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When it comes to the opioid crisis, one would expect every state dollar allocated to the epidemic would be spent. That’s apparently not exactly what happened this fiscal year. A substantial surplus remains in the Alcohol Abuse Prevention and Treatment Fund, also known as the Alcohol Fund, and lawmakers are trying to pin the blame on almost everyone.

The Alcohol Fund was created in 2000 by the Legislature as a mechanism that takes 5 percent of the gross profits from the sale of alcohol to support education, prevention, treatment, and recovery programs for substance abuse, which encompasses alcohol and drug abuse.

The focus right now for the Governor’s Commission on Alcohol Drug Abuse Prevention, Treatment, and Recovery, which gives out the funds, is the opioid crisis, but alcohol abuse is also part of its mission. The commission was allocated approximately $9 million in the 2017 fiscal year and will reportedly end the year on June 30 $2 million to $4 million in the black.

Tym Rourke, chair of the governor’s commission, said he is working with the Department of Health and Human Services to determine the exact amount and will release those figures this week.

That’s where the confusion lies for legislators as they finalize the state’s biennium budget this month. DHHS Commissioner Jeffrey Meyers has said he anticipates a $2 million surplus from contracts that didn’t use their full funds. The nonpartisan Legislative Budget Assistant is putting the number at $4.3 million. The discrepancy and uncertainty as to why the funds weren’t all used during the year was on full display during the Senate marathon budget session on Wednesday.

Sen. Martha Hennessey, D-Hanover, who also sits on the governor’s commission, questioned why there was an amendment introduced that would allocate $2 million from the Alcohol Fund for the construction of a juvenile substance abuse wing at the Sununu Youth Services Center in Manchester without the commission’s approval.

Senate Majority Leader Jeb Bradley, R-Wolfeboro, said they had to have “some frank talk” about the Alcohol Fund.

“It is pathetic that there is $4.3 million sitting in an account unexpended in the middle of a heroin crisis. That’s what we should be focused on. That’s outrageous,” he said. “So let’s look at the reforms this amendment tries to put in place … that’s called taking action, not sitting on $4.3 million.”

Hennessey countered to say that the fund would only have a $2 million surplus, but said Gov. Chris Sununu and Meyers should also be to blame.

“The governor and commissioner at HHS have not helped to facilitate the spending of this,” she said. “They are waiting to find out what kind of health care we’re going to have, what’s going on with Medicaid, all of which is up in the air. So if our governor and HHS aren’t helping to make this possible, that money can’t be spent.”

The Alcohol Fund fund has only been fully financed one time since its inception, which was in the 2003-2004 biennium — the first year it began. Since then, governors or the Legislature transferred the revenue to the general fund and would only appropriate a small amount to the Alcohol Fund. In the current biennium passed under former Democratic Gov. Maggie Hassan, the fund was financed at 1.7 percent. In Sununu’s budget proposal and in the Senate’s budget, the fund was doubled to 3.4 percent.

Rourke applauded the Senate for increased monies to the fund, but reminded lawmakers that the Alcohol Fund is non-lapsing and any money left over is rolled over to the next fiscal year, so the commission could “repurpose and redeploy those dollars.”

Rourke said he had concerns about another amendment introduced in the Senate budget that would give the DHHS commissioner the ability to take money out of the Alcohol Fund itself and not from the potential surplus.

“The [governor’s] commission has a statutory authority over the fund and DHHS administers it, based on priorities set by the Commission” he told NH Journal. “The main concern is the precedent it would give for a commissioner to take money from the Alcohol Fund, without approval of the spending plan by the Commission.”

He said the 3.4 percent funding for the next biennium is mostly going to be used to sustain ongoing investments and state contracts to combat the opioid crisis. If the commissioner can take funds at anytime, Rourke is concerned that they would have to cancel contracts and put funding for other programs at risk.

So why is there a surplus in the first place? Rourke attributes it to two factors: Medicaid and workforce issues.

When the Legislature voted to renew Medicaid expansion in 2016, treatment and recovery centers were not clear if people who showed up would be covered by private or public insurance. The commission wanted to keep the funds available to those centers in case they needed to cover their insurance costs. Rourke said contractors ultimately didn’t need to draw on those funds.

He also said the workforce crisis in the mental health system resulted in funds not being used by contractors.

“We have treatment contractors who may have been given funding and have had a difficult time hiring appropriate staff,” he said. “Obviously, you’re not drawing on that salary while you’re waiting for that hire. If you talk to providers, there is that pressure on them on hiring and maintaining staff.”

The Senate budget is likely to go to a conference committee with the House, where lawmakers from both chambers will go over the details before voting on the final spending plan. The House previously stripped money for the Alcohol Fund in its version of the budget, so Rourke said he will continue to work with lawmakers on ensuring the funds are kept in place.

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The latest stop in Tom Price’s opioid crisis listening tour brought the health and human services secretary to the New Hampshire State House on Wednesday. He wasn’t alone, though. Always near him was Kellyanne Conway, counselor to President Donald Trump. They were joined by Gov. Chris Sununu, state Health and Human Services Commissioner Jeffrey Meyers, and Democratic U.S. Rep. Annie Kuster of New Hampshire, among other treatment providers, law enforcement, first responders, and families who have been impacted by the substance abuse crisis.

The meeting in Concord only lasted about an hour and members of the press were not allowed to be in the Executive Council chambers where the listening session took place. Afterwards, Price and Conway went to Manchester Fire Department to learn about the city’s Safe Station program. Press were also kicked out at first, but were then invited back in.

At a press conference after the listening session, Price said solving the opioid crisis is a priority for the Trump administration and his visit was a chance to see how states are dealing with it at the ground level.

“The Department is all in, the President is all in,” he said. “He has such passion for this issue, because he knows the misery and the suffering that has occurred across this land, and wants to help, help solve it.”

Price points to the recent $3.1 million in funds — with more money on the way — being sent to New Hampshire as evidence of the administration’s commitment to getting more resources out into the field.

Yet, more funds are needed for the Granite State, which has the second-highest overdose deaths per capita in the country. Nearly 500 people have overdosed on drugs in 2016. New Futures, a nonprofit focused on the opioid crisis, released a report Monday that found substance misuse costs the state’s economy about $2.36 billion each year.

Sununu praised the White House for its “tremendous” effort in reaching out to the states to see what they think of certain policies and solutions to combat opioid misuse.

“This administration has provided a great philosophy in that they want to set a foundation and a platform for good policy out of Washington but they look to the states to implement it,” he said. “Unlike the previous administration where Washington was going to implement and control everything, they want the states to be the implementers.”

However, Democrats are blasting the U.S. House of Representatives’ passage of the American Health Care Act, which would make major changes to Medicaid expansion. Democrats argue that the bill would weaken funding for federal programs to battle the drug epidemic.

Just before Price and Conway’s arrival, protesters staged a “die-in,” laying on the floor in the hallways of the State House, holding up signs that said, “Trump lied, I died” and “I died for a billionaire’s caviar.”

Protestors at the #DieIn today ready to welcome @HHSGov Sec Tom Price & reject the #AHCA #nhpolitics #thisisnotnormal #handsoffourhealthcare pic.twitter.com/Gy6w1cYe7c

— Ashley Marcoux (@ashmarx9) May 10, 2017

Democrats held their own press conference while Price and Conway met with New Hampshire leaders, criticizing Sununu for holding a closed-door meeting.

“New Hampshire won’t stand for a plan where premiums skyrocket, benefits shrink, and thousands are booted off [health care] coverage,” said Senate Minority Leader Jeff Woodburn.

Price said Trump is committed “to make certain that every individual has access to the kind of coverage that they want for themselves and for their family.”

“I think it’s important to step back and say is the Medicaid program the most appropriate program for every individual in that economic setting,” he added. “Is there a better way to provide coverage? Is there a better way to provide services? Whatever the answer to that is the president is committed and we’re committed to making certain every single American has a seamless transition.”

He vowed “that nobody falls through the cracks. That no rug is pulled out from anybody and that we make certain that the coverage and the care is available to every single American.”

Sununu said he had “some severe reservations” about the House’s health care bill, but he appreciates “the progress the House made.”

“We have to move that ball forward,” he said. I do have reservations in some areas when you look at the details. But people have to understand this is simply one part of the process. The Senate is going to go through their process. It shows that Congress isn’t stalled, not stagnated. They’re not going to do nothing. I think we’ve had eight years of a lot of do nothing. They’re doing something and they’re standing up for the American people.”

Conway said the opioid epidemic should be a bipartisan issue that Democrats and Republicans solve together.

“We look at this as a non-partisan issue in need of a bipartisan solution,” she said. “And we are working with people on both sides of the aisle in Washington and within each of the states to do exactly that.”

However, there are instances of disagreement between Republicans, especially on the American Health Care Act. It also appears that New Hampshire leaders and the White House aren’t always on the same page.

Several media outlets reported that the Trump administration was contemplating a 95 percent cut for the White House Office of National Drug Control Policy (ONDCP), which houses the agency’s high-intensity drug trafficking program and drug-free communities support program. Officials dismissed the claims and reaffirmed Trump’s support for ending the opioid crisis. Sununu called the reports “very disconcerting.”

Price and Conway did not mention the national drug czar’s office during their visit. While New Hampshire is one of the hardest hit states of the drug epidemic, it appears an official from the state has not been invited to sit on the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, leaving many to question how committed Trump is to fulfilling his campaign promise.

New Jersey Gov. Chris Christie is chairing the commission, and it was announced Wednesday that Democratic Gov. Roy Cooper of North Carolina, Republican Gov. Charlie Baker of Massachusetts, and former Democratic Rep. Patrick Kennedy of Rhode Island will also serve on the commission. Bertha Madras, a former deputy director of the Office of National Drug Control Policy, will also work on the commission, but no one from the Granite State.

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In a controversy that led to the resignation of the New Hampshire Hospital CEO, it’s been revealed Wednesday that Dartmouth-Hitchcock has been in violation of a $36 million contract to staff the state’s psychiatric facilities.

Health and Human Services Commissioner Jeffrey Meyers broke the news to Gov. Chris Sununu on Wednesday morning that Dartmouth-Hitchcock has only been regularly providing between eight to 10 psychiatrists, instead of the 11 required by the contract. The position of geriatric psychiatrist has also not been filled since January. The $36 million contract for Dartmouth-Hitchcock to provide services at NH Hospital, the state-run hospital for mental health services, was signed by the Executive Council last fall.

Sununu told the Executive Council during their regularly scheduled meeting on Wednesday that he asked NH Hospital CEO Robert MacLeod to “step aside.” He also asked former HHS Commissioner Donald Shumway to run the hospital on an interim basis.

“We’ve been paying for psychiatrists that have not necessarily been there,” Sununu said during a news conference. “It’s troubling, it’s disappointing.”

Meyers sent Dartmouth-Hitchcock a letter Tuesday asking the hospital for a “corrective action plan” to be submitted by May 9. He discovered the violations after Executive Councilor Chris Pappas, D-Manchester, raised questions about the hospital’s staffing during the Executive Council’s meeting last month.

Executive Councilor Andru Volinsky, D-Concord, called for an outside evaluation of the quality of care at Dartmouth-Hitchcock. Sununu wanted a review of the contract for other compliance issues by the state’s attorney general. He would also be seeking reimbursement from the state psychiatric hospital for payments based on full staffing.

“Throughout the course of this contract, the state agreed that the staffing levels have been appropriate and the patient care is high quality,” according to a statement from the hospital. “From the inception of this contract to provide clinical psychiatric services at New Hampshire Hospital, Dartmouth-Hitchcock has provided the state, including through weekly reports, current and projected staffing levels and any projected deficiencies.”

Dartmouth-Hitchcock also said it has “only been paid by the state through January of this year.”

“In light of questions raised regarding compensation for Dartmouth-Hitchcock, it is critically important to note that the agreement with the state is a ‘fixed price’ contract, and Dartmouth-Hitchcock has only been paid by the state through January of this year,” according to the statement. “Any suggestion that Dartmouth-Hitchcock has not been completely forthcoming with the state is factually incorrect and reflects a misunderstanding that requires clarification.”

The hospital said it is “deeply troubled” by criticisms from Sununu and Meyers and requested a meeting with them.

“Consequently, we have requested a meeting with Governor Sununu and Commissioner Meyers to discuss our mutual concerns and forge a path forward,” the statement reads. “Dartmouth-Hitchcock has been, and will remain, fully committed to the care of the State’s most vulnerable citizens, and we look forward to working with interim CEO Donald Shumway in continuing to provide that care at New Hampshire Hospital.”

Yet, the controversy comes on the heels of several news reports about concerns that the state doesn’t provide enough mental health services and that waiting list times for treatment beds has also increased.

The contract with Dartmouth-Hitchcock was controversial from the start when it was signed in September 2016 and became a significant issue during the election.

Last year, Dartmouth-Hitchcock transferred from Dartmouth College’s medical school to the private hospital and a group of psychiatrists quit amid a labor contract dispute.

The Executive Council approved the contract on September 7 and two days later, Dartmouth-Hitchcock announced its intention to lay off between 270 and 460 employees. The layoff announcement took then-Democratic Gov. Maggie Hassan by surprise, she said. It became a talking point for the New Hampshire Republican Party in their battle to reelect former Republican U.S. Sen. Kelly Ayotte.

The NHGOP also filed right-to-know requests charging that Hassan knew about the layoff announcement before the Executive Council voted on the contract.

At the time, Sununu, who was an executive councilor and gubernatorial candidate, called to cancel the contract and rebid it. However, he was outvoted and has since not called for the contract to be rebid.

Dartmouth-Hitchcock CEO James Weinstein also announced in December that he would retire from Dartmouth-Hitchcock on June 30.

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