As work requirements are set to roll out Jan. 1 for Medicaid recipients on Granite Advantage, the New Hampshire Department of Health and Human Services is trying to get the word out on the latest information from the federal government about how proving eligibility for Medicaid will work.
Granite Advantage is New Hampshire’s version of expanded Medicaid health insurance, for people who meet certain income limits.
In 2027, people who receive Medicaid through Granite Advantage will have to either work, volunteer or be in school in order to receive benefits, unless they meet certain exemptions.
One exemption is if a person is deemed “medically frail.”
Recently, the definition of medical frailty changed after a federal judge ruled on Oct. 29 that the Trump administration’s interpretation of the definition was too narrow.
During a webinar this week, Jonathan Ballard, the state health department’s chief medical officer, said the department is trying to update medical providers so that they can help patients who automatically meet the criteria keep their insurance without submitting proof of work — such as those who are disabled or have serious medical conditions.
“It is recommended that we make it as little burdensome on the beneficiary and on the medical providers as possible,” Ballard said. “One way to do that is to look at the medical claims of beneficiaries of Medicaid recipients.”
Granite Advantage will use the diagnosis codes submitted by providers to allow people who meet the criteria to automatically receive exemption status. The state will also look at prescription coverage and the use of medical equipment like wheelchairs, mobility devices, and respiratory equipment to see if a person meets the criteria based on the law.
For those who aren’t automatically exempted, Ballard said the individual or their medical providers should submit a statement to the state health department if they believe they still meet exemption criteria.
Rolling out all of the information about work requirements, Ballard said, has been a balancing act.
“We just have learned eleven days ago [that] things have changed,” Ballard said, referring to the federal ruling redefining medical frailty. “We want to wait until we can give them the exact right information.”
The state health department also allows individuals to self attest, under penalty of perjury, that they meet medical frailty requirements. The state does not allow self attestation for whether an individual is working.
Granite Advantage participants will also be able to look up their exemption status in the NH Easy portal.
Granite Advantage participants who are working, volunteering or in school at least 80 hours per month will still have to report their status every six months. Those who meet the exemptions can check with the portal to see if they’re automatically enrolled.
