Health Policy Changes Affecting Coverage, Caregiving, and Water Infrastructure

Several of the most significant health policy changes approved this year relate to Medicaid, long-term care, family caregiving, and public infrastructure impacting health.

Updates to State Medicaid Work Requirements to Match New Federal Law

The biggest shift in State health policy this year stems from Senate Bill 134, which was crafted in response to changes to federal law made last summer. This legislative session was the first opportunity on the regular schedule to pass legislation since those changes were passed. New State law modifies the State’s Medicaid work requirements laws to make them compatible with the new federal law, which effectively requires non-exempt Medicaid Expansion enrollees to engage in work or other eligible activities for 80 hours per month.

While the State law required more hours per month previously, that State law had not been implemented; estimates for the number of people who will lose coverage due to the work requirements range from 14,000 to 29,000 in New Hampshire by 2028, depending on the details of policy implementation that are left up to the states by federal law. Senate Bill 134 established some of these details for New Hampshire.

The New Hampshire law requires that individuals receiving their health care through the New Hampshire Granite Advantage Health Care Program, New Hampshire’s version of Medicaid Expansion, provide documentary evidence of meeting the work requirements, rather than self-reporting. That verification of this evidence will be required at least quarterly, which is more frequent than the once every six months required by federal law.

The new law also defines the parameters of the medical frailty exemption, requiring a statement from a medical provider certifying that a condition impairs an individual’s ability to perform activities of daily living. The New Hampshire Department of Health and Human Services is not allowed to add new exemption categories or expand the definitions of existing exemptions without permission from the Legislature, and will be required to provide regular reports on the implementation of the work requirements, which will start in January 2027.

New Support for Family Caregivers

Another new law, the result of the multi-part Senate Bill 608, requires the State government to work with the federal government’s Medicaid program to expand reimbursements for services. Specifically, the law will seek reimbursement for care provided by family caregivers to Granite Staters with acquired brain disorders or to residents receiving care for a physical disability in their homes or communities, using a particular program that provides substantial help to older adults. Reimbursement dollars flowing to these supports may make delivering these services within families easier for households financially. The provisions of this new law will take effect if the changes receive the necessary approvals from the federal government and if sufficient funding is available.

Nursing Home Reimbursement Rates

Also related to Medicaid, Senate Bill 663, which the Governor has not signed yet, would create a working group to review the methodology for Medicaid reimbursement rates for nursing facilities. This group would be required to consider, and make recommendations regarding, how much the State pays nursing facilities for services with consideration to access to care, hospital discharges, capital costs, and workforce needs for nursing facilities.

Nursing facilities would also receive an infusion of $2.5 million in State dollars to support nursing facility reimbursements through House Bill 155, if it is signed into law by the Governor. Those dollars could be used to support the ability of nursing facilities to care for Medicaid patients. This bill includes other significant fiscal policy changes as well, which are discussed in more detail in the tax section of this analysis.

Water Infrastructure Funding

Related to the health and quality of drinking water for some of the state’s most populous towns, the not-yet-signed Senate Bill 541 would allocate $5 million of a $50 million appropriation provided in 2020 to the New Hampshire Department of Environmental Services to fund “Phase 2B” of the Southern New Hampshire Regional Water Interconnection Project. The Project is intended to provide clean water to communities with contaminated wells, including some with Per- and Polyfluoroalkyl Substances (PFAS)and MtBE pollution. The bill would also change a preexisting appropriation related to water infrastructure at Pillsbury Lake Village.

Recovery Program Reviews

A bill approved by the Legislature in May that has not been acted upon by the Governor, Senate Bill 298, would study the current structure of recovery programs, while making two other unrelated changes to law regarding air quality in public buildings and State interpretations of regulations.

The bill would establish a committee of legislators to assess the current State certification process and operational standards for substance use recovery programs, including whether mandatory certification can effectively replace voluntary registration. The five-member committee would be tasked with quantifying costs, potential cost savings, federal funding opportunities, and sustainable mechanisms for financial support.

Policy Changes Could Affect Food Assistance and Student Nutrition

Lawmakers approved two measures this year related to food assistance programs. Neither bill has been acted upon yet by the Governor.

Proposed SNAP Study

One bill, Senate Bill 615, would establish a commission to study the Supplemental Nutrition Assistance Program (SNAP), which provides aid to afford food, using primarily federal funds, to about 73,000 Granite Staters as of May 2026. This proposed law would require the commission to consider how to direct SNAP dollars toward more healthy food purchases, examine fraud and waste in SNAP, and to consider the economic impacts in New Hampshire if certain changes to SNAP were enacted. The commission would have to produce an interim report by November 2026, and a final one by November 2027. Based on national-level analyses, fraud in SNAP is rare.

Expanding Access to Summer Food Benefits

The second bill, House Bill 1727, provides a legal framework for schools in the state to securely share information with the New Hampshire Department of Health and Human Services so that students who qualify for free or reduced-price school meals can be automatically enrolled in summer meal plans, unless their families choose to opt out. The Summer EBT program use electronic benefit transfer cards to help eligible families purchase food for children when school is not in session and school meals are unavailable.

Changes to Education Policy and Funding

A wide variety of education policies were considered by the Legislature, but only a subset of bills passed. The approved bills could affect how New Hampshire funds special education in public schools, defines its responsibility to provide an adequate education, and administers certain education programs.

Special Education Funding Changes

The largest change to the way the State funds education directly was House Bill 1563, which was awaiting action by the Governor. This bill would likely increase State aid to local schools for certain higher-cost special education services to school districts.

Current law provides school districts with State aid to cover 80% of costs for students with needs requiring expenditures greater than 350% of the average cost per pupil, and the State covers all costs beyond the point at which a student’s needs exceed 1,000%, or ten times, the average cost per pupil. The revised formula in this bill would add State aid for students with costs between 250% and 350% of the average cost per pupil, with the State providing enough funding to cover 15% of these costs.

At the same time, the revision would reduce the amount the State pays for costs above 1,000% of average cost per pupil from full payment to 90% of costs, which will require school districts to pay one-tenth, rather than none, of those high-need scenarios above a certain expense.

While school districts will likely receive more aid in aggregate from this change, the actual aid delivered to school districts will depend on the composition of students and the relative costs of providing needed services. The funding provided by this change could impact local property taxes.

Legislature Makes Revisions to Definition of an Adequate Education

A second bill did not change funding directly but constituted a statement of policy change by the Legislature. House Bill 1815, which the Governor has signed into law, altered the definition of “an adequate education” by eliminating a phrase identifying “the specific criteria and substantive educational program that deliver the opportunity for” an adequate education. This change could alter the interpretation as to which services are funded with the education aid currently provided by the Legislature in law relative to the State’s constitutional requirements.

The new language also specifically includes all differentiated aid in the education funding formula in the State’s contribution to an adequate education, rather than solely the base per pupil amount of aid. Language added by the new law may also impact future court cases regarding education funding, as it declares that State and local funding should contribute to a “shared responsibility” for education, and that funding for education should be determined by “legislative and executive” branches of government, without listing the judicial branch.

Other Education Policy Changes

Two other bills made smaller changes to education policy.

A bill that became law in April, House Bill 1503, allows the New Hampshire Department of Education to draw upon State Public School Infrastructure Funds to create maps of public schools for the purpose of emergency personnel responses to critical incidents. This fund has been used in the past for school security and other building upgrades.

Another bill that is already law, House Bill 222, eliminated the requirement that a chartered public school have a written agreement with a local public school district if the charter school is serving a student with a disability who is a resident of the district. These agreements previously were required to document how the student would receive services to which they were entitled to under federal and State laws and regulations. This bill would make other changes in law unrelated to education as well, including to staffing at the Department of Corrections.

Changes for Child Care Providers, Families, and Employers

Lawmakers approved five bills that could affect child care providers, public funding for early childhood education programs, access to child care assistance, and the availability of child care across New Hampshire.

Child Care Staffing Rules Made Permanent

Signed into law in May, House Bill 1771 makes a temporary section of law that establishes minimum staffing ratios for child care providers permanent and gives an opportunity for providers to request a waiver. Previous law from 2024 would have expired without this change, and the current staffing ratio requirements, the waiver opportunity, and the 2026 reporting requirements would have been eliminated.

Workforce Support Funding Requirement Repealed

A bill that became law without the Governor’s signature, House Bill 1515, repealed the requirement, enshrined in State law last year via the State Budget’s Trailer Bill, that the New Hampshire Department of Health and Human Services include a provision to fully fund certain child care workforce support programs in its biennial State Budget request. The programs, which are targeted at educator recruitment and retention and have previously been appropriated $7.5 million per year by the Legislature, will no longer have to be included in the Department’s proposal for the agency phase of the State Budget process. Previous workforce supports for child care providers may have contributed to higher wages among the child care workforce, which may have supported access to these services for families.

New Tax Credit Aims to Expand Child Care Supply

At the intersection of child care funding and tax policy, House Bill 1433, which has not yet been signed by the Governor, creates a tax credit for businesses that spend money to increase the supply of child care.

Businesses that spend money on property or buildings that will supply child care, or on the operations of child care centers that then subsequently have higher operating budgets for direct child care services, are eligible for the credit. Businesses that contract directly with a child care provider, or operate a child care program themselves, may also be eligible for the credit.

The 50% credit applies to the Business Profits Tax and the Business Enterprise Tax starting in 2027, with a cap of up to $5 million provided per year and the option for businesses to carry the credit forward for up to four future tax years. This chance could direct more resources to expanding access to child care, although uptake for a federal tax credit program for businesses has been limited.

Child Care Scholarship Program Changes

Signed into law in May, Senate Bill 608, made two changes to the Child Care Scholarship Program. The law eliminates the work requirement for retired individuals who have reached the federal Social Security retirement age and eliminates Child Care Scholarship Program cost sharing with families for children in a relative’s care, meaning 100% of the cost is paid by the public program up to the reimbursement threshold. The provisions of this new law will take effect if the State receives the necessary approvals from the federal government and if sufficient funding is available.

Zoning Changes Could Allow More Family-Based Child Care

A fifth bill expands opportunities for the establishment of child care centers in residential areas. The proposed language in House Bill 1195, which has not been acted upon by the Governor yet, would require municipalities to allow family-based daytime child care for up to 12 children anywhere where residential use is permitted by local regulations. This change could ease barriers to adding more child care opportunities for families.

Housing Policy Changes Impact Renters and Limit Local Regulations

Several bills that would change housing policy passed the Legislature this year, with the proposals primarily focused on restricting the ability of local governments to regulate housing relative to prior law. While the Legislature acted to create more opportunities for adding housing units at the local level, no new funding to support housing efforts was appropriated.

New Options for Rental Applications

The Legislature approved House Bill 1336, a bill not yet acted upon by the Governor, which would establish a “regulated conditional deposit” for potential renters. The bill would allow renters to offer an additional deposit to landlords as part of their housing application to compensate for not meeting certain screening criteria, such as credit score thresholds,  income requirements, recent unpaid judgments, previous landlord references, and prior eviction history. In certain situations, landlords might be required to refund these deposits if a tenant later proves they meet the housing applicant criteria specified by the landlord.

The bill also clarifies that an advance rent payment is not a security deposit and does not need to be held in reserve, along with the order of repayment if a security deposit is paid by someone other than the renter.

Municipalities Would Have Fewer Options to Restrict Housing Development

Several bills approved this year would limit local restrictions on housing development

Passed by the Legislature but not yet acted upon by the Governor, House Bill 1010 would require municipalities to allow multi-family residential dwellings to be constructed on commercially zoned land under certain circumstances. Proposed developments would be required to help ensure adequate infrastructure, including roadways, water sources, and sewage disposal, for the new properties. Municipalities could reject development projects that lacked sufficient traffic, water, and wastewater safety and sustainability planning or sourcing. Municipalities would still be able to restrict residential development where manufacturing or industrial use would create conditions that would be incompatible with residential use, including dust, glare, and vibrations.

Another housing-related bill that the Governor has not acted upon yet is Senate Bill 564, which would prohibit municipalities from imposing caps on road lengths and the number of dead-end streets in an area. The bill would also require municipalities to permit structures related to utilities, including water, sewer, drainage, and electrical, in wetland buffer and conservation areas of subdivisions provided that new roadways and utility installations comply with fire codes and both wetland and shoreline development restrictions.

Also awaiting the Governor’s consideration, Senate Bill 415 would limit certain regulations and oversight of condominiums by increasing the threshold for certain required oversight of condominiums to 25 units from 10 units, and by eliminating certain requirements for smaller condominium organizations.

Infrastructure, Finance, and Revitalization Tools

The Legislature also passed House Bill 1588, which awaits action from the Governor. This bill would create a new legal path for cities and towns to finance building and upgrading infrastructure. Municipalities could create special assessment districts and spending programs. For these districts to function, 60% of property owners in an area would have to enter a special assessment memorandum of understanding with the city or town. This could enable improvement projects to be financed solely by the subsection of residents in a community whose area would be directly served by these projects, such as those served by a water or sewer line or by a set of sidewalks. The bill would also require multi-family units to be permitted as a matter of right in commercially-zoned areas, and limits the number of restrictions that could be placed on multi-family units to only those permitted in statute. Pre-existing structures also would be able to be converted into multi-family dwelling units or mixed use buildings, with limitations on changes that would otherwise violate other zoning requirements. Finally, municipalities would not be able to require that accessory parking for vehicles be garaged.

The Governor has also not yet acted on House Bill 1103, which would expand municipal access to a revitalization tax relief program to include residential projects alongside office, commercial, and industrial projects, while also changing the requirements that a certain amount of housing units added be designated for households with lower incomes for a project to qualify for the tax relief program. Also not yet signed by the Governor, House Bill 1042, would raise the statutory cap on the New Hampshire Housing Finance Authority’s notes and bonds by $200 million, and the cap on the amount of unpaid principal by $400 million, permitting more opportunities to make loans for housing acquisition and construction projects.

Revenue Changes Affect Business Taxes, Tolls, and State Sale Proceeds

The Legislature proposed reducing the amount of revenue collected from businesses through taxation while increasing revenue by increasing tolls for drivers using cash or out-of-state transponders on New Hampshire’s turnpikes.

Business Enterprise Tax Changes Could Reduce Future Revenue

The largest tax revenue policy change passed by the Legislature came through House Bill 155, which makes modifications to the Business Enterprise Tax (BET). The bill, which has not yet been signed by the Governor, raises the filing thresholds, based on two different measures of business activity, for the BET from about $316,000 in 2027 to $400,000 for that year. This change would likely exempt several thousand small businesses from having to file, but as most of the revenue for the BET is collected from much larger filers, this change would likely not have a very large negative revenue impact.

House Bill 155 also incorporated a potential BET rate reduction, which would have a much larger negative impact on State revenue, that would only be implemented under certain circumstances. The BET rate would be reduced by 0.05 percentage points if the State has:

1. a Rainy Day Fund balance that has reached its statutory cap, which is equal to 10% of the State General Fund unrestricted revenues collected during the most recent State Budget biennium,
2. combined General Fund and Education Trust Fund revenues above target amounts for the year,
3. combined business tax revenues from the BET and the Business Profits Tax above the prior year’s collections, and
4. combined business tax revenues that have generated at least $100 million in State revenue surplus identified by the State from prior years, with each year with a business tax surplus under $100 million being rolled forward into the additive total.

This combination of conditions has never previously occurred, primarily because the Rainy Day Fund has never been at its statutory cap. That cap was raised in 2021, and funds received by the State as the result of legal settlements, 10% of which flow to the Rainy Day Fund, are not subject to the cap. With a full Rainy Day Fund, these tax rate reductions are more likely.

The total BET rate, which is currently 0.55%, cannot be lowered below 0.25% under this proposal. Past reductions in the BET have lowered the amount of revenue available for public services, and those rate reductions have not provided clear economic benefits to the state.

Toll Changes May Increase Revenue for Turnpikes

Another major revenue policy change would increase State revenue through tolling on the State’s turnpikes. Pending action by the Governor, Senate Bill 627 would increase Turnpike toll prices for all vehicles that do not pay via a transponder connected to a funded New Hampshire E-Z Pass account, including people paying cash and vehicles equipped with transponders from other states. The bill also requires the State to provide free transponders to New Hampshire residents who open or currently maintain New Hampshire E-Z Pass accounts for 210 days following the date of the law taking effect.

The fiscal impact statement estimates total costs of $82,960 to provide transponders and $150,000 for software updates to facilitate the change. Estimated new revenue collected, which would be dedicated to supporting Turnpike projects in the Ten Year Transportation Improvement Plan, would be $56.2 million in State Fiscal Year 2028 and a projected 1.5% increase every year thereafter.

Redirecting Proceeds from the Sale of Sununu Youth Services Center

The Legislature also passed Senate Bill 481. This bill, should it be signed into law, redirects the proceeds from the sale of the Sununu Youth Services Center in Manchester, currently a State building, from the Youth Development Center Claims and Administration Settlement Fund to the General Fund. The bill would also change some of the procedures of the sale, including potential buyer requirements, and authorizes the State agency overseeing the property to seek appropriations from policymakers to upkeep the property until it is sold. The switch in revenue flows will make the resources available from this sale useable for State purposes other than settling claims associated with alleged abuses inflicted on youth in the State’s care over decades, which are likely to generate hundreds of millions of dollars in additional fiscal liability for the State.

Legislation with Impacts on Local Property Taxes

Lawmakers approved two key changes related to local property taxes this year.

School Property Tax Caps Going to Voters

A large potential policy change to the structures and limitations on fiscal policy for local government services is House Bill 1300. The bill, which has not been signed by the Governor, requires that ballots in the November 2026 and November 2028 elections include a question for voters on whether property taxes funding schools should be capped at a growth rate based on consumer inflation and new construction adding to the property tax base. The school administrative unit’s central office spending would be limited to 6% of the total appropriations of the school district, and bonded capital costs would be excluded from these limits.

The legislation also requires that specific language be presented to voters, stating “caps apply only to administrative operations of the SAU central office and do not affect classroom instruction, school-based services, or other municipal expenditures.”

The support of 60% of voters would be required to enact the cap, and local legislative bodies, including residents gathered at annual meetings, can override the tax cap in certain circumstances. If approved by voters and not overturned, these property tax caps on school district property taxes would be in effect until 2032.

Municipalities Gain More Flexibility to Expand Veteran Tax Credits

Another local property tax policy change came through House Bill 1494, which has been signed into law. This new law increased the maximum amounts that municipalities can provide in property tax credits to veterans, combat veterans, and surviving spouses of veterans who died while in service.