Lacking federal approval, New Hampshire forced to hold off on new Medicaid premiums

New Hampshire is delaying implementation of its premium system for Medicaid as it awaits federal approval to move forward.

“The situation is status quo,” Jake Leon, spokesperson for the Department of Health and Human Services, said in an email to the Bulletin. “Medicaid premiums have not been implemented. Still waiting on federal guidance on the impact of HR1 (the One Big Beautiful Bill Act).”

The premiums were expected to go into effect July 1, but DHHS has not offered a new timeline for when it will start charging the premiums.

In order to implement the charges, the state needs approval from the U.S. Centers for Medicare and Medicaid Services because the program is run jointly by states and the federal government.

However, as the Bulletin first reported in January, DHHS officials have been concerned the premium system may conflict with a new federal law. Roughly a week after Gov. Kelly Ayotte signed New Hampshire’s premium system into law in June 2025, President Donald Trump signed H.R. 1 — commonly known as the One Big Beautiful Bill Act.

The federal legislation institutes a cost-sharing program for some Medicaid enrollees in all 50 states. That cost sharing will require enrollees to pay a maximum of $35 per service for most services.

Olivia May, New Hampshire’s director of Medicaid enterprise management, told the Bulletin at the time, “I think there’s open questions about whether you can have both” state premiums and federal cost sharing. Leon said Thursday that DHHS is still waiting on the federal government to answer that question. Some have argued that the premiums won’t be illegal until October 2028 when the federal cost sharing goes into effect. 

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Democrats, who have opposed the premiums since their inception, used the potential legal conflict as fresh justification for halting the plan.

“Last spring, the budget enacted premiums for Medicaid before we knew what Congress was going to do,” Nashua state Sen. Cindy Rosenwald said at a legislative hearing earlier this year. “The sensible thing for us to do now is to change course and not waste money on a system we can only use for 18 months.”

The plan, if and when it is implemented, will require some enrollees to pay premiums in order to receive health coverage. The premiums are based on a family’s size and income:

• 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.

The plan to charge premiums emerged in early 2025. Ayotte first pitched it in her budget proposal as a means to balance the budget in a tough fiscal environment. GOP lawmakers approved the premiums with some tweaks, and Ayotte signed it into law in June 2025.

Democrats lambasted the plan as “an income tax on the poor.” Ayotte, on the other hand, has defended it by pointing out that many states — 22 as of 2026, according to KFF — don’t offer Medicaid at all to children whose households earn more than 255% of the federal poverty line and characterized this as a necessary step to protect generous eligibility standards.

The premiums are just one of several major changes coming to Medicaid in New Hampshire. At the same time, state lawmakers voted to increase prescription drug copays from $1 to $2 or $3. On the federal level, the One Big Beautiful Bill Act, made major changes to Medicaid nationwide. In addition to the aforementioned federal cost-sharing, the federal law creates work requirements for the program beginning next year.