With major federal policy updates taking effect, New Hampshire health officials are bracing for sweeping changes to the Granite Advantage Health Care Program. State projections indicate that approximately 6,300 residents could lose their Medicaid coverage by March 2027 as new work and community engagement mandates take effect.
The upcoming policy shift stems from federal legislation (HR 1) and requires affected adult beneficiaries to meet specific activity quotas to keep their benefits.
Who Is Affected?
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The new rules apply to non-exempt Granite Advantage members between the ages of 19 and 64. However, the rollout timeline differs depending on enrollment status:
Current Members: Work requirements and 6-month redeterminations will begin at each member’s first scheduled redetermination date in 2027.
New Applicants: For individuals applying on or after January 1, 2027, requirements are effective immediately, meaning applicants must demonstrate compliance during the month prior to application.
Requirements and Approved Activities
Unless an exemption applies, covered individuals must complete a minimum of 80 hours per month of qualifying activities. Approved community engagement includes:
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Paid or unpaid employment, or work exchanged for goods and services
Community service
Participation in approved workforce training programs
Enrollment in school or career and technical education on at least a half-time basis
Alternatively, members can satisfy the mandate through an income threshold, requiring gross earnings of at least $580 per month—calculated based on 80 hours multiplied by the federal minimum wage of $7.25. For seasonal workers, eligibility can be determined using a six-month monthly average.
Exemptions
State guidelines outline several key exemptions for individuals who are not required to meet the 80-hour threshold. Exempt groups include:
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Individuals younger than 19 or older than 64
Pregnant individuals or those who have been pregnant within the past 12 months
Parents, guardians, or caretakers of a dependent child aged 13 or younger, or caretakers of a person with a disability
Former foster youth under the age of 26
Veterans with a “total” disability rating
Individuals classified as medically frail—including those with blindness, qualifying disabilities, substance use disorders, severe mental health conditions, or complex medical needs
Medicare Part A or Part B beneficiaries
Next Steps for Beneficiaries
As the Department of Health and Human Services (DHHS) awaits final federal guidance, state officials advise beneficiaries to keep their contact details updated, respond promptly to official notices, and utilize online portals like NH EASY to monitor status updates and track upcoming redetermination deadlines.
Here are the official resource links for the data and policy information regarding the New Hampshire Granite Advantage Health Care Program changes:
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New Hampshire Department of Health and Human Services (DHHS): View the official guidance and program details on the Medicaid Work Requirements: What You Need to Know portal.
DHHS FAQs & Implementation Documents: Review the detailed breakdown of rules, timelines, and exemptions in the 2026 NH Medicaid Eligibility Work Requirements FAQs and the official Medicaid Work Requirements & Renewal Changes Overview.
Federal Medicaid Resources: Check out federal summary information on the Medicaid.gov Granite Advantage Health Care Program Eligibility Changes page.