked so much of our staff in our efforts to provide necessary supports and services to those living with mental illness and substance use disorders. It is time to honor their commitment and recognize the value of their work. It is also time to ensure that the individuals and families we serve — our neighbors and co-workers — have continued access to care. We must have a meaningful increase in Medicaid reimbursement rates in 2023.

Jay Couture, president and CEO of Seacoast Mental Health Center in Portsmouth, lives in Rye.

Categories: Opinion