Dear Governor Ayotte,

New Hampshire is facing a youth mental health crisis, and the evidence is impossible to ignore. 

According to the 2023 Youth Risk Behavior Survey, 40 percent of high school students reported persistent feelings of sadness or hopelessness. More than one in five seriously considered suicide in the past year, and about 17 percent made a plan. Nine percent reported an attempt. Picture a classroom of 25 kids: ten of them are struggling with persistent hopelessness. Five have thought about ending their lives. Four have figured out how. Two have tried.

We also know that the majority of these children are privately insured. And yet, children with private insurance face some of the greatest barriers to accessing the mental health care they need to remain in their homes, schools, and communities. Today, too many children cannot access timely care and instead end up in our restrictive and costly settings, including the Sununu Youth Services Center. Such placements happen when our systems fail children over and over.

New Hampshire’s High Fidelity Wraparound program, known as FAST Forward, changes that. It provides a bundle of intensive, team-based support delivered in the community for children at risk of hospitalization or out-of-home placement. It is an evidence-based clinical model and widely recognized as a national best practice. Not only is it significantly less costly than inpatient or residential care, but most importantly it helps stabilize youth in their homes and communities.

Despite this, private insurers do not cover FAST Forward, even after years of dialogue, commissions, and work groups. Instead, a $2.5 million-dollar General Fund appropriation has been used to subsidized care for commercially insured children. These funds are not enough, nor are they sustainable. This leaves families struggling to access services, in many cases until their children become sick enough to qualify for Medicaid. 

At the same time, providers are being forced to reduce capacity due to this funding instability—putting additional pressure on emergency departments, inpatient units, and residential care. Given the significant budget constraints DHHS faces in FY 27, we know the financial and human toll will only grow. This is a structural market failure, and it has a structural solution. 

For more than six years, New Hampshire has studied gaps in children’s behavioral health coverage by commercial carriers and pursued voluntary, non-legislative solutions. Despite extensive stakeholder engagement, commissions, and negotiations, these gaps persist. Senate Bill 498 reflects the reality that continued study alone will not solve this problem.

Senate Bill 498 provides a practical, balanced solution. It ensures that private health plans contribute to the cost of community-based behavioral health services for children—either by covering these services directly or through a shared financing mechanism. In doing so, it aligns responsibility with coverage and helps build a more stable, accessible system of care. The expected impact on commercial premiums is minimal, especially compared to the significant costs of out-of-home care this program helps avoid.

The undersigned organizations and individuals urge you to support SB 498. This legislation offers a path toward a New Hampshire where children in crisis can access the care they need, when and where they need it; where providers are sustainably supported; and where the State is no longer required to fill persistent gaps in private coverage.

Children and families cannot afford further delay. We respectfully urge your leadership in advancing this critical step forward and your support as we collectively work to move Senate Bill 498 out of the House.