NH subcommittee reviews plan to implement federal Medicaid work requirements, schedules follow-up

CONCORD — The New Hampshire House Health, Human Services and Elderly Affairs subcommittee held a work session to review draft amendments to Senate Bill 134 that would implement federal Medicaid work requirements enacted in HR 1 (commonly called OB3).

Chairman MacLean opened the meeting by saying the panel’s focus was practical: “The question is not so much if as, how and when,” and asked staff to walk members through differences between the federal law and the state’s earlier 2018–2019 approach.

Why it matters: The federal law creates a mandate for certain Medicaid populations to meet community engagement or work activities before or to retain coverage; the subcommittee heard that the change affects adults roughly 19 through 64 and would require new IT, verification and outreach systems, new notice processes and twice‑annual eligibility checks.

Attorney John Williams, legislative director for health and services, told the panel the draft language aligns the state statute with the federal application template and would pause portions of the older state law while the federal requirement is in force. “My name is John Williams. I’m the legislative director for health and services,” Williams said as he introduced the draft language.

Director Littmann, who led staff presentation on policy tradeoffs, recommended pursuing a state plan amendment rather than an 1115 waiver. He said waivers carry higher up‑front actuarial and administrative costs and longer approval timelines, while a state plan approach is more likely to be approved faster and to align vendor and IT contracts with federal specifications. Littmann also summarized the federal rule timeline and funding assumptions: “There was a $100,000,000 for states. That will be divided evenly. We expect to get about $2,000,000 to help cover the cost of implementation.”

Staff explained key substantive differences between New Hampshire’s prior approach and the federal law. Examples discussed include the hourly requirement (New Hampshire’s earlier proposal used 100 hours versus the more common 80‑hour standard), the timing of look‑back and verification windows (staff proposed a short initial look‑back for eligibility and longer look‑backs for ongoing verification), and stricter federal rules about whether individuals must meet requirements before obtaining coverage versus after enrollment.

Panel members discussed exemptions, verification and administrative burden. Staff said the federal law specifies certain mandatory exemptions (disability, pregnancy, caregiving) and that CMS may give states some latitude on additional hardship or good‑cause categories; the subcommittee was advised to avoid locking rigid, state‑specific definitions into statute before federal rules are finalized. Littmann described pilot work to simplify verification, including a federally supported app that can pull payroll or aggregator data from services such as ADP and make automated verification easier for some beneficiaries.

Staff also warned of operational impacts: the department estimated roughly 56,000 people in the affected population, projected significantly increased redetermination workload (the department currently does about 12,000–13,000 redeterminations per month and has seen closures rise from roughly 900 per month during pandemic flexibilities to 3,500 per month since those flexibilities ended). The panel heard that the effective implementation date under federal law is January 1, 2027, and that the state needs to be ready by Dec. 31, 2026; federal rulemaking and guidance are expected by June 1, 2026, and some beneficiary notices must begin as early as Oct. 1, 2026, to meet the 90‑day notification requirement.

On implementation sequencing, staff recommended obtaining executive council spending authority early in 2026 to fund IT vendor work and testing, pursuing the state plan amendment within 30 days of the federal application template’s publication, and piloting verification tools with CMS. They estimated IT updates could be completed for under $2 million given the anticipated federal allocation of roughly $2 million to New Hampshire.

Several members pressed for guardrails on exemptions and verification; staff and counsel repeatedly advised leaving details flexible so state rules can be aligned with federal guidance rather than fixed in statute. Representative Woods and others raised concerns about churn and coverage gaps and emphasized oversight during early implementation.

There were no formal votes on the bill at the session. The subcommittee agreed to reconvene for further review and directed staff to continue outreach to CMS, the governor’s office and other agencies. The panel set a follow‑up meeting for Oct. 22 at 1 p.m. to consider final language and next steps.

Looking ahead: Staff said the department will continue rulemaking, coordination with employment services and MCOs for outreach, and planning to limit coverage losses while meeting federal deadlines. The subcommittee will review updated draft language at its Oct. 22 meeting.