Ayotte’s opponents on the campaign trail take aim at her Medicaid record

As Gov. Kelly Ayotte seeks to fend off challengers in her reelection bid, her top Democratic challenger, Cinde Warmington, has sought to make Medicaid — and the several changes to the program Ayotte forced through the Legislature in 2025 — a key issue of the race.

Warmington, a former executive councilor from Concord, and Jon Kiper, a Newmarket progressive running as an independent, both hope to make Ayotte a one-term governor.

“Gov. Kelly Ayotte has not only made these devastating cuts of her own, but she has stood silent to the cuts that the Trump administration has made,” Warmington said at a campaign event in Canaan last month, “which, by the way, we haven’t begun to see the impact of.”

Medicaid serves as the nation’s public health coverage program for those with low incomes and disabilities. It’s operated and funded jointly by the state and federal governments, which means it’s shaped by elected officials in both Concord and Washington.

“I’m very committed to ensuring that our Medicaid program remains strong,” Ayotte told a Bulletin reporter in her office this month. “I meet with the commissioner of Health and Human Services every single week, and we talk about these issues. So my plan is to continue to make sure we have strong eligibility, and as we look at the Medicaid program, making sure any changes that would be implemented are done in a way that helps support people in their coverage, especially children as a priority.”

Ayotte unveiled her spending plan in the early months of her governorship. Among the most impactful provisions were changes to Medicaid designed to save money in a tight budget year. Those changes were all approved by the GOP-controlled Legislature and signed into law by Ayotte in June 2025.

First, Ayotte proposed a premium system. Some New Hampshire Medicaid enrollees — those who earn 100% of the poverty line or more — will soon be required to pay a fee to receive coverage. In Ayotte’s original plan, that fee would have been capped at 5% of a family’s household income. This has been continually lambasted by Democrats as an “income tax on the poor.” Republicans in the Legislature ultimately amended the plan from a percentage of a household’s income to a flat fee varying by family size and income bracket.

The Department of Health and Human Services is set to begin collecting these fees in July. Based on the new law and 2026’s federal poverty level standards, here’s what people are set to pay: 

• A household of one person earning $15,950 a year — 100% of the poverty level, per 2026’s federal standards — is set to pay $60 a month to keep their coverage under the new system.
• A family of two people earning $21,640 is set to pay $80 a month
• A family of three earning $27,320 a year is set to pay $90 a month.
• A family of four earning $33,000 a year is set to pay $100 a month.
• A family of five earning $38,680 a year is set to pay $100 a month.
• A family of two earning $55,182 a year — 255% of the poverty level — is set to pay $190 a month.
• A family of three earning $69,666 is set to pay $230 a month.
• A family of four earning $84,150 is set to pay $270 a month.
• A family of five earning $98,634 is set to pay $270 a month.

Ayotte has defended this plan by pointing out the state already has one of the most permissive eligibility guidelines.

“New Hampshire has some of the highest eligibility in New England and throughout the nation when it comes to Medicaid, and especially with respect to covering children,” Ayotte said. “And so I wanted to make sure in this budget that we protected that eligibility, that there was absolutely no diminishment in that eligibility. And so we’ve done that.”

Indeed, as of January 2026, New Hampshire is tied with Connecticut for the fourth most expansive Medicaid eligibility limit for children in the country, according to the health nonprofit Kaiser Family Foundation. New Hampshire children whose families make up to 323% of the federal poverty line can access Medicaid.

Second, Ayotte proposed increasing pharmacy copays, the share of the price of prescription drugs that Medicaid enrollees are responsible for, from $1 or $2 to $4 per prescription (unless that exceeds 5% of household income).

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Warmington said that if she’s elected governor in November, reversing these changes will be “a top priority.” She promised that her budget proposal will include the reversals.

Asked how she might accomplish the goal if one or both chambers remain in control of Republicans, Warmington cited her experience being the only Democrat on the Executive Council from 2021 to 2025.

“I think we’re going to win across the board,” she said. “But I have a long record of knowing when to stand my ground and when to find the common ground, and I think the key to that is listening.”

Kiper, who previously ran as a Democrat before shifting to an independent campaign, believes the point of the premiums was to push people off Medicaid. He acknowledged the financial position Ayotte was in though.

“We don’t have enough money, and I don’t think that the approach to it is getting poor people to pay more for healthcare,” he said. “I would reverse that, but again, we need to fill that gap. So how are you gonna do it?”

Kiper proposed holding a series of forums around the state where officials can show residents options for new taxes and have them weigh in. Through that process, he hopes he can uncover a new funding mechanism. But Kiper also likes the idea of allowing people above the current eligibility to buy into Medicaid as well.

“And this is a little bit counter to or parallel, but I’ve always thought anyone should go to buy into Medicaid,” he said. “There’s been times where I was on Medicaid and I was going to the doctor, and I literally thought to myself, ‘I wouldn’t mind paying five bucks for this.’”

But Medicaid changes are coming from the feds, too. Republicans in Congress have significantly altered Medicaid nationwide through President Donald Trump’s signature legislative priority, the One Big Beautiful Bill Act.

The One Big Beautiful Bill Act is estimated to cut federal spending to Medicaid by roughly $991 billion nationwide over the next decade, per KFF. Its biggest provision comes in the form of work requirements. The One Big Beautiful Bill Act also imposed a work requirement on the program, mandating that enrollees work 80 hours per month to receive coverage.

At the time, Ayotte told the Bulletin, “I disagree with federal reductions to SNAP and Medicaid benefits and will work closely with DHHS to protect our most vulnerable citizens.”

To Democrats, who have sought to connect Ayotte and Trump in the minds of voters, this wasn’t enough.

“You actually have to speak out and say this is hurting the people of our state, and that motivates people around the state to enable them to stand up as well,” Warmington said. “All of the electeds in the state need to be hearing from the people of our state that this is unacceptable, and they’re not hearing that from the top, so there’s no leadership on that issue.”

The primary election will be held on Sept. 8, but with Kiper running as an independent, neither Ayotte nor Warmington have a declared opponent in the primary. The general election is Nov. 3.