Upcoming Changes to NH Medicaid

With the passage of New Hampshire's 2026-27 State Budget and federal legislation known as the One Big Beautiful Bill Act, new requirements and costs are coming to Medicaid programs for some Granite State enrollees. These changes come from both state-level policy decisions approved in New Hampshire's budget and federal reforms that will reshape Medicaid programs nationwide. Together, these changes will affect thousands of New Hampshire residents currently enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The overview below outlines some of the key changes.

While changes to Medicaid are coming, your coverage remains the same for now.

Many of the changes have not yet taken effect and will be implemented on specific dates in the coming months and years. The general timelines are included below if available, and a summary can be found here.

Not sure if you're covered by Medicaid? In New Hampshire, Medicaid provides health insurance through NH Healthy Families, Amerihealth Caritas NH, and WellSense Health Plan. Medicaid also provides services through several waivers and other programs. View common programs and learn more about your potential coverage by clicking the button below.

Am I Covered by Medicaid?

Diversity, Equity, and Inclusion Prohibitions

New policies included in New Hampshire's state budget prohibit the state from implementing or engaging in any policies or programs related to diversity, equity, and inclusion. These policies define “Diversity, Equity, and Inclusion” as any program or initiative that seeks to achieve unique outcomes for specific demographics and apply to any public entity, public school, state agency, or state contract. This prohibition will limit the state’s ability to address the needs of its residents and jeopardize access to dedicated services for many Granite Staters, including youth and adults with disabilities, women, people of color, older adults, veterans, LGBTQ+ people, and more. The prohibition became effective on July 1, 2025, and all state agencies and public schools are required to review existing contracts to identify diversity, equity, and inclusion related provisions by Fall of 2025.

Start Date: July 1, 2025 - This law is currently in effect.

Family Planning Restrictions

For 53 years, New Hampshire's Family Planning Program has been providing low-to-no-cost preventive and reproductive health care at health centers across the state, including cancer screenings, birth control, annual exams, and HIV and STI services. The new federal law prohibits providers that offer certain family planning services and receive $800,000 or more in Medicaid payments, including Planned Parenthood, from receiving funds for the next year. Planned Parenthood cannot receive any Medicaid payments, regardless of what medical services their Medicaid patient is receiving (i.e., HIV care and cancer screenings). Although Planned Parenthood does not get reimbursed, they are continuing to provide care to Medicaid patients that is being covered by fundraising dollars. Follow Planned Parenthood of Northern New England for updates.

It's inevitable some low-income Granite Staters will have limited to no options for affordable contraception, cancer screenings, STI testing, and other essential care as a direct result of this provision in the new federal law.

Start Date: July, 2025 - This law is currently in effect.

State Directed Payments

State directed payments (SDPs) are financial arrangements that allow state Medicaid programs to direct managed care organizations (MCOs) to enhance reimbursement for Medicaid providers, with the purpose of increasing the quality of care. The new federal law phases down existing SDPs by 10 percentage points each year until the total rate reaches 100% of Medicare payment rates for Medicaid Expansion states and 110% of Medicare payment rates for non-Medicaid Expansion states. The law also bans states from establishing new SDPs to bring rates up to commercial levels (base rates paid to Medicaid providers, without accounting for supplemental payments like SDPs, are often quite low.) SDPs are a foundational part of Medicaid reimbursement for many providers and a critical component of our safety-net infrastructure. Limiting SDPs threatens states' ability to maintain services for Medicaid enrollees.

Who does it impact? Mainly providers, but patients may see effects.

Start Date: July, 2025 - This law is currently in effect. However, the law may not apply to New Hampshire. NH DHHS is currently working through details.

Increased Prescription Costs for Granite Advantage

Individuals enrolled in the Granite Advantage Health Care Program (also known as Medicaid expansion) who earn certain incomes are now seeing their prescription costs increase to $4 per medication. This change is already in effect and creates new financial barriers that may make it harder for some Granite Staters to maintain their health and manage their care.

Who will it apply to? Adults covered by the Granite Advantage Health Care Program with incomes at or above 100% of the federal poverty level (FPL). You can check your FPL based on family size and income at povertylevelcalculator.com.

Start Date: This policy is now active. Earlier timelines projected implementation in fall 2025, but the change has since moved forward and is currently in place.

ACA Enhanced Premium Tax Credit Expiration

The Affordable Care Act (ACA) Marketplace (also called the Health Insurance Marketplace, Exchange, or HealthCare.gov) is where individuals and families can shop for and purchase health insurance coverage. It is designed for people who don't get insurance through their job, aren't eligible for Medicare or Medicaid, and need to buy coverage on their own. Enhanced premium tax credits were created to reduce monthly costs, known as premiums, for many working individuals. These enhanced premium tax credits have now expired.

For people to stay in the same Marketplace plan, this expiration causes their monthly premium to more than double. For example, a 60-year-old couple making $85,000 each year would see their yearly premium costs increase by over $22,600 in 2026.

Who will it impact? Individuals and families who buy their own health insurance through the ACA Marketplace.

Start Date: January 1, 2026 - Enhanced premium tax credits have expired.

Monthly Costs for Granite Advantage and CHIP

Some people enrolled in NH Medicaid will be required to pay monthly premiums/fees. Individuals enrolled in the Granite Advantage Health Care Program (also known as Medicaid expansion) earning certain incomes (100% of the federal poverty level and above) will pay $60-$100 per month based on their family size. Families with children enrolled in the Children’s Health Insurance Program (CHIP) earning certain incomes (255% of the federal poverty level) will pay $190-$270 monthly based on their family size. For example, a family of three earning $68,000 annually will pay $230 each month, creating new financial barriers that may make it harder for these New Hampshire residents to maintain their health care coverage.

Who will it apply to? Some individuals covered by the Granite Advantage Health Care Program (Medicaid expansion) and some families in the Children's Health Insurance Program (CHIP). You can find your federal poverty level based on your family size and income at povertylevelcalculator.com.

Start Date: CHIP premiums are scheduled for January 1, 2026, but NH DHHS is currently awaiting federal guidance before they can start; Granite Advantage premiums were scheduled for July 1, 2026, but have been DELAYED

Non-Citizen Coverage

Beginning on October 1, 2026, adults who are not pregnant must be a U.S. citizen, U.S. national, Legal Permanent Resident, Cuban-Haitian Entrant or Compact of Free Association Migrant to remain eligible for full-benefit Medicaid coverage.

New Hampshire’s Department of Health and Human Services is currently notifying affected individuals. If you think this could affect you, watch your mail and your NH Easy account, and contact your provider or case manager with questions.

For those who arrived in the United States on or after January 1, 2026, Refugee Medical Assistance and Refugee Cash Assistance has been extended from 4 months to 8 months for ORR-eligible individuals.

Have questions about your Medicaid coverage? Start with your health care provider or case manager. You can also call NH DHHS Customer Service at 1-844-ASK-DHHS (1-844-275-3447).

Who will it apply to? Certain individuals based on their immigration status.

Start Date: October 1, 2026.

Work Requirements - Federal and State

Due to the new federal law, beginning January 1st, 2027, Granite Advantage Medicaid eligibility rules are changing. You may need to meet a new monthly work requirement to qualify and keep your coverage.

If the requirement applies to you, you must report one of the following:

80 hours of work or earn at least $580 a month.
80 hours doing volunteer or community service.
80 hours participating in certain job-training programs.
80 hours participating in an educational program (like college, technical programs, or General Educational Development (GED) programs).

You can combine different activities to reach your 80 hours.

Who will it apply to? People between 19 and 64 years old enrolled in Medicaid Expansion/Granite Advantage. However, some groups will be eligible for an exemption, including:

Pregnant or postpartum individuals
People who are disabled or "medically frail"*
American Indian or Alaska Native individuals
Parents, guardians, or caregiver relatives, or family caregivers of young children (under 14) or of people with disabilities
Veterans with a total disability rating
Foster youth/former foster youth under age 26
Anyone already meeting similar work requirements through SNAP or TANF
People participating in a drug or alcohol rehabilitation or treatment program
People released from a correctional facility within the last three months
Meet the TANF work requirements or are a member of a household receiving SNAP benefits and are not exempt from the SNAP work requirements
People who have or qualify for Medicare (Part A (Hospital Insurance) and/or Part B (Medical Insurance)

*The federal definition of “medically frail” is narrow and notes: a condition has to "significantly impair" someone's ability to comply with the work requirement — a diagnosis alone isn't enough.

Start Date: January 1st, 2027: The NH Department of Health & Human Services (DHHS) is currently working through all implementation and exemption details. Many specifics have not been finalized yet, and more federal guidance may be provided.

More Frequent Eligibility Redeterminations

Under current law, Medicaid enrollees must renew their eligibility once every 12 months. Changes included in the new federal law will require states to instead review eligibility every six months for Medicaid expansion adults. This new policy will become effective for renewals scheduled on or after December 31, 2026. Currently, redeterminations for NH Medicaid recipients can be completed via mail or through NH EASY.

Who will it apply to? Individuals in the Granite Advantage Health Care Program (Medicaid expansion).

Start Date: More frequent redeterminations will begin for renewals scheduled on or after December 31, 2026.

Reduced Retroactive Coverage

Currently, new Medicaid enrollees can obtain retroactive coverage for qualifying medical expenses incurred up to 90 days prior to their application for coverage. Under the new federal law, this window will be shortened to 30 days for Medicaid expansion enrollees, and 60 days for traditional enrollees.

Who will it apply to? Everyone who applies for Medicaid.

Start Date: January 1, 2027

Medicaid Expansion Cost-Sharing Requirements

New Hampshire will be required to impose cost-sharing on certain medical services for adults enrolled in the Granite Advantage Health Care Program (Medicaid expansion). Cost-sharing is the portion of health care costs that you pay out of your own pocket when you use medical services. Instead of insurance covering 100% of everything, you share the cost with your insurance plan.

Cost-sharing will only apply to Granite Advantage individuals who have incomes above 100% of the federal poverty level (FPL). For a single individual, 100% of FPL is $15,650 annually or $1,304.17 monthly.

New Hampshire must set the costs above $0 but no more than $35 per service, and families cannot be charged more than 5% of their total household income per year. Certain services will be exempted and remain free, such as primary care visits, prenatal care, pediatric care, emergency room care (except for non-emergency visits to the ER), mental health and substance use disorder services, and services to certain community health centers.

Who will it impact? Individuals in the Granite Advantage Health Care Program (Medicaid expansion) earning above 100% of FPL. You can find your federal poverty level based on your family size and income at povertylevelcalculator.com.

Start Date: October 1, 2028

Provider Tax Reductions

The provider tax is a tax on acute care hospitals in New Hampshire, which gets matched by the federal government to help pay for the state’s Medicaid program. In New Hampshire, this is known as the Medicaid Enhancement Tax (MET), which is currently a 5.4% tax on acute care hospitals’ net patient services revenue (NPSR). The tax will be lowered incrementally from 5.4% to 3.5% by 2032. Based on a recent report released by NH Medicaid, for each 0.1% reduction in the allowed tax percentage, they estimate that New Hampshire is expected to lose $6.4 million in MET revenue, plus the corresponding federal match.

Who will it impact? Some providers (mainly hospitals—it does not apply to nursing homes), but patients may see effects.

Start Date: Starting October 1, 2028 (FY 2029), the provider tax thresholds will reduce 0.5% each year until they reach 3.5% by October 1, 2031 (FY 2032).

Timeline Summary

A summary of the Medicaid and health insurance changes timeline can be found on our Resources page.

Go to the Timeline

Webpage Last Updated: February 3, 2026

The information provided on this website regarding Medicaid programs and related services is intended for general informational purposes only.

Medicaid policies are changing frequently, and while we strive for accuracy, the information on this website may not reflect the most current updates. Please verify all Medicaid information directly with your local Medicaid office or official government sources before making any decisions.