New Hampshire reviews Medicaid work requirements

New Hampshire is considering significant changes to its Medicaid program that could affect many recipients, including those with intellectual and developmental disabilities. Republican lawmakers have proposed stricter work requirements and the introduction of premiums and copays within the Granite Advantage Medicaid expansion. These changes reflect a broader national discussion about Medicaid eligibility and program design.

Stricter documentation and work mandates

The current proposals extend beyond requiring Medicaid recipients to affirm they meet work rules. Lawmakers seek documented evidence of employment, such as quarterly work records, rather than relying on self-attestation. Some drafts suggest that enrollees must maintain employment for three consecutive months before coverage can be reinstated if lost due to noncompliance.

This approach signals a shift toward more rigorous verification processes, which may present challenges for individuals with fluctuating or unstable employment situations. It also raises operational questions about how coverage interruptions and restorations are managed administratively by state agencies.

legislative pushback and potential impacts

Democratic legislators in the state have introduced bills aimed at rolling back these changes. Senate Bill 484 and companion House legislation focus on repealing premiums and copays implemented earlier in 2025 under the Medicaid expansion. These efforts emphasize concerns about access and affordability for vulnerable populations.

Critics caution that tightening work requirements and adding financial barriers could result in significant coverage losses. The most affected groups may include low-income workers with variable hours, people with disabilities, and those in precarious employment sectors. Preliminary analyses indicate that thousands could lose Medicaid access if the proposals advance without modification.

The debate underscores ongoing tensions in Medicaid policy between cost containment, program integrity, and inclusive access. New Hampshire’s decisions will likely influence regional policy trends, particularly in balancing workforce incentives with the stability of safety-net programs.As these developments progress, IDD providers and advocates will need to monitor potential implications for service coordination, Medicaid eligibility, and overall equity in care delivery.