SB 506-FN - AS INTRODUCED
2026 SESSION
26-2102
05/08
SENATE BILL 506-FN
AN ACT relative to community engagement and work requirements under the state Medicaid program.
SPONSORS: Sen. Pearl, Dist 17; Sen. Gray, Dist 6; Sen. Innis, Dist 7; Sen. Sullivan, Dist 18; Sen. Avard, Dist 12; Sen. McGough, Dist 11; Sen. Gannon, Dist 23; Sen. Lang, Dist 2; Sen. Murphy, Dist 16; Sen. Abbas, Dist 22; Rep. Moffett, Merr. 4; Rep. W. MacDonald, Rock. 16
COMMITTEE: Health and Human Services
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ANALYSIS
This bill directs the department of health and human services to establish community engagement and work requirements under the New Hampshire granite advantage health care program, or the state's expanded Medicaid program, pursuant to authorization for such requirements established in the One Big Beautiful Bill Act of 2025, Public Law 119-21.
This bill is a request of the department of health and human services.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
26-2102
05/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty-Six
AN ACT relative to community engagement and work requirements under the state Medicaid program.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Hampshire Granite Advantage Health Care Program; Community Engagement and Work Requirements. Amend 2025, 141:412 to read as follows:
141:412 New Hampshire Granite Advantage Health Care Program, [1115 Demonstration; Renewed Application to CMS] Community Engagement and Work Requirements.
I. On or before[ January] December 1, 2026, or on an earlier date within 30 calendar days after publication of the federal application template, the department of health and human services shall [resubmit] submit to the Center for Medicare and Medicaid Services (CMS) [a Section 1115 demonstration waiver to the state Medicaid plan relative to enforcing] required documentation relative to implementing community engagement and work requirements as a condition of Granite Advantage eligibility in accordance with the One Big Beautiful Bill Act of 2025, Public Law 119-21, Section 71119 (2025). Prior to submitting the [Section 1115 waiver] required documentation to CMS, the department shall submit the proposed [waiver] plan to implement community engagement and work requirements to the fiscal committee of the general court for [approval] review.
II. Beginning November 1, 2025 and [annually] quarterly thereafter through December 31, 2026, and then annually thereafter, the department shall provide a report regarding the status of the [waiver application] plan under review by CMS and implementation of the community engagement and work requirements [in RSA 126-AA:2, III] eligibility in accordance with Public Law 119-21, Section 71119 (2025), to the senate president, the speaker of the house of representatives, the senate clerk, the house clerk, and the governor.
2 New Hampshire Granite Advantage Health Care Program Established; Community Engagement and Work Requirements; Suspended. The provisions of RSA 126-AA:2, directly related to the community engagement and work requirements, shall be suspended for the duration of the federal community engagement and work requirements under Public Law 119-21, Section 71119 (2025), as amended. If the federal community engagement and work requirements are subsequently eliminated, the commissioner of the department of health and human services shall immediately certify in writing the removal of the suspension to the director of the office of legislative services, the secretary of state, the senate president, the speaker of the house of representatives, the senate clerk, the house clerk, and the governor.
3 New Hampshire Granite Advantage Health Care Program Established. Amend RSA 126-AA:2, I(a) to read as follows:
I.(a) The commissioner shall apply for any necessary waivers and state plan amendments to implement [a 5-year demonstration program beginning on January 1, 2019 to create] and administer the New Hampshire granite advantage health care program which shall be funded exclusively from non-general fund sources, including federal funds. The commissioner shall include in an application for the necessary waivers submitted to the Centers for Medicare and Medicaid Services (CMS) a waiver of the requirement to provide 90-day retroactive coverage and a state plan amendment allowing state and county correctional facilities to conduct presumptive eligibility determinations for incarcerated inmates to the extent provided under federal law. To receive coverage under the program, those individuals in the new adult group who are eligible for benefits shall choose coverage offered by one of the managed care organizations (MCOs) awarded contracts as vendors under Medicaid managed care, pursuant to RSA 126-A:5, XIX(a). The program shall make coverage available in a cost-effective manner and shall provide cost transparency measures, and ensure that patients are utilizing the most appropriate level of care. Cost effectiveness shall be achieved by offering cash incentives and other forms of incentives to the insured by choosing preferred lower cost medical providers. Loss of incentives shall also be employed. MCOs shall employ reference-based pricing, cost transparency, and the use of incentives and loss of incentives to the Medicaid and newly eligible population. For the purposes of this subparagraph, "reference-based pricing" means setting a maximum amount payable for certain medical procedures.
4 Effective Date. This act shall take effect upon its passage.
26-2102
Revised 1/28/26
SB 506-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to community engagement and work requirements under the state Medicaid program.
FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
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Estimated State Impact | ||||||
| FY 2026 | FY 2027 | FY 2028 | FY 2029 | ||
Revenue | $0 | $0 | $0 | $0 | ||
Revenue Fund(s) | None | |||||
Expenditures* | $37,500 state; $1,017,892 federal | $62,500 state; $1,042,892 federal | $407,800 state; $250,000 federal | $407,800 state; $250,000 federal | ||
Funding Source(s) | General funds, federal funds, Granite Advantage Trust Fund | |||||
Appropriations* | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
*Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill | ||||||
METHODOLOGY:
This bill requires the Department of Health and Human Services to establish community engagement and work requirements under the Granite Advantage Health Care Program. The Department notes that the bill aligns state law with federal legislation, specifically HR 1, also known as the One Big Beautiful Bill Act and the Working Families Tax Cut. The federal legislation allows states to implement community engagement requirements through a state plan amendment, rather than through an 1115 waiver as previously required. The Department states that this approach is more flexible and less administratively burdensome than a waiver, and will be implemented more quickly. Finally, the Department notes that approximately $2.2 million in federal grant funding will be available for computer systems costs. The Department received $1.9 million in December 2025 and anticipates that another $200,000 to $300,000 will soon be available.
The table below depicts the Department's projected expenditures:
| FY26 | FY27 | FY28 | FY29 |
Systems Upgrades, Modifications and Maintenance | $980,392 | $980,392 | $200,000 | Indeterminable |
Memorandum of Understanding with New Hampshire Employment Security | $0 | $0 | $357,800 | $357,000 |
Community Outreach Efforts | $75,000 | $125,000 | $100,000 | $100,000 |
Total: | $1,055,392 | $1,105,392 | $657,800 | $457,000 |
State Share: | $37,500 | $62,500 | $407,800 | $407,800 |
Federal Share: | $1,017,892 | $1,042,892 | $250,000 | $250,000 |
AGENCIES CONTACTED:
Department of Health and Human Services
| Date | Body | Type |
|---|---|---|
| Jan. 21, 2026 | Senate | Hearing |
Jan. 12, 2026: Hearing: 01/21/2026, Room 100, SH, 01:00 pm; SC 2
Nov. 21, 2025: Introduced 01/07/2026 and Referred to Health and Human Services; SJ 1