David Preece

Dear Chair and Members of the Committee, I write in strong support of HB 1160, which updates the membership and duties of the County-State Finance Commission to better reflect the real financial relationship between New Hampshire’s counties and the State. Counties are responsible for delivering some of the most critical human services in our system — including long-term care, Medicaid-funded services, and care for vulnerable adults — yet they do so under a funding structure largely controlled by the State. When rates, reimbursement formulas, or Medicaid plans change, counties are often left holding the financial risk without meaningful input. HB 1160 fixes that imbalance. By modernizing the Commission’s membership and clarifying its oversight authority, this bill ensures that counties have a real seat at the table when state agencies make decisions that directly affect county budgets and local property taxpayers. The revised structure properly includes state leadership, county representatives, and legislative oversight, creating a forum where policy and funding decisions can be evaluated before they become fiscal crises. The changes to the Commission’s duties are equally important. HB 1160 strengthens oversight of: • Medicaid long-term care plans, • rate setting by the Department of Health and Human Services, • county billing systems, and • the management of county payment limits. These are not abstract issues. They determine whether counties can afford nursing home care, community-based services, and supports for elderly and disabled residents — or whether those costs end up falling on local property taxpayers with no warning and no recourse. HB 1160 also removes outdated and inappropriate responsibilities that no longer reflect how services are funded, allowing the Commission to focus on what truly matters: the shared financial obligations of the State and counties for long-term care and human services. This bill promotes transparency, accountability, and fiscal stability. It strengthens cooperation between levels of government rather than leaving counties to react after the damage is done. I respectfully urge the Committee to recommend Ought to Pass on HB 1160. Sincerely, David John Preece State Representative, Hillsborough District 17