TAKE ACTIONCoverage for Children's Behavioral Health Care Coordination

MYTH #1: This is a Medicaid program.

It’s not. FAST Forward, the program that provides wraparound, serves every child in New Hampshire regardless of their insurance type. The system of care in New Hampshire exists for every single child in this state. Right now private carriers refuse to pay for their own members accessing these services, so New Hampshire taxpayers are currently picking up the tab.

MYTH #2: This bill will raise premiums.

At most, this assessment costs 24 cents per member per month. Families are already paying nearly $7,000 a year out of pocket for private coverage that provides zero support during a pediatric mental health crisis. Twenty-four cents.

This program is cost saving. Since 2014, when New Hampshire rolled out this program, the Department of Health and Human Services (DHHS) has experienced a 28% reduction in inpatient hospitalization expenses. 28%! This was millions of dollars. Because kids are being served in their community instead of costly institutions.

Let's also consider what's already happening: when private carriers refuse to cover these children and their condition worsens, the kids get pushed onto Medicaid — which New Hampshire taxpayers fund at 50 cents on every dollar. When children get community-based care early, they don't end up in hospitals.

So that 24 cents, even that is a stretch. Realistically, this bill could actually drive costs down.

MYTH #3: This bill would require changing several laws.

Not true. While any bill can be subject to a legal challenge, even if meritless, this bill contains an important provision that protects it: a severability clause. This means that, even if insurance carriers tried to challenge this in court, the bill is built to withstand it. If one piece of the bill were ever struck down, the rest of the law stays standing. So the core assessment framework would be preserved. We know this because it is modeled on New Hampshire's vaccine association, which has never seen a successful legal challenge.

MYTH #4: The right people haven't been working on this.

This issue has been studied exhaustively. There have been three formal processes examining this exact problem: the Insurance Department's Behavioral Health Advisory Committee, an interim legislative study committee convened in 2022 specifically to pursue a non-legislative solution to SB 70, and the SB 411 study committee in 2024. Non-legislative solutions were also pursued last year, after the House removed the policy from their version of the Budget in Committee of Conference. In all of these meetings, industry experts have been present, participating and reporting progress on contracts that have never materialized. House members have also been involved and even sit on the Insurance Department’s Behavioral Health Advisory Committee. The groundwork has been laid. What hasn't happened is action.

MYTH #5: Providers haven't been coming to the table.

The two non-profit organizations delivering FAST Forward were actively in documented conversations with insurance carriers in 2024. Insurance carriers claim the providers haven’t given them the patient data they need to build the billing infrastructure needed to cover FAST Forward. But the reason patient data hasn't been shared isn't stonewalling — it's HIPAA, state law, and provider policies around confidentiality. They legally cannot share a child's clinical file with an insurance company that has made no commitment to pay for their care. 

And here’s what the insurance carriers aren’t saying: Insurance companies analyze risk as part of their billion-dollar business models. You’d be shocked to know the amount of information they’re keeping on you to predict the costs associated with your current and future health conditions. So, they already know which of their members have been hospitalized for mental health crises. They know which families are filing outpatient claims. They know which of their patients suddenly has dual insurance because they now qualify for Medicaid. The idea that they don't know who these kids are is not credible.

MYTH #6: FAST Forward providers should have been billing insurance all along.

In every Department of Health and Human Services contract, there's a standard clause called the payer of last resort. It means: if private insurance doesn't pay, the state does. Private carriers have routinely denied Fast Forward claims, saying they don't cover these services and that the providers are not in their network. So the state has been paying — every time, for every child. Senate Bill 498 fixes this by ensuring carriers finally contribute their fair share instead of passing the cost onto taxpayers.

MYTH #7: This bill can't apply to self-funded insurance plans.

New Hampshire's private insurance market is roughly split — about half fully insured plans, and half self-funded plans. Here's why that matters: state laws around mandating benefits apply to fully insured plans, but not self-funded ones. So a standard insurance mandate would only reach half the market.

But the Supreme Court has clearly established that while states cannot mandate benefit designs for self-funded plans, they can impose indirect economic burdens — like surcharges or assessments — on health plans. Because an assessment is a cost of doing business rather than a directive on how to structure a benefit plan, it is a legitimate tool to reach self-funded plans.

That's exactly what Senate Bill 498 does. The assessment model captures both self-funded and fully insured plans — the entire private insurance market in New Hampshire. No loopholes. No carve-outs.