(Editor's note: This story has been corrected to reflect that the new federal bill will cut the Medicaid budget by about $1 trillion.)
Big changes are coming in 2026 for the more than 180,000 New Hampshire residents covered by Medicaid, following the recent passage of the state’s new budget, signed into law by Gov. Kelly Ayotte in late June. Here’s what you need to know.
New premiums, higher drug copays coming
New Hampshire residents covered by Medicaid — which includes low-income adults and people with disabilities — do not pay any premiums now.
But starting in July 2026, individuals making 100% of the federal poverty line, and families with children making at least 255% of the federal poverty line, will begin paying monthly premiums.
For those individuals, monthly premiums will cost:
- $60 for a household of one
- $80 for a household of two
- $90 for a household of three
- $100 for a household of at least four
For those families, monthly premiums will cost:
- $190 for a household of two
- $230 for a household of three
- $270 for a household of at least four
Copays for prescription drugs will also go up to $4.
The new law also brings back income verification forms, which were suspended during the COVID-19 pandemic.
Effort to establish work requirements
The state budget bill does not actually set new work requirements, but rather directs the state’s Department of Health and Human Services to submit a waiver to the federal agency that administers Medicaid by January 2026.
If granted, the waiver would allow New Hampshire to impose work requirements — which is likely, given the passage of Congress’ sweeping Republican-backed policy bill, which will impose work requirements for most adults enrolled in Medicaid.
The new federal law will require most adults without children to prove they are working, volunteering, or attending school at least 80 hours a month before they can access health care coverage through Medicaid.
Advocates concerned patients could lose access
The new federal law will cut the Medicaid budget by roughly $1 trillion over the next decade, notes Steve Ahnen, president of the New Hampshire Hospital Association.
Advocates like Ahnen are concerned this and changes at the state level will mean many Medicaid enrollees will lose access to coverage — and subsequently, lose access to care or risk taking on medical debt they cannot afford to pay.
Christina FitzPatrick, New Hampshire state director of the AARP, is also concerned about the many new bureaucratic requirements for people to maintain their benefits.
Roughly 70,000 older adults in New Hampshire are enrolled in Medicaid. FitzPatrick said many enrollees could lose access to coverage just for missing paperwork deadlines, having trouble navigating the reporting system, or not having the right documents to prove they are working or volunteering. In addition, she worries the new monthly premiums could put a financial strain on their budgets.
“When you impose costs on people with very low incomes, when you impose costs on them for accessing their care, they will go without care,” FitzPatrick said. “They're operating on too thin of a margin to absorb those extra costs and as a result, their health will suffer.”
FitzPatrick said another group the AARP is concerned about is caregivers, who often rely on Medicaid as supporting family members is often a full-time responsibility. FitzPatrick said it can be difficult for them to find jobs that provide private health insurance and are flexible enough to allow them to care for loved ones.
She said caregiving is not among the exemptions to the new federal work requirements.
“So, family caregivers are left in a situation where they can’t work because of their caregiving responsibilities and lose their health insurance as a result,” FitzPatrick said. “And that is not an acceptable situation to these family caregivers who are giving so much to their loved ones and also making our healthcare system work.”
Ahnen with the New Hampshire Hospital Association said these changes could also impact the state’s entire health care system.
Ahnen said the New Hampshire hospital system is currently running at about 90% capacity. He predicts that if more patients lose access to Medicaid, it may impact emergency rooms that see under- and uninsured patients who often delay seeking care due to financial burdens.
“We're challenged by getting patients out of the hospital,” Ahnen said. “People who no longer need acute inpatient services, maybe they need to go to a skilled nursing facility or a rehab center or home health or a nursing home, but none of those areas are able to accept that patient because they either don't have insurance or you know insurance denials or delays or things like that. And so, those patients end up waiting in the hospital, meaning they're taking a bed that another patient could use.”
Ahnen says higher demand on emergency rooms and health care systems in general means everyone, regardless of insurance status, could have some impact in their ability to get medical care.
Ahnen also notes people on Medicaid make up a significant portion of those seeking services for mental health and substance use disorder services. Recovery programs, Ahnen said, will also be impacted if they aren’t able to place and treat people who need their services.
“If larger numbers of people who suffer from those conditions aren't able to access [Medicaid]...,” he said. “I worry that we'll see some very unfortunate things where people continue to be sick.”
