New Hampshire lawmakers work to hash out specifics on Medicaid work requirements

New Hampshire Medicaid Director Henry Lipman speaks to state lawmakers during Wednesday’s House Health and Human Services Committee meeting. (Photo by William Skipworth/New Hampshire Bulletin)

Some Republicans in New Hampshire want the state’s Medicaid work requirements to go further than the requirements being implemented nationwide.

In an effort led by Rep. Jim Kofalt, of Wilton, Republicans want to ban self-attestation as an option for determining eligibility under the new work requirements, which means Medicaid enrollees would need to provide quarterly documentary proof of employment rather than attesting to their work status.

Medicaid is the nation’s public health care program, run jointly by the state and federal governments, for people with low income and unique needs. Congress mandated work requirements for the program when it passed the One Big Beautiful Bill Act, President Donald Trump’s signature legislative priority in his second term, in July. Under the new law, Medicaid enrollees must work 80 hours per month in order to receive coverage.

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Meanwhile, state-level Republicans also passed Medicaid work requirements as part of the new state budget.

Kofalt proposed an amendment to the new state law that would not only ban self-attestation but require Medicaid enrollees to work three continuous months before they can receive coverage. However, New Hampshire Medicaid Director Henry Lipman and other Medicaid officials said during a House Health and Human Services Committee meeting Wednesday that Kofalt had agreed to rework the amendment without that three-month look-back.

The work requirements will apply only to Medicaid enrollees in the Granite Advantage program, also known as Medicaid expansion, which covers the highest income groups eligible for Medicaid. The work requirements provide exceptions for “medical frailty” and “special needs” as “medically certified by a statement” from a medical professional.

Lawmakers will seek to avoid mistakes the state made last time it tried to implement Medicaid work requirements. In 2018, the state mandated that Medicaid enrollees work 100 hours a month to receive coverage. About one month after the effective date of the rule, the state reversed course and then-Gov. Chris Sununu paused the requirements. Only 8,000 of the 25,000 people subject to the requirement had complied and documented their hours. The rest were set to lose coverage before Sununu intervened. Leading up to the reversal, the state had spent over $130,000 in outreach efforts to teach people what the requirements were and how to complete the paperwork to prove they were working.