House HHS hears hours-long debate over Medicaid work-requirement bill and waiver plan

Senate Bill 134, which would direct the Department of Health and Human Services to pursue a federal waiver imposing work and community-engagement requirements on Granite Advantage (the state’s Medicaid expansion program), drew more than two hours of testimony and sharply divided witnesses before the House Health, Human Services and Elderly Affairs Committee.

Proponents framed the bill as a policy to encourage work and lower long-term costs. Senator Howard Pearl, prime sponsor, said the waiver would apply to able-bodied adults and include exemptions similar to Temporary Assistance for Needy Families (TANF). Executive Councilor John Steven told the committee the policy affirms a state preference for work, pointing to earlier TANF reforms as a model.

Opponents — including clinicians, legal-aid attorneys, behavioral-health providers, hospitals and DHHS staff — warned that putting monthly reporting and verification in place would cause eligible people to lose coverage. Henry Littman and Karen Hebert of the Department of Health and Human Services told the committee the department already had built a work-reporting system that was later halted by litigation; reviving and modernizing it would carry nontrivial IT and staffing costs and could produce service disruptions if not fully funded and staffed.

Several providers and advocates said prior implementations produced coverage losses with little or no employment gains. Raymond Burke of New Hampshire Legal Assistance and representatives of the New Hampshire Hospital Association and New Futures urged the committee to await federal developments and warned of litigation risk. Karen Hiebert, DHHS’s Division of Economic Stability director, said the department’s earlier implementation produced tens of thousands of monthly compliance tasks and that standing up a program under the statute as written would require additional staff, call-center capacity and system work.

Supporters said the program could connect enrollees with training, volunteer options, community resources and work-readiness supports. Executive Councilor John Steven said prior state TANF reforms increased work engagement and argued a well-designed waiver could produce long-term gains.

Where it stands: Committee members questioned timing, cost and likely legal outcomes. DHHS said the law as written would require large administrative capacity and that alternative designs (for example, annual or eligibility-point reviews rather than monthly reporting) would be less costly and easier to administer. Several committee members asked DHHS for more specific estimates and recommended tying design choices to administrative capacity and current federal rules.

The record: Testimony included detailed experience from providers and clients, DHHS staff estimates of IT and personnel needs, and legal arguments about federal waiver law and pending federal policy changes. Opponents repeatedly cited prior New Hampshire experience in which thousands of people were at risk of losing coverage during an earlier implementation attempt; DHHS estimated that, applying earlier noncompliance rates to current enrollment, tens of thousands of enrollees would need to document work or request exemptions within an implementation year.

What’s next: Committee deliberations are expected to focus on the specific design choices—frequency of reporting, list of exemptions, appeals and cure periods and available funding for system build and staffing—and on whether to recommend the bill with a January deadline for waiver submission or to postpone until federal developments clarify allowable approaches.