Based on the U.S. Census Bureau’s population estimates from July 1, 2024, an average of 13.4 percent of New Hampshire’s population received Medicaid coverage in 2024, a decline from 15.2 percent of the population enrolled in 2023. Medicaid is a state-federal fiscal partnership which provides public health coverage for adults and children in households with low incomes, people with disabilities, pregnant mothers, and other eligible populations. An average of 7.4 percent of adults ages 19 through 64 were enrolled in the state’s Granite Advantage Health Care Program, more commonly known as “Granite Advantage” or Medicaid Expansion. This program provides coverage for Granite Staters ages 19 through 64 with incomes below 138 percent of the federal poverty guidelines (FPG), or $21,597 for a household of one in 2025. As of May of this year, adults enrolled in the Granite Advantage program represented approximately a third, or 31.8 percent, of the state’s total Medicaid population.
Granite Advantage Enrollment by County
Coos County experienced the largest proportion of its population enrolled in Granite Advantage, with an average of around 12.1 percent of adults ages 19 to 64 receiving coverage. Sullivan, Belknap, and Carroll Counties all had similar shares, with an average of more than nine percent of adults in each county enrolled in the program. Approximately 5.2 percent of Rockingham County’s adults received Granite Advantage coverage, which was the lowest average percentage across all ten counties.
While 7.8 percent of adults were enrolled in the program in Hillsborough County, these residents represented more than a third (33.1 percent) of the total average Granite Advantage population in 2024. The smallest number of adult enrollees were located in Coos County, which is the state’s smallest county by population size.
Enrollment by Municipality
More than a third (33.9 percent) of Stratford’s total population received Medicaid coverage in 2024, which was the largest percentage across all municipalities in the state. Stewartstown, Warren, and Franklin also experienced large proportions of their populations enrolled in Medicaid, at 30.1, 29.3, and 25.0 percent, respectively. An average of only 2.0 percent of Hanover’s population was enrolled in Medicaid, which was the lowest percentage among all organized municipalities with more than 100 residents.
An average of 9,095 Manchester residents were enrolled in Granite Advantage in 2024, representing 14.7 percent of the total average number enrolled in the program during that year. Nashua (5,209 adults), Concord (2,455 adults), and Rochester (2,284 adults) all had two thousand or more residents receiving Granite Advantage coverage due to each municipality’s large population size.
Total Medicaid Enrollment by Legislative District
New Hampshire is organized into 24 State Senate Legislative Districts, with each municipality categorized into a district. District 1, comprised of Coos County and portions of Grafton County, had approximately one in five (20.2 percent) residents receiving Medicaid coverage. An average of only 6.8 percent of District 24’s population, comprised of most towns along the state’s coastline, was enrolled in the program, which was the lowest percentage in the state.
New Hampshire is organized into more than 200 State House Legislative Districts, with each municipality categorized into a district. An average of more than one in four (27.0 percent) residents in District COO 5, comprised of the city of Berlin, were enrolled in Medicaid. District ROC 22, comprised of the town of New Castle, had the lowest proportion of its population receiving coverage, with approximately 2.1 percent enrolled.
New Hampshire also has several State House Floterial Districts, which are used to distribute remaining populations that do not fall within other House districts. District COO 7, comprised of residents in Berlin, Carroll, Jefferson, and Whitefield, had close to one in four (23.9 percent) residents receiving Medicaid coverage. An average of only 3.5 percent of District ROC 37’s population, comprised of residents in New Castle and Newington, was enrolled in the program.
Changes to the Granite Advantage Program
Several changes impacting Medicaid Expansion enrollees were included in both the new State Budget and federal reconciliation bill recently signed into law. Under the current biennium State Budget, adults in the Granite Advantage program will be required to comply with work requirements outlined in statute, pending federal Medicaid waiver submission and approval. Under these changes, enrollees will be required to work or participate in an eligible community engagement activity for at least 100 hours per month, more than the 80 hours per month mandated in the federal budget reconciliation package. Under the new federal requirements, which would primarily impact Granite Advantage enrollees, an estimated 20,000 adults could experience coverage losses. Work requirements could also create additional administrative and financial burdens for the state; New Hampshire spent approximately $6.1 million when attempting to implement Medicaid work requirements in 2019.
The current State operating budget also implements premiums for the Granite Advantage population, pending federal Medicaid waiver submission and approval. Granite Advantage adults with incomes above 100 percent of the FPG, or $15,650 for a household of one in 2025, would be required to comply with the cost shares to receive coverage. Premiums would vary based on household size, ranging from $60 a month for a household of one to $100 for a household of four or more. The new federal budget also implements cost shares for the Medicaid Expansion population with incomes between 100-138 percent of the FPG, although cost shares would require copayments up to $35 per service and prohibit states from charging premiums. According to national research, states that have implemented cost shares for Medicaid enrollees with the lowest incomes experienced decreased Medicaid enrollment, reduced health coverage, and delayed access of care.
– Jess Williams, Policy Analyst