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 .

I. On or before January 1, 2026, the department of health and human services shall resubmit to the Center for Medicare and Medicaid Services (CMS) a Section 1115 demonstration waiver to the state Medicaid plan relative to enforcing community engagement and work requirements as a condition of Granite Advantage eligibility . Prior to submitting the Section 1115 waiver to CMS, the department shall submit the proposed waiver to the fiscal committee of the general court for approval .

II. Beginning November 1, 2025 and annually thereafter , the department shall provide a report regarding the status of the waiver application and implementation of the community engagement requirements in RSA 126-AA:2, III , 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 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.

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 , Community Engagement and Work Requirements .

I. On or before 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 submit to the Center for Medicare and Medicaid Services (CMS) 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 required documentation to CMS, the department shall submit the proposed plan to implement community engagement and work requirements to the fiscal committee of the general court for review .

II. Beginning November 1, 2025 and quarterly thereafter through December 31, 2026, and then annually thereafter , the department shall provide a report regarding the status of the plan under review by CMS and implementation of the community engagement and work requirements 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 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.