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.
The changes have not yet taken effect but will be implemented on specific dates in the coming months and years. The general timelines are included below if available.
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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.
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.
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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.
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Who does it impact? Mainly providers, but patients may see effects.
Start Date: July, 2025 - This law is currently in effect.
ACA Enhanced Premium Tax Credit Expiration
The new federal law includes an expiration of the insurance enhanced premium tax credits under the Affordable Care Act at the end of the year. This will make the costs go up for almost everyone who is buying their own health insurance. Policy experts anticipate the expiration of the enhanced premium tax credit will create a cost-of-living crisis in 2026 for millions of American families who do not have access to employer insurance and do not qualify for federal insurance programs like Medicaid and Medicare. Looking at preliminary rate filings from 105 ACA Marketplace insurers in 19 states and Washington, D.C., most health insurers are requesting premium increases between 10% and 20% for 2026, and 27% are requesting increases of 20% or more. Most Americans will not be able to afford that.
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Who will it impact? Individuals and families who buy their own health insurance through the ACA Marketplace.
Start Date: January 1, 2026
Premiums and Pharmacy Co-Pays for Granite Advantage/CHIP
Some Medicaid recipients will be required to pay monthly premiums/fees and higher prescription copays starting July 1, 2026. Individuals enrolled in the Granite Advantage Health Care Program (also known as Medicaid expansion) earning certain incomes (100% of the federal poverty line and above) will pay $60-$100 per month for individuals. Families with children enrolled in the Children’s Health Insurance Program (CHIP) earning certain incomes (255% of the federal poverty line) will pay $190-$270 monthly. Prescription copays will also increase to $4 for both of these groups. For example, a family of three earning $68,000 annually will pay $230 each month plus $4 per prescription, creating new financial barriers that may make it harder for some New Hampshire residents to maintain their health care coverage.
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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: Fall of 2025 for pharmacy co-pays; July 1, 2026 for premiums.
Non-Citizen Coverage
Beginning in October, 2026, federal matching payments for Emergency Medicaid will be reduced to the state's regular Federal Medical Assistance Percentage (FMAP) for coverage for individuals who do not qualify for other Medicaid programs due to their immigration status. Emergency Medicaid often helps pay for life-threatening or urgent medical needs, as well as childbirth for pregnant people.
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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, Medicaid recipients will be required to work or participate in other approved activities for at least 80 hours each month (about 20 hours per week) to keep their health insurance coverage. Due to state law, Medicaid expansion recipients may need to work or engage in other approved activities for at least 100 hours each month (about 25 hours per week). New Hampshire still needs to develop these new rules, and they are NOT yet set.
Who will it apply to? People between 19 and 64 years old who receive Medicaid will need to meet these requirements. However, some groups are exempt, including parents with dependent children, people with disabilities, and pregnant or postpartum women. Everyone, including those who are exempt, will need to regularly report to the state whether they're working the required hours or qualify for an exemption. The New Hampshire Department of Health and Human Services will be responsible for checking and verifying all of these reports.
Start Date: The U.S. Department of Health and Human Services must publish official guidelines by the end of 2025. Then New Hampshire will have until December 31, 2026 to put these work requirements into place. The state can implement them earlier, or apply for an extension in certain situations.
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.
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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 one month for Medicaid expansion enrollees, and two months for traditional enrollees.
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Who will it apply to? Everyone who applies for Medicaid.
Start Date: January 1, 2027
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.
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Who will it impact? Mainly providers, but patients may see effects.
Start Date: Starting October 1, 2027, the provider tax thresholds will freeze for two years, and then reduce 0.5% each year until 2032.
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.
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Cost-sharing will only apply to Granite Advantage individuals who have incomes above 100% of the federal poverty limit (FPL). For a single individual, 100% of FPL is $15,650 annually or $1,304.17 monthly.
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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.
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Who will it impact? Individuals in the Granite Advantage Health Care Program (Medicaid expansion).
Start Date: October 1, 2028
Webpage Last Updated: August 1, 2025
The information provided on this website regarding Medicaid programs and related services is intended for general informational purposes only.
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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.