New Medicaid Work Rules Could Leave Tens of Thousands in New Hampshire at Risk, Report Says

Advocates also warn that the effects could spread beyond Medicaid enrollees.

Health officials and advocates in New Hampshire are bracing for a major shift in Medicaid coverage next year, after a new report projected that about 29,000 residents could lose benefits under tougher work verification rules. State leaders, however, contend the estimate overstates the likely impact.

The changes are tied to the 2025 federal spending law, the One Big Beautiful Bill Act, which requires certain adults to show at least 80 hours a month of work, schooling, community service or another approved activity unless they qualify for an exemption. In New Hampshire, the rules are expected to be stricter than the federal baseline because the state will require proof every three months instead of every six and will demand documentation rather than relying on self-reporting.

According to the New Hampshire Fiscal Policy Institute, those added steps could make it harder for eligible residents to keep coverage even if they are already meeting the activity requirements. Sam Burgess, who leads Healthcare Access and Affordability at New Futures, said the new system creates more administrative barriers and suggested the central issue is not willingness to work but the ability to document it.

Advocates also warn that the effects could spread beyond Medicaid enrollees. Kris McCracken, president and CEO of Amoskeag Health, said the added layers would turn a process that had been manageable into something far more complicated.

The report estimated that losing coverage for 23,000 to 29,000 people could strain health care providers, who must still treat patients even when they no longer have insurance. That, in turn, could force some clinics and hospitals to cut services or shift costs to patients and private insurers.

State officials dispute the report’s conclusions and say they are doing what they can to help residents stay enrolled if they remain eligible. New Hampshire Medicaid director Henry Lipman said the state is still holding informational sessions about the possible changes and that the first affected enrollees would not see disruptions until as early as March.

Advocates note that New Hampshire tried a similar approach in 2019, but a federal judge blocked it before it took effect.