Richard Scheinblum has tracked the news for months.
With every twist and turn of the One Big Beautiful Bill Act, he watched and waited to see how spending and policy changes on the federal level would affect southwest New Hampshire’s health care system.
The version that landed on President Donald Trump’s desk — including sweeping changes to Medicaid, which provides health coverage to people with low incomes and people with disabilities — will impact Monadnock Community Hospital in Peterborough, where Scheinblum works as the chief financial officer, and its patients.
But the scope of that impact is still unknown
“The devil is going to be in the details,” Scheinblum said. “Any reduction in payment, from my perspective, will have to be examined in light of our ability to provide the services our community expects.”
Two big changes are coming next year to Medicaid, which could affect the roughly 186,000 people in New Hampshire who are enrolled in the government insurance program. People with Medicaid insurance will be required to work, attend school or engage in community service for at least 80 hours each month, and they’ll have to resubmit documentation to prove their eligibility every six months, instead of once a year.
Scheinblum hopes people won’t lose their insurance over technicalities, like missing filing deadlines, and that the government ensures “the minimum amount of people are affected negatively.”
“As far as us, regardless, we will still take care of people. That’s what we’re here for,” Scheinblum said. “We’re here to take care of our community, regardless of ability to pay.
Monadnock Community Hospital, a 25-bed critical access community hospital that serves about 39,000 people in its primary service areas in Cheshire, Hillsborough and Merrimack counties, runs a “charity care” financial assistance program for patients without insurance. Prior to Medicaid expansion in 2014, the hospital spent about $4 million on financial aid every year, Scheinblum said, but as more people became eligible for Medicaid, less charity care was needed. The program now averages around $800,000 in a year.
If that federal expansion goes away, Scheinblum said it’s a “larger strategic question” to determine if or how much of a safety net Monadnock Community Hospital will be able to provide.
“It’s so new, and I think we have to be methodical and careful about any planning at this time,” he said.
The federal spending bill also promises $50 billion to support rural hospitals from 2026 to 2030, but Scheinblum isn’t counting on the aid. It’s unclear how that money will be distributed, he said, and whether it’ll be tied to any specific cost offsets or programs.
State-level changes to Medicaid are on the way, too. New Hampshire’s Medicaid recipients will have to start paying monthly premiums in 2026, as approved in the state budget last month. That applies to any individual with an annual income over 100% of the federal poverty level — $15,650 — and families with children who make more than 255% of the federal poverty level — around $82,000 for a family of four. Currently, people insured by Medicaid do not have to pay any premiums.
“Some of those premiums are, you can almost equate them to a week’s worth of groceries or something,” Scheinblum said. “I do have a concern about that additional cost on patients and their ability to afford and have health insurance.”
Democratic lawmakers in Congress estimate that the One Big Beautiful Bill Act, signed by Trump earlier this month, puts more than 300 rural hospitals at risk of closure, including Cheshire Medical Center in Keene.
Scheinblum doesn’t think Monadnock Community Hospital, which is the only local provider for many medical services left in the region, is in danger of shutting its doors. Like many rural hospitals, however, it’s struggling financially. Just shy of half its revenue comes from federal government programs like Medicare and Medicaid, he said, and the hospital is currently operating at a negative margin of around 4% to 5%.
That deficit comes partly from expanding service offerings internally instead of contracting them out, and those investments are still ramping up. Other pressures include staffing costs, like wage inflation and health benefits for hospital workers.
The hospital plans to keep providing care to Monadnock region residents as usual, but for now, Scheinblum has more questions than answers.
“We haven’t made any drastic changes in anticipation of anything now,” Scheinblum said. “I just think we need more information, and … we want to be methodical about how we plan if and any changes that we’re going to make.”
Charlotte Matherly is the statehouse reporter for the Monadnock Ledger-Transcript in partnership with Report for America. Follow her on X at @charmatherly, subscribe to her Capital Beat newsletter and send her an email at cmatherly@cmonitor.com.
