Read the full stored bill text
CHAPTER 18
SB 134-FN - FINAL VERSION
03/06/2025 0401s
8Jan2026... 3093h
2026 SESSION
25-1122
05/09
SENATE BILL
134-FN
AN ACT
relative to work requirements under the state Medicaid program.
SPONSORS: Sen. Pearl, Dist 17; Sen. Lang, Dist 2; Sen. Murphy, Dist 16; Sen. Innis, Dist 7; Sen. McGough, Dist 11; Sen. Gannon, Dist 23; Rep. Osborne, Rock. 2; Rep. Moffett, Merr. 4; Rep. Edwards, Rock. 31
COMMITTEE: Health and Human Services
─────────────────────────────────────────────────────────────────
AMENDED ANALYSIS
This bill establishes community engagement and work requirements under the New Hampshire granite advantage health care program, or the state's expanded Medicaid program, pursuant to authorization for such requirements established in Section 71119, Public Law 119-21. This bill also directs the department of health and human services to file documentation with the Center for Medicare and Medicaid Services relative to implementing community engagement and work requirements as a condition of granite advantage eligibility.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Explanation: Matter added to current law appears in
bold italics.
Matter removed from current law appears [
in brackets and struckthrough.
]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/06/2025 0401s
8Jan2026... 3093h 25-1122
05/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty-Six
AN ACT
relative to work requirements under the state Medicaid program.
Be it Enacted by the Senate and House of Representatives in General Court convened:
18:1 New Sections; New Hampshire Granite Advantage Health Care Program; Work Requirements. Amend RSA 126-AA by inserting after section 5 the following new sections:
126-AA:6 Work Requirements.
I. In this section:
(a) “Applicable individual” means an individual described in 42 U.S.C. section 1396a(xx)(9)(A) who is eligible for the granite advantage health care program, and who is subject to work requirements.
(b) “Work requirements” mean the Medicaid community engagement and work requirements established under Section 71119 of Public Law No. 119-21.
II. No applicable individual shall be enrolled in Medicaid unless, at the time of application, the individual demonstrates compliance with the work requirements for the one month immediately preceding the month during which the individual applies. The department of health and human services shall require documentary evidence and shall not accept self-attestation at the time of application.
III. The department of health and human services shall verify an applicable individual’s compliance with documentary evidence. Verification shall occur on an ongoing basis, at least quarterly between redetermination periods. Self-attestation shall not be accepted.
IV. The department of health and human services may rely on ex parte records and or documentary evidence provided by the applicable individual to verify exemption from work requirements. The department of health and human services shall verify all exemptions and shall not accept self-attestation from individuals seeking exemptions.
V. The department of health and human services shall not seek or implement any additional optional exemptions under 42 U.S.C. section 1396a(xx)(3)(B) or other program waivers without obtaining express approval of the oversight committee on health and human services established in RSA 126-A:13.
VI. The department of health and human services shall only approve an exemption for an individual based on the status of medically frailty or otherwise an individual with special needs if the individual has been medically certified per a statement from a physician, physician associate, nurse, nurse practitioner, designated representative of the physician’s office, a licensed or certified psychologist, or a social worker, as having disabling mental disorders, having a physical, intellectual, or developmental disability that significantly impairs their ability to perform activities of daily living, including eating, dressing, bathing, grooming, getting in and out of bed and chairs, walking, going outdoors, using the toilet, or is in treatment for a chronic substance use disorder. In no case may the department of health and human services expand the definition of an individual who is medically frail or otherwise an individual with special needs beyond the scope of the definition established under 42 C.F.R. section 440.315 unless as otherwise modified in Public Law 119-21, Section 71119 (2025).
VII. Any applicable individual who fails to comply with the work requirements shall be provided notice and an additional 30 days to supply verification of compliance or exemption. After the 30-day notice period, the department of health and human services shall disenroll any applicable individual who does not demonstrate compliance with the work requirements or qualify for an exemption.
VIII. In the event of a conflict between this section and the requirements of Public Law 119-21, Section 71119 (2025), the requirements of the federal statute or regulation shall control.
126-AA:7 Severability. If any portion of this chapter or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of the chapter which can be given effect without the invalid provisions or applications, and to this end the provisions of this chapter are severable.
18:2 New Hampshire Granite Advantage Health Care Program; Community Engagement and Work Requirements. Amend 2025, 141:412 to read as follows:
141:412 New Hampshire Granite Advantage Health Care Program
,
[
1115 Demonstration; Renewed Application to CMS
]
Community Engagement and Work Requirements
.
I. On or before [
January
]
December
1, 2026,
or on an earlier date within 30 calendar days after publication of the federal application template,
the department of health and human services shall [
resubmit
]
submit
to the Center for Medicare and Medicaid Services (CMS) [
a Section 1115 demonstration waiver to the state Medicaid plan relative to enforcing
]
required documentation relative to implementing
community engagement and work requirements as a condition of Granite Advantage eligibility
in accordance with the One Big Beautiful Bill Act of 2025, Public Law 119-21, Section 71119 (2025)
. Prior to submitting the [
Section 1115 waiver
]
required documentation
to CMS, the department shall submit the proposed [
waiver
]
plan to implement community engagement and work requirements
to the fiscal committee of the general court for [
approval
]
review
.
II. Beginning November 1, 2025 and [
annually
]
quarterly
thereafter
through December 31, 2026, and then annually thereafter
, the department shall provide a report regarding the status of the [
waiver application
]
plan under review by CMS
and implementation of the community engagement
and work
requirements [
in RSA 126-AA:2, III
]
eligibility in accordance with Public Law 119-21, Section 71119 (2025)
, to the senate president, the speaker of the house of representatives, the senate clerk, the house clerk, and the governor.
18:3 New Hampshire Granite Advantage Health Care Program Established; Community Engagement and Work Requirements; Suspended. The provisions of RSA 126-AA:2, directly related to the community engagement and work requirements, shall be suspended for the duration of the federal community engagement and work requirements under Public Law 119-21, Section 71119 (2025), as amended. If the federal community engagement and work requirements are subsequently eliminated, the commissioner of the department of health and human services shall immediately certify in writing the removal of the suspension to the director of the office of legislative services, the secretary of state, the senate president, the speaker of the house of representatives, the senate clerk, the house clerk, and the governor.
18:4 New Hampshire Granite Advantage Health Care Program Established. Amend RSA 126-AA:2, I(a) to read as follows:
I.(a) The commissioner shall apply for any necessary waivers and state plan amendments to implement [
a 5-year demonstration program beginning on January 1, 2019 to create
]
and administer
the New Hampshire granite advantage health care program which shall be funded exclusively from non-general fund sources, including federal funds. The commissioner shall include in an application for the necessary waivers submitted to the Centers for Medicare and Medicaid Services (CMS) a waiver of the requirement to provide 90-day retroactive coverage and a state plan amendment allowing state and county correctional facilities to conduct presumptive eligibility determinations for incarcerated inmates to the extent provided under federal law. To receive coverage under the program, those individuals in the new adult group who are eligible for benefits shall choose coverage offered by one of the managed care organizations (MCOs) awarded contracts as vendors under Medicaid managed care, pursuant to RSA 126-A:5, XIX(a). The program shall make coverage available in a cost-effective manner and shall provide cost transparency measures, and ensure that patients are utilizing the most appropriate level of care. Cost effectiveness shall be achieved by offering cash incentives and other forms of incentives to the insured by choosing preferred lower cost medical providers. Loss of incentives shall also be employed. MCOs shall employ reference-based pricing, cost transparency, and the use of incentives and loss of incentives to the Medicaid and newly eligible population. For the purposes of this subparagraph, "reference-based pricing" means setting a maximum amount payable for certain medical procedures.
18:5 Effective Date. This act shall take effect upon its passage.
Approved: March 27, 2026
Effective Date: March 27, 2026