Will New Hampshire's proposal to stop homeless “drop-offs” protect cities or delay care?

Sometimes New Hampshire’s Queen City gets criticized for the number of unhoused people within its borders. But according to state Senator Victoria Sullivan (R-Manchester), not all of those people are true Manchester residents.

“I know firsthand of people who were literally dumped in Manchester by other towns,” Sen. Sullivan testified at a public hearing in January. “They did not have any services set up for them. They were just brought to the city of Manchester and left on our streets.”

Now Sen. Sullivan is championing a bill that would require an agreement between municipalities before individuals are transferred for services.

While supporters see the bill as a necessary protection for both vulnerable citizens and city resources, critics worry the added bureaucracy could create life-threatening delays for treatment—and might not even stop the drop-offs.

Manchester used as a drop-off for people in need

Under state law, each town and city in New Hampshire has an obligation to provide welfare assistance to people in need. However, not every municipality has a homeless shelter, a substance misuse treatment center, or other services. As a result, a town may transport an individual to a service location outside their borders.

Problems start when individuals are dropped off, but there are no available beds or services. WMUR has reported on unhoused individuals getting dropped off in Manchester from Londonderry, Lincoln, and even as far as Sanford, Maine when Manchester homeless shelters are full. The individuals are left in need, and the city of Manchester must then dedicate resources to help them to safety.

Sen. Victoria Sullivan introduced SB 441 to address the problem. The bill requires any town or city looking to transport individuals in need to another municipality to have a Memorandum of Understanding (MOU) with the receiving municipality. That MOU would need to address services to be provided, any financial contributions from the sending municipality, coordination protocols, and potentially limits on the number of individuals to be transferred. The bill includes a $5,000 fine for violations.

After the bill passed the Senate, Sen. Sullivan released the following statement:

“This bill stops municipalities from sending individuals in need of treatment or support without a plan. Backed by law enforcement, it requires clear agreements between towns, protects vulnerable Granite Staters, and ensures help actually reaches them—safely, quickly, and responsibly—without leaving the receiving town on the hook financially.”

Complicated state and local costs

As Sen. Sullivan noted in her statement, part of her concern is that Manchester is unfairly shouldering the cost of services for individuals who are not Manchester residents, or perhaps even New Hampshire residents.

At the public hearing for SB 441, Steve Tower of New Hampshire Legal Assistance testified that if a town or city sends a resident to another municipality for services, they are still responsible for financially supporting that person. Sometimes there are disputes between municipalities about who is responsible for paying for services, but another bill, HB 348, aims to create a dispute resolution process.

The Senate accordingly adopted an amendment to SB 441 that limits the MOU requirement to transportation for services unrelated to a general welfare application, such as transportation for substance misuse treatment.

However, many of those services are offered by nonprofits that receive a mix of federal, state, and private funding. Since those nonprofits are not operated by municipalities, they may not be governed by an MOU between municipalities.

At the public hearing for SB 441, Jenny O'Higgins, a legislative liaison for the state Department of Health and Human Services (DHHS), testified to several other concerns about how the bill might work. The bill requires the DHHS to oversee the MOUs and impose fines, but Ms. O’Higgins testified DHHS does not oversee individual municipalities. DHHS estimated it would need at least two more full-time staff to implement the requirements of SB 441. There are also privacy concerns around the information municipalities might share when transporting individuals for treatment.

Other substance misuse concerns

Other opponents of SB 441 express concern that the additional layer of bureaucracy would obstruct treatment for substance misuse.

“Best practice shows us that when people present and they are ready to engage in substance use treatment, we have a very, very short window of time to capture them to engage them in the treatment process,” Jake Berry, Senior Vice President at New Futures, testified at the public hearing in January. “Any hurdles that are erected, any bureaucratic challenges that are introduced, such as this, really could severely impact these people’s access to treatment and the success rates that we have for individuals.”

While most of the debate over SB 441 has focused on municipalities transporting individuals for services, there are also a few lines in SB 441 aimed at increasing local government control over harm reduction organizations. For example, SB 441 allows municipalities to develop criteria for messaging and harm reduction materials. Harm reduction includes needle exchanges, Narcan distribution, and similar support to reduce the negative health consequences of drug use.

“These programs, I would argue, encourage drug use,” Sen. Sullivan said after presenting a packet of information from the New Hampshire Harm Reduction Coalition to fellow legislators in January. “There’s nothing in these pamphlets that says ‘get help.’”

Jake Berry once again offered a dissenting voice. “Anything that would allow municipalities to really infringe upon these critical services we fear would blunt their impact and would ultimately lead to more overdoses and more overdose deaths,” he said.

Opportunity for public input

Everyone at the public hearing for SB 441 agreed it is unacceptable for officials to abandon individuals in Manchester – or any other city – without ensuring they are connected to available services. The debate is then whether SB 441 is the right solution to that problem.

Do you think New Hampshire should require MOUs between municipalities related to transporting individuals for services? You will have an opportunity to share your views at the next public hearing for SB 441, before the House Health, Human Services and Elderly Affairs Committee. Learn more about testifying at a public hearing and contacting elected officials with the Citizens Count Advocacy Toolkit.