By Marc Gilman
(800) 927-9326 |
Key Takeaways
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Starting January 1, 2027, most adults ages 19–64 covered through the Granite Advantage Health Care Program (New Hampshire’s Medicaid expansion) will need to complete 80 hours a month of work or another qualifying activity to keep their coverage.
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Granite Advantage enrollees will also move from annual to twice-a-year eligibility renewals starting in 2027, and retroactive coverage will be limited for some groups.
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Some cost changes are already underway ahead of 2027: prescription copays for many Granite Advantage members have already increased, and new monthly premiums for higher-income Granite Advantage and CHIP households are being phased in, though start dates have shifted while the state awaits federal guidance.
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Eligibility rules for many non-U.S. citizen adults are narrowing starting October 1, 2026 — this affects a specific set of immigration categories (including many refugees and asylees) and does not apply to children or pregnant individuals.
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These changes come from a combination of the federal 2025 budget reconciliation law and New Hampshire’s own 2026–27 state budget — most apply specifically to Granite Advantage and CHIP, not to traditional Medicaid categories like coverage for seniors, people with disabilities, or pregnant women.
What Is Actually Changing, and When?
New Hampshire delivers Medicaid coverage through three managed care plans — NH Healthy Families, AmeriHealth Caritas NH, and WellSense Health Plan — and the eligibility rules underneath that coverage are shifting on two different timelines: some changes are already active, and the larger set arrives January 1, 2027.
Already underway (2025–2026):
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Prescription copays for many Granite Advantage members with incomes at or above the federal poverty level have already increased to $4 per medication, and the state has reinstated income verification forms that had been suspended since the COVID-19 pandemic.
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New monthly premiums are being phased in for higher-income households: Granite Advantage adults at or above 100% of the federal poverty level face premiums of $60 (household of one) up to $100 (household of four or more), and CHIP families at or above 255% of the federal poverty level face premiums starting around $190 (household of two) and rising with family size. Both were originally scheduled for mid-2026 but have faced delays pending federal guidance, so exact start dates have moved.
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Eligibility changes for non-U.S. citizen adults, effective October 1, 2026. Under a separate provision of the same federal law (Section 71109), federal funding for Medicaid and CHIP will narrow to a smaller set of immigration categories starting this date: U.S. citizens and nationals, lawful permanent residents who have completed the standard five-year waiting period, and a short list of other specifically authorized categories (including Compact of Free Association migrants and certain humanitarian-status exemptions that remain unchanged). Some lawfully present adults who are currently eligible — including many refugees and asylees — will no longer qualify for federally funded Medicaid or CHIP after this date. This applies to both current enrollees and new applicants as of October 1, 2026, not just future applications. Children and pregnant individuals are not affected by this particular change.
Starting January 1, 2027:
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Work and community engagement requirements. Granite Advantage members ages 19–64 will generally need to complete 80 hours a month of work, job training, education, volunteering, or a combination of these — or show monthly income of at least $580 — to maintain eligibility. This is a federal requirement under the 2025 budget reconciliation law (often called the One Big Beautiful Bill Act) and applies to every state that expanded Medicaid, not just New Hampshire.
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Twice-yearly renewals. Granite Advantage eligibility will be reviewed every six months instead of annually. This comes from Section 71107 of the same federal law (Public Law 119-21) and applies uniformly to Medicaid expansion adults nationwide, not just in New Hampshire.
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Shorter retroactive coverage window. Some enrollees currently get up to three months of retroactive coverage after approval; for new Granite Advantage enrollees, that window is being narrowed to 30 days going forward.
For people who renew their coverage before the end of 2026, that renewal generally carries them through 2027 without the new requirements kicking in until their next redetermination — so the timing of your next renewal matters.
Who Is Actually Affected?
This is the detail that gets lost in a lot of the coverage: these changes are targeted, not universal. They apply almost entirely to the Granite Advantage Health Care Program (New Hampshire’s Medicaid expansion population — the state reported 47,571 members subject to the new rules as of July 1, 2026) and to certain CHIP families. Traditional NH Medicaid categories — coverage for seniors, people with disabilities, pregnant women, and children outside CHIP’s premium-paying tier — are largely unaffected by the work requirement and premium changes.
Exemptions from the work requirement are still being finalized by the state and CMS, but are expected to include pregnant individuals, former foster youth, certain veterans, and people who are medically frail or otherwise unable to work — the medically frail and special-needs exemptions require certification from a medical professional’s statement, not just self-report. Self-attestation (simply stating you qualify for an exemption or met the requirement) is being phased out in favor of documented verification, which means the administrative burden of proving compliance is a real part of this change, not just the requirement itself. New Hampshire also passed its own state-level work requirement law (SB 134) alongside the federal one; as of mid-2026, state lawmakers and DHHS have been working to reconcile the two, and a legislative oversight committee confirmed the state and federal rules are now closely aligned on most major points.
New Hampshire isn’t new to this particular policy, which is worth knowing as context: the state briefly implemented its own Medicaid work requirement in 2019, requiring 100 hours a month. About a month after the rule took effect, only around 8,000 of the roughly 25,000 people subject to the requirement had complied and documented it — the state suspended the program shortly after, and federal courts halted it entirely not long after that. The practical lesson from that experience lines up with the state’s own advice this time around — the biggest risk to coverage tends to be missed paperwork and notices, not actually failing to meet the requirement.
For context on scale: DHHS has noted that roughly 65% of Medicaid recipients statewide are already working, and independent estimates of how many New Hampshire residents could ultimately lose coverage because of these combined changes vary widely by source and assumptions — figures reported in 2026 range from roughly 14,000 to 29,000 people, though the actual number will depend heavily on how exemptions and verification are implemented.
Where Does Insurance Planning Fit In?
If you or a family member could be affected by the work requirement, the renewal schedule change, or the new premiums, the most useful thing you can do right now is make sure your NH EASY account and contact information are current, so you don’t miss a renewal notice — missing one is a far more common cause of coverage loss than actually failing to meet a requirement. If a change in income or household circumstances means Medicaid coverage becomes harder to maintain, it’s worth understanding your alternatives — including Marketplace coverage — well before a gap in coverage happens, not after.
What To Do Next
If you’re covered through Granite Advantage or CHIP and aren’t sure how these changes affect you, or if you’re helping a family member navigate a coverage question, Gilman Agency can help you understand your options and make sure you’re not caught off guard by a renewal deadline.
Call us at (800) 927-9326 or email to schedule a review.
Sources: New Hampshire Department of Health and Human Services, “Stay Covered NH: Information for People with Medicaid,” “Medicaid Work Requirements: What You Need to Know,” and “Eligibility Changes for Non-US Citizen Adults”; NAMI New Hampshire, “Get the Latest Updates on NH Medicaid”; Olivia Richardson, “Access to NH Medicaid coverage is changing. Here’s what you need to know,” New Hampshire Public Radio (July 2025); “Granite Advantage members face new work requirements in 2027,” Concord Monitor (July 2026); “Committee endorses tweaks to Medicaid work requirement,” Union Leader (June 2026); “New Hampshire lawmakers work to hash out specifics on Medicaid work requirements,” New Hampshire Bulletin (November 2025); “National report estimates 14k to 29k could lose Medicaid in New Hampshire due to recent law,” New Hampshire Public Radio (April 2026); NH Medicaid Matters (nhneedsmedicaid.com), “Upcoming Medicaid Changes”; healthinsurance.org, “Medicaid eligibility and enrollment in New Hampshire”; Center for Health Care Strategies, “A Summary of Federal Medicaid Work Requirements”; State Health and Value Strategies, “H.R.1’s Changes to Non-Citizen Coverage: Frequently Asked Questions”; Hill, Burroughs & Adams, “New Strategies, Similar Results: New Hampshire’s Experience with Medicaid Work Requirements,” Health Services Research (2020).
