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The Exchange

N.H. Medicaid Work Requirement Underway But Debate Continues

Sara Plourde For NHPR

New Hampshire has joined a handful of states that mandate some Medicaid recipients to engage in certain activities: for example, a job, school, or community services. But recent federal changes tightening certain aspects of the program, as well as proposed legislation, have renewed debate over the Granite State's approach. 


  • Jeb Bradley, Republican state senator from Wolfeboro. He serves on the Health and Human Services committee.
  • Dan Feltes, Democratic state senator and senate majority leader from Concord. 
  • Jason Moon, NHPR health reporter.
  • Mattie Quinn,  Health and human services reporter for Governing Magazine. 
Some Background:

New Hampshire has joined a handful of other states requiring certain Medicaid beneficiaries to fulfill a work requirement. In New Hampshire, that amounts to 100 hours of "community engagement," also known as a work requirement -- part of the state's five-year extension of its Medicaid expansion program, now called the Granite Advantage Health Care Program.  

Last May, New Hampshire received its first waiver from the Centers for Medicare and Medicaid Services, CMS, allowing the state to impose work requirements as part of a five-year extension of the program. New Hampshire's provisions are considered some of the strictest in the country. 

In December, CMS revised the state's work requirements, prompting concern among some lawmakers who called the changes onerous. In response, the Joint Legislative Committee on Administrative Rules unanimously rejected those revised rules.   

This month, a deal was reached on the new Medicaid work rules. But new legislation in the state senate, introduced by Sen. Cindy Rosenwald, has stirred up debate again. Among Rosenwald's proposed changes: If more than 500 people lose their benefits under the new plan, the work requirement would end. 

Although the work requirement is set to go into effect on March 1st,  a 75-day "on-ramp" period means people subject to the requirement won't actually have to submit their hours until June. 

Meanwhile, these requirements have met with difficulties in other states.  A federal court struck down work requirements last July, halting implementation of Kentucky's program.  In Arkansas, thousands lost health coverage -- attributed to the state's work requirements. 

Among the barriers workers could face in complying with work requirements, according to the Kaiser Family Foundation: 

30% of Medicaid adults report that they never use a computer, 28% do not use the internet, and 41% do not use email, which may pose a barrier to both gaining a job and complying with reporting requirements under state waivers. (See Implications of Work Requirements in Medicaid: What Does The Data Say?)

The Trump Administration has defended work requirements, denying charges that their goal is to expel people from the Medicaid program. 


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