Medicaid director warns HB 1755 reporting rules could threaten safety‑net providers and $22.5M in rebates

Henry Litman, the state’s Medicaid director, told the Health, Human Services and Elderly Affairs subcommittee that HB 1755 — which would expand transparency and reporting tied to 340B discounting programs — raises serious operational and fiscal concerns for New Hampshire’s Medicaid program.

“There’s about $22.5 million of rebate revenue that comes to the Department of Health and Human Services to help finance Medicaid,” Litman said, arguing that the state’s current approach (which prevents certain 340B entities from taking a discount and collecting the rebate simultaneously) creates a delicate balance between provider viability and state finances. He warned that the bill’s January 1, 2027 timeline for standing up oversight and the proposed enforcement penalties could be unrealistic without dedicated funding and staff for implementation.

Litman said two core issues are at stake: protecting safety‑net providers — federally qualified health centers, rural clinics and certain specialty programs that rely heavily on 340B discounts — and avoiding a loss of state rebate revenue if participation or rebate mechanics change. He recommended convening a workgroup that includes legislative staff, providers and DHHS to tailor reporting requirements to New Hampshire’s provider landscape rather than adopting an undifferentiated national model.

Committee members asked whether states that have passed similar transparency laws saw providers leave 340B; Litman said evidence is mixed and the legislative models differ. He cautioned that some model bills include stiff enforcement (he and others noted $1,000-a-day fines in examples) that could unintentionally penalize safety‑net providers struggling with administrative burden.

Litman also described the federal compliance context, saying the Health Resources and Services Administration oversees 340B and that audits focus on matters such as inventory segregation and correct claiming of discounts. He offered to provide committee members with federal regulations and comparative state materials for further study.

The subcommittee closed the HB 1755 hearing with a request for additional information and follow-up; Litman said he would share resources and recommended more calibrated planning before imposing new statewide reporting and enforcement requirements.