Subcommittee advances two amendment paths to implement Medicaid work requirements, plans merged proposal for full committee

The Health, Human Services and Elderly Affairs Subcommittee met Nov. 5 for a work session on SB 100 and SB 134 and discussed two competing amendments (3051h and 3054h) to align New Hampshire law with new federal Medicaid work-requirement rules. Members conducted straw polls and agreed to advance both the bare-bones amendment (3051h) and a more detailed drafting (3054h), with staff directed to merge the two and present the merged amendment to the full committee on Nov. 12 at 10:00 a.m.

The meeting focused on technical differences between the amendments and operational questions about verification and program administration. Representative Coval described 3051h as the baseline change aligning state statute to federal requirements and suspending existing New Hampshire-specific work requirements while federal rules are in place. "Those work requirements that currently exist in New Hampshire statute, we're not going to repeal them, we're going to suspend them," Coval said. He said 3054h adds definitions and implementation detail, including a look-back requirement, documentary verification standards, and limits on self-attestation.

Key provisions discussed in 3054h and in committee questioning included:

- Look-back period: the amendment as drafted references a three-consecutive-month look-back immediately preceding the month of application as the state’s requirement; members noted federal guidance allows a state choice of one to three months.

- Verification: 3054h would require documentary evidence (payroll records, unemployment records or other administrative data) and specifies that the department "shall not accept self attestation at the time of application." The amendment also contemplates quarterly verification thereafter.

- Ex parte records: the department may rely on ex parte sources (administrative data pulls) to verify either compliance or exemption status so applicants do not always need to supply documents.

- Medical frailty: 3054h includes definitions for medical frailty that mirror federal rules and provides an exemption pathway for those individuals, subject to documentation.

- Notices and remedy: the amendment specifies a 30-day notice period during which a recipient can address compliance gaps before a termination action.

- Redeterminations and reporting: staff explained the department would perform redeterminations on a six-month cadence and perform interim quarterly checks; the package includes additional reporting requirements in 3054h.

Medicaid Director Henry Littman and John Williams, director of legislative affairs for the Department of Health and Human Services, told the subcommittee the language generally aligns with federal rules but raised operational cautions. "I think that what's put out here does comply with the interests of being consistent with federal law," Littman said, while warning that increased verification and more frequent determinations could strain the department’s ability to process long-term care eligibility and other workloads.

Committee members raised several concerns during discussion. Dr. Weber and Representatives Leverett and Hart emphasized the risk that stricter verification (a three-month look-back and no initial self-attestation) could disadvantage people who experience sudden medical emergencies and cannot readily assemble documentation or whose relatives are out of state. Representative Leverett said such cases can be "punitive" to people who previously were compliant but then have catastrophic events. Representative Coval and others argued that restricting self-attestation is necessary to protect program integrity and prevent gaming.

Department officials described mitigation strategies, including outreach and a CMS-supported app that would let applicants pull payroll or payroll-aggregator data directly into the department’s system. Officials estimated 60–80% of applicants could use the app or automated data sources; they said up to roughly 40% might be unable to do so and would require other verification pathways.

The subcommittee did not hold a formal recorded vote on either amendment. Instead, members took straw polls: the group reported broad support for the baseline amendment 3051h (majority in favor) and majority but smaller support for 3054h (reported as 4 of 5 members). The chair instructed OLS to draft a merged amendment that inserts page 1, lines 3–22 of 3051h into 3054h and to incorporate minor severability language revisions; the merged amendment is expected to be released in advance of the Nov. 12 full committee meeting.

Representative Woods concluded with a public statement opposing work requirements on principle while acknowledging the committee’s task to minimize harm under current federal policy. No final committee action or statutory change occurred at this meeting; the subcommittee referred the two amendment paths to the full committee for action.

What’s next: the full Health, Human Services and Elderly Affairs Committee will consider the merged amendment and the alternative amendment when it convenes Nov. 12 at 10:00 a.m. OLS will circulate the merged text in advance.