New Hampshire State Budget

Location New Hampshire
Organization New Hampshire Center for Public Policy Studies

The New Hampshire Center for Public Policy Studies, a nonpartisan, independent organization that pursues data-based research on public policy issues, developed an HIA on the health implications of selected budget proposals in the state budget process.

The HIA assessed the potential health impacts of transferring the financial burden of providing services to needy New Hampshire residents from the state to local communities. Also called “downshifting,” the state would cut the aid or programs without reducing local communities’ obligations to pay for those services. The HIA compared the potential impact on health of three programmatic changes: elimination of state aid to local communities; reductions in hospital Medicaid reimbursement rates; and changes to the state’s grants to low income families through its Temporary Assistance to Needy Families program.

The HIA offered some options for mitigating the potential impacts, including:

  • Regionalize local welfare departments and pool resources to increase efficiency: To be cost effective, this strategy would have to be woven into an existing infrastructure or service provision network such as county government, the local public health networks, hospital networks or other social service agencies with a regional focus.
  • Focus on High Impact Areas of the State:Communities where the impact may be felt the most and where demand is the highest are the more rural parts of the state. One potential mitigating strategy is for state policymakers to look forward to any potential changes and target state resources to those communities with the highest measures of need.


As a result of the work conducted by the HIA, legislation was introduced to study the implications of downshifting. This legislation did not pass.

HIA in the United States
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Decision makers at all levels are using the fast-growing field of HIA to take health into account when making decisions in a broad range of sectors, including agriculture, education, energy and budgeting, in all types of locations--rural, suburban, and urban, local, regional or statewide. Learn more about the information sources that were used to develop this page.

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At A Glance
  • Status Complete
  • Completion Date 2012
  • Decision-Level State
  • Sector Economic Policy
  • Organization Type Nonprofit