1 Short Title. This act shall be known as The New Hampshire Needs Caregivers Act.

2 Statement of Purpose.

I. New Hampshire's health care workforce is the foundation of our health care safety net, and the foundation is in crisis due to a lack of consistent investments. As a result, residents of New Hampshire will go without care. Recently, the state worked to stabilize the system using federal funds, including direct aid to hospitals, community providers, and long-term care facilities, and investments in our Medicaid program; however, there remains a strong need to invest in programs to foster a future health care workforce within the Granite State.

II. The state of New Hampshire shall address the health care workforce shortage by leveraging state funding through public and private partnerships, investing in programs designed to incentivize students to seek employment in health care and remain in New Hampshire upon graduation; and equipping health care organizations with the tools necessary to secure skilled clinicians.

3 Department of Health and Human Services; Division of Public Health Services; Public-Private Health Care Workforce Recruitment and Retention Hub; Infrastructure Contracts.

I. The department of health and human services, division of public health services, rural health and primary care section shall amend its current contract with Bi-State Primary Care Association's Recruitment Center to require the Recruitment Center to strengthen the infrastructure needed to sustain and transform community-based primary care services through the creation of a Public-Private Health Care Workforce Recruitment and Retention Hub that promotes collaboration across the continuum of care. Bi-State Primary Care Association shall administer the Public-Private Health Care Workforce Recruitment and Retention Hub and manage the sub-recipient contracts, and leverage federal, state, and private funding, and seek new funding opportunities when appropriate.

II. Bi-State Primary Care Association shall design the sub-recipient contracts to facilitate health care workforce development, recruitment, retention, support nursing preceptor and mentoring programs, provide training and technical assistance, and loan repayment opportunities. Bi-State Primary Care Association shall:

(a) Expand and implement its national outreach and marketing campaign designed to recruit qualified clinicians to New Hampshire;

(b) Collaborate with an area health education center to increase the number of entry-level clinical staff through investments in programs designed to improve care and access to care, particularly in rural and underserved areas of this state, and to enhance the health and public health workforce in New Hampshire. Such programs may include: engaging under-represented populations in the health care professions in middle school and high school; offering health professions students opportunities to experience learning in rural or medically underserved regions of New Hampshire designed to encourage participants to settle and work in these regions; and enriching the standard health curriculum by providing health professions students training in aspects of health care such as integration of behavioral health and primary care, social determinants of health, cultural competency, interprofessional team-based care, and addressing the challenges associated with substance misuse through career ladder training and leadership programming. The area health education center shall partner with the New Hampshire Nurses Association by convening stakeholders to build a collective voice for nursing excellence and workforce sustainability in New Hampshire by determining the current initiatives that collect demand, supply, and academic workforce data, and identify the gaps. The stakeholders shall make recommendations for a future New Hampshire Nursing Workforce Center as designated by the National Forum of Nursing Workforce Centers;

(c) Collaborate with an area health education center for the purpose of creating and expanding graduate level nursing mentoring and precepting programs. The area health education center shall provide the necessary support to graduate level nursing preceptors and the health care organizations that act as training sites;

(d) Collaborate with an area health education center for the purpose of supporting the New Hampshire Needs Caregivers Program. This program shall promote, recruit, and fund training of up to 500 individuals interested in a career in health care as a licensed nursing assistant. The New Hampshire Needs Caregivers Program shall create scholarship opportunities to cover the cost of tuition for licensed nursing assistant training up to $2,600; supportive services; and assist individuals in finding courses and employment;

(e) Expand student loan repayment opportunities for clinicians with bachelors' degrees employed by non-profit health care organizations in exchange for the agreement to work for the non-profit health care organization for 24 months for part-time employees to 36 months for full-time employees; and

(f) Collaborate with a family medicine residency program in rural New Hampshire at a teaching health center program to support the training of family medicine residents in the north country. The teaching health center program shall be accredited or eligible for accreditation by a nationally recognized accreditation agency.

4 Department of Health and Human Services; Rural Health and Primary Care Section; Appropriations.

I. Appropriation; Public-Private Health Care Workforce Recruitment and Retention Hub. The sum of $580,000 for the fiscal year ending June 30, 2026 and the sum of $580,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph I of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

II. Appropriation; Workforce Recruitment, Advertising, and Marketing. The sum of $250,000 for the fiscal year ending June 30, 2026 and $250,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose described in paragraph II(a) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

III. Appropriation; Bi-State Primary Care Association Sub-Recipient Contract with an Area Health Education Center. The sum of $3,100,000 for the fiscal year ending June 30, 2026 and the sum of $3,000,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(b) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

IV. Appropriation; Bi-State Primary Care Association Sub-Recipient Contract with an Area Health Education Center; Graduate Nursing Student Preceptors and Financial Support for Host Organizations. The sum of $300,000 for the fiscal year ending June 30, 2026 and the sum of $300,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(c) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

V. Appropriation; Bi-State Primary Care Association sub-recipient contract with an area health education center; New Hampshire Needs Caregivers. The sum of $500,000 for the fiscal year ending June 30, 2026 and the sum of $750,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(d) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

VI. Appropriation; Bi-State Primary Care Association sub-recipient contracts; Public-Private Health Care Workforce Recruitment and Retention Hub Loan Repayment Programs. The sum of $300,000 for the fiscal year ending June 30, 2026 and the sum of $300,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(e) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

VII. Appropriation; Bi-State Primary Care Association sub-recipient contract with a rural residency training at a teaching health center program. The sum of $500,000 for the fiscal year ending June 30, 2026 and the sum of $500,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purposes set forth in paragraph II(f) of section 3 of this act. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.

VIII. Appropriation; State Loan Repayment Program. The sum of $1,000,000 for the fiscal year ending June 30, 2026 and the sum of $1,000,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the state loan repayment program. This appropriation shall be nonlapsing. Of this appropriation, the sums of $300,000 for the fiscal year ending June 30, 2026 and $300,000 for the fiscal year ending June 30, 2027 shall be expended by clinicians in the nursing profession. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

IX. Appropriation; Early Childhood and Family Mental Health Credential. The sum of $203,500 for the fiscal year ending June 30, 2026 and the sum of $203,500 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, bureau of children's behavioral health for the purpose set forth in RSA 167:3-l, IV(a)(2). The bureau shall use the funding to support the training of up to 60 clinicians per year of the biennium. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

X. Appropriation; Primary Care Workforce Program. The sum of $115,000 for the fiscal year ending June 30, 2026 and the sum of $115,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section, for an administrator I position for the purpose of administering paragraph I of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

XI. Appropriation; Primary Care Workforce Program. The sum of $91,000 for the fiscal year ending June 30, 2026 and the sum of $91,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section, for a compliance coordinator II position for the purpose of administering paragraph VIII of section 4 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

XII. Appropriation; Primary Care Workforce Program. The sum of $81,000 for the fiscal year ending June 30, 2026 and the sum of $81,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section, for an administrative assistant I position for the purpose of administering paragraph VIII of section 4 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

5 Department of Health and Human Services; Medicaid Rate Increases; Appropriation.

I. The commissioner of the department of health and human services shall increase Medicaid provider rates by 3 percent in the fiscal year ending June 30, 2026 and an additional 3 percent in the fiscal year ending June 30, 2027. The commissioner shall make the necessary adjustments to the medical rate setting data book and direct the actuary and managed care organizations to pass through the increased funding to rates.

II. There is hereby appropriated to the department of health and human services the sum of $20,000,000 for the fiscal year ending June 30, 2026, and the sum of $20,000,000 for the fiscal year ending June 30, 2027, for the purpose of increasing Medicaid provider rates. The department shall utilize such funds to increase rates pursuant to section 1902(a)(30)(A) of the Social Security Act, to promote efficiency, economy, and quality of care within New Hampshire's Medicaid program. The department may accept and expend any federal funds available for the purposes of this section without the prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated. The rate increases shall go into effect no later than January 1, 2026. If feasible, the department shall implement any of the rate increases prior to that date, with priority given to those the commissioner has deemed most critical. For each provider rate increase, the department shall report to the fiscal committee of the general court, by October 1, 2025, the accounting units in the state operating budget to which funds will be or have been allocated, along with the rate increases that will be provided from the funds appropriated.

III. There is hereby appropriated to the department of health and human services the sum of $2,600,000 for the fiscal year ending June 30, 2026 and the sum of $2,600,000 for the fiscal year ending June 30, 2027, for the purpose of increasing rates paid to providers of opioid treatment programs. Said amounts are intended to cover the cost of rate increases for both the traditional Medicaid population and granite advantage program population. The department may accept and expend any federal funds available for the purposes of this section without the prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

6 Effective Date. This act shall take effect July 1, 2025.

1 Short Title. This act shall be known as The New Hampshire Needs Caregivers Act.

2 Statement of Purpose.

I. New Hampshire's health care workforce is the foundation of our health care safety net, and the foundation is in crisis due to a lack of consistent investments. As a result, residents of New Hampshire will go without care. Recently, the state worked to stabilize the system using federal funds, including direct aid to hospitals, community providers, and long-term care facilities, and investments in our Medicaid program; however, there remains a strong need to invest in programs to foster a future health care workforce within the Granite State.

II. The state of New Hampshire shall address the health care workforce shortage by leveraging state funding through public and private partnerships, investing in programs designed to incentivize students to seek employment in health care and remain in New Hampshire upon graduation; and equipping health care organizations with the tools necessary to secure skilled clinicians.

3 Department of Health and Human Services; Division of Public Health Services; Public-Private Health Care Workforce Recruitment and Retention Hub; Infrastructure Contracts.

I. The department of health and human services, division of public health services, rural health and primary care section shall amend its current contract with Bi-State Primary Care Association's Recruitment Center to require the Recruitment Center to strengthen the infrastructure needed to sustain and transform community-based primary care services through the creation of a Public-Private Health Care Workforce Recruitment and Retention Hub that promotes collaboration across the continuum of care. Bi-State Primary Care Association shall administer the Public-Private Health Care Workforce Recruitment and Retention Hub and manage the sub-recipient contracts, and leverage federal, state, and private funding, and seek new funding opportunities when appropriate.

II. Bi-State Primary Care Association shall design the sub-recipient contracts to facilitate health care workforce development, recruitment, retention, support nursing preceptor and mentoring programs, provide training and technical assistance, and loan repayment opportunities. Bi-State Primary Care Association shall:

(a) Expand and implement its national outreach and marketing campaign designed to recruit qualified clinicians to New Hampshire;

(b) Collaborate with an area health education center to increase the number of entry-level clinical staff through investments in programs designed to improve care and access to care, particularly in rural and underserved areas of this state, and to enhance the health and public health workforce in New Hampshire. Such programs may include: engaging under-represented populations in the health care professions in middle school and high school; offering health professions students opportunities to experience learning in rural or medically underserved regions of New Hampshire designed to encourage participants to settle and work in these regions; and enriching the standard health curriculum by providing health professions students training in aspects of health care such as integration of behavioral health and primary care, social determinants of health, cultural competency, interprofessional team-based care, and addressing the challenges associated with substance misuse through career ladder training and leadership programming. The area health education center shall partner with the New Hampshire Nurses Association by convening stakeholders to build a collective voice for nursing excellence and workforce sustainability in New Hampshire by determining the current initiatives that collect demand, supply, and academic workforce data, and identify the gaps. The stakeholders shall make recommendations for a future New Hampshire Nursing Workforce Center as designated by the National Forum of Nursing Workforce Centers;

(c) Collaborate with an area health education center for the purpose of creating and expanding graduate level nursing mentoring and precepting programs. The area health education center shall provide the necessary support to graduate level nursing preceptors and the health care organizations that act as training sites;

(d) Collaborate with an area health education center for the purpose of supporting the New Hampshire Needs Caregivers Program. This program shall promote, recruit, and fund training of up to 500 individuals interested in a career in health care as a licensed nursing assistant. The New Hampshire Needs Caregivers Program shall create scholarship opportunities to cover the cost of tuition for licensed nursing assistant training up to $2,600; supportive services; and assist individuals in finding courses and employment;

(e) Expand student loan repayment opportunities for clinicians with bachelors' degrees employed by non-profit health care organizations in exchange for the agreement to work for the non-profit health care organization for 24 months for part-time employees to 36 months for full-time employees; and

(f) Collaborate with a family medicine residency program in rural New Hampshire at a teaching health center program to support the training of family medicine residents in the north country. The teaching health center program shall be accredited or eligible for accreditation by a nationally recognized accreditation agency.

4 Department of Health and Human Services; Rural Health and Primary Care Section; Appropriations.

I. Appropriation; Public-Private Health Care Workforce Recruitment and Retention Hub. The sum of $580,000 for the fiscal year ending June 30, 2026 and the sum of $580,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph I of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

II. Appropriation; Workforce Recruitment, Advertising, and Marketing. The sum of $250,000 for the fiscal year ending June 30, 2026 and $250,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose described in paragraph II(a) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

III. Appropriation; Bi-State Primary Care Association Sub-Recipient Contract with an Area Health Education Center. The sum of $3,100,000 for the fiscal year ending June 30, 2026 and the sum of $3,000,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(b) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

IV. Appropriation; Bi-State Primary Care Association Sub-Recipient Contract with an Area Health Education Center; Graduate Nursing Student Preceptors and Financial Support for Host Organizations. The sum of $300,000 for the fiscal year ending June 30, 2026 and the sum of $300,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(c) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

V. Appropriation; Bi-State Primary Care Association sub-recipient contract with an area health education center; New Hampshire Needs Caregivers. The sum of $500,000 for the fiscal year ending June 30, 2026 and the sum of $750,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(d) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

VI. Appropriation; Bi-State Primary Care Association sub-recipient contracts; Public-Private Health Care Workforce Recruitment and Retention Hub Loan Repayment Programs. The sum of $300,000 for the fiscal year ending June 30, 2026 and the sum of $300,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph II(e) of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

VII. Appropriation; Bi-State Primary Care Association sub-recipient contract with a rural residency training at a teaching health center program. The sum of $500,000 for the fiscal year ending June 30, 2026 and the sum of $500,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purposes set forth in paragraph II(f) of section 3 of this act. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.

VIII. Appropriation; State Loan Repayment Program. The sum of $1,000,000 for the fiscal year ending June 30, 2026 and the sum of $1,000,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the state loan repayment program. This appropriation shall be nonlapsing. Of this appropriation, the sums of $300,000 for the fiscal year ending June 30, 2026 and $300,000 for the fiscal year ending June 30, 2027 shall be expended by clinicians in the nursing profession. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

IX. Appropriation; Early Childhood and Family Mental Health Credential. The sum of $203,500 for the fiscal year ending June 30, 2026 and the sum of $203,500 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, bureau of children's behavioral health for the purpose set forth in RSA 167:3-l, IV(a)(2). The bureau shall use the funding to support the training of up to 60 clinicians per year of the biennium. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

X. Appropriation; Primary Care Workforce Program. The sum of $115,000 for the fiscal year ending June 30, 2026 and the sum of $115,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section, for an administrator I position for the purpose of administering paragraph I of section 3 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

XI. Appropriation; Primary Care Workforce Program. The sum of $91,000 for the fiscal year ending June 30, 2026 and the sum of $91,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section, for a compliance coordinator II position for the purpose of administering paragraph VIII of section 4 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

XII. Appropriation; Primary Care Workforce Program. The sum of $81,000 for the fiscal year ending June 30, 2026 and the sum of $81,000 for the fiscal year ending June 30, 2027 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section, for an administrative assistant I position for the purpose of administering paragraph VIII of section 4 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

5 Department of Health and Human Services; Medicaid Rate Increases; Appropriation.

I. The commissioner of the department of health and human services shall increase Medicaid provider rates by 3 percent in the fiscal year ending June 30, 2026 and an additional 3 percent in the fiscal year ending June 30, 2027. The commissioner shall make the necessary adjustments to the medical rate setting data book and direct the actuary and managed care organizations to pass through the increased funding to rates.

II. There is hereby appropriated to the department of health and human services the sum of $20,000,000 for the fiscal year ending June 30, 2026, and the sum of $20,000,000 for the fiscal year ending June 30, 2027, for the purpose of increasing Medicaid provider rates. The department shall utilize such funds to increase rates pursuant to section 1902(a)(30)(A) of the Social Security Act, to promote efficiency, economy, and quality of care within New Hampshire's Medicaid program. The department may accept and expend any federal funds available for the purposes of this section without the prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated. The rate increases shall go into effect no later than January 1, 2026. If feasible, the department shall implement any of the rate increases prior to that date, with priority given to those the commissioner has deemed most critical. For each provider rate increase, the department shall report to the fiscal committee of the general court, by October 1, 2025, the accounting units in the state operating budget to which funds will be or have been allocated, along with the rate increases that will be provided from the funds appropriated.

III. There is hereby appropriated to the department of health and human services the sum of $2,600,000 for the fiscal year ending June 30, 2026 and the sum of $2,600,000 for the fiscal year ending June 30, 2027, for the purpose of increasing rates paid to providers of opioid treatment programs. Said amounts are intended to cover the cost of rate increases for both the traditional Medicaid population and granite advantage program population. The department may accept and expend any federal funds available for the purposes of this section without the prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

6 Effective Date. This act shall take effect July 1, 2025.