NH officials outline Medicaid, SNAP changes and timeline for rural health transformation grant

Laurie Weaver, commissioner of the New Hampshire Department of Health and Human Services, told the Health and Human Services Oversight Committee on Sept. 26 that the department is working to finalize an application for the federal rural health transformation grant before a November 3 deadline and is continuing stakeholder roundtables and a request for information process.

The update moved quickly into federally driven changes to SNAP and Medicaid that DHHS staff said could increase state costs and administrative workload. Karen Hebert, director of the Division of Economic Stability, told the committee that recent federal legislation (referred to in testimony as HR 1 / the "Big Beautiful Bill Act") will change how SNAP is funded and administered and will likely require the state to cover a larger share of some costs beginning in federal fiscal year 2026–2027.

Hebert said the federal-state split for SNAP administrative costs will change from the current 50/50 arrangement to 75/25 (state share rising) effective in October 2026, and that the SNAP benefit itself — historically 100% federally funded — may require a state share depending on the state's error rate. "This is impactful to about the 43,000 households that receive SNAP benefits in New Hampshire," Hebert said. She explained that the state would owe some share of benefits if New Hampshire's error rate exceeds a federally set threshold over the measurement period.

DHHS staff described how the error rate is measured and the department's strategy to reduce errors. Hebert said many errors are clerical or procedural mistakes discovered during federal audits, not client fraud, and that the department is auditing cases internally, expanding staff training and seeking federal and private grant funding for technology to automate manual tasks. She said DHHS applied for a federal technology grant of just over $1 million and is pursuing a donated grant-writer to help meet the fast timeline for grant applications.

State Medicaid director Henry Littman and Associate Commissioner Trish Chile briefed the committee on changes being implemented under the state's HB 2 and the later OB 3 legislation. Littman said returning to pre-public-health-emergency renewal rules and a lower compatibility threshold have already reduced enrollment. "We were probably at about 185,000 individuals in June and at the beginning of September we were about 178,000," Littman said, describing a decline tied to resumed, more manual eligibility verification and fewer automatic renewals.

Littman reviewed several policy changes the department is preparing to implement, with some dates tied to state or federal fiscal years. Highlights included: - Premiums for some children under HB 2, which DHHS estimates could affect roughly 8,600 children out of about 90,000, with implementation planning aimed for Jan. 1, 2026. - Pharmacy copays were raised (a flat $4) and took effect this past October under the HB 2 schedule. - Granite Advantage (Medicaid expansion) cost-sharing or premiums: HB 2 envisioned premiums for certain expansion enrollees; OB 3 prohibits premiums but requires cost sharing. DHHS said it is working with CMS on whether a waiver or other mechanism will allow premium-like requirements to proceed. - Work requirements for some Medicaid populations: Littman said the department is evaluating whether to pursue a state-plan option rather than a costlier Section 1115 waiver. He noted a reporting requirement to the legislature before submission and said federal implementation support (up to about $2 million, as discussed) may be available. The legal risk from litigation is uncertain but may be lower than earlier waiver litigation, he said. - Redeterminations and retroactive coverage: Beginning Dec. 31, 2026, DHHS expects more frequent redeterminations for expansion enrollees (twice annually) and a reduction in retroactive coverage periods (general Medicaid retroactive coverage reduced from 90 to 60 days; expansion enrollees to 30 days), which DHHS warned could increase provider billing risk. - Provider tax changes: OB 3 reduces maximum provider tax levels in steps beginning in 2027, ultimately lowering the Medicaid enhancement tax ceiling and reducing funds available to the program by 2029 under the current law.

Committee members asked for clarifications on how error rates are calculated, whether client failures to report income count as agency errors (Hebert said client failures are not counted as agency error), and how recoupment of overpayments would work if an administrative error occurred. Littman and Hebert said they would follow up with written answers and additional detail in October when the department returns with more specific fiscal estimates.

Weaver also noted the department's limited internal capacity: she said DHHS currently has a high vacancy rate and approximately 400 unfunded positions, and that securing outside support for grant-writing and technology is central to meeting the tight deadlines for the rural health transformation opportunity. "We have teams working on categorizing and streamlining the feedback that we've gotten," Weaver said, describing the cross-sector stakeholder engagement the department has held since July.

The committee did not take formal votes on the policy items during the hearing; staff said they will return with more detailed fiscal and implementation plans at a future meeting.