The study, New Medicaid Work Requirements Threaten Health Care Access for Up to 29,000 Granite Staters, With Several Implementation Decisions Still Left Up to the State, examines current Medicaid enrollment, the new federal requirements, decisions already made by New Hampshire lawmakers, and the potential consequences for residents and the state’s broader health care system.Under the new federal law, most adults enrolled in New Hampshire’s Medicaid Expansion program will be required to document at least 80 hours per month of work, community service, education, or other qualifying activities to maintain their coverage, unless they qualify for an exemption. While the law establishes minimum requirements, states have flexibility in how they implement and enforce them.
The analysis finds that New Hampshire has already adopted requirements that are stricter than what federal law mandates, while several important state decisions remain that could affect how many Granite State residents are able to maintain their coverage.
Key findings from the study include:
- Up to 29,000 Granite Staters could lose Medicaid coverage by 2028. Between 23,000 and 29,000 fewer adults could be enrolled in Granite Advantage by 2028. That represents approximately 48 to 60 percent of the program’s August 2026 enrollment. An estimated 4,000 to 6,000 young adults ages 19 to 24 could be among those losing coverage.
- New Hampshire has adopted stricter requirements than federal law mandates. While federal law requires states to verify compliance at least once every six months, New Hampshire will require verification every three months. The State will also require documentary proof of compliance rather than allowing individuals to self-attest that they meet the requirements. These additional requirements could increase administrative burdens and make it harder for eligible residents to maintain coverage.
- Decisions still ahead could determine how many people retain coverage. New Hampshire must still finalize important implementation policies, including how it will determine medical frailty exemptions, use existing data to automatically verify eligibility, establish parameters of additional hardship exemptions, and coordinate outreach with health care providers and community organizations. These decisions could be especially consequential for residents with disabilities or health conditions, as well as those in rural communities who face barriers to accessing health care services and navigating administrative requirements.
- Coverage losses could have broader consequences for New Hampshire’s health care system. When people lose Medicaid coverage, hospitals and other providers may face higher uncompensated care costs as uninsured patients struggle to pay for health care services. Providers may seek to offset these losses by negotiating higher payments from private insurers, potentially driving up health insurance premiums and costs for Granite Staters with private health insurance coverage.
“These changes could affect more Granite Staters than only those who lose their Medicaid coverage,” said Williams. “When more people lose health coverage, hospitals and other health care providers may be left covering the costs of care that patients can’t afford to pay for. Those costs could ultimately be passed on to Granite Staters with insurance, including private insurance plans, through higher premiums. How New Hampshire implements these requirements could have major consequences for the state’s health care system as a whole.”
You can read the full study, New Medicaid Work Requirements Threaten Health Care Access for Up to 29,000 Granite Staters, With Several Implementation Decisions Still Left Up to the State, at https://nhfpi.org/resource/new-medicaid-work-requirements-threaten-health-care-access-for-up-to-29000-granite-staters-with-several-implementation-decisions-still-left-up-to-the-state/.
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