New Hampshire's Medicaid expansion has not been repealed, but it is changing significantly in 2026 and 2027. The state's expansion program, called the Granite Advantage Health Care Program, still covers adults earning up to 138% of the federal poverty level (FPL). What has changed is how much some enrollees will pay out of pocket, what activities they may be required to document, and how often the state will review their eligibility. If you are enrolled in Granite Advantage, or if you are wondering whether you still qualify, here is what you need to know right now.
Is New Hampshire's Medicaid Expansion Being Repealed?
No. New Hampshire expanded Medicaid under the Affordable Care Act in 2014, and the expansion remains in place as of 2026. The Granite Advantage program continues to cover adults ages 19 to 64 with household incomes up to 138% FPL.
What has happened is that New Hampshire's Republican-controlled legislature passed a state budget in 2025 that added premiums and work requirements to the program. Governor Kelly Ayotte signed the budget into law in June 2025. Democrats attempted to reverse those changes in 2026 through Senate Bill 484, which would have repealed the premiums and capped cost-sharing at $5. The New Hampshire Senate rejected that bill 16 to 8 along party lines in 2026.
Separately, the federal "One Big Beautiful Bill Act" passed in 2025 added new nationwide requirements affecting all Medicaid expansion states, including New Hampshire, starting in 2027.
The bottom line: Granite Advantage still exists and still covers the same population. What is changing is the cost and the administrative requirements for staying enrolled.
What Is the Granite Advantage Program?
The Granite Advantage Health Care Program is New Hampshire's name for its Medicaid expansion population. It covers:
- Adults ages 19 to 64
- Household income at or below 138% of the federal poverty level
- New Hampshire residents who are U.S. citizens or qualified immigrants
As of April 2026, approximately 51,000 people were enrolled in Granite Advantage, out of roughly 171,000 total Medicaid and CHIP enrollees in New Hampshire. That number is down from about 60,900 enrolled in mid-2025, suggesting some enrollees have already lost coverage during ongoing eligibility reviews.
2026 Medicaid Income Limits in New Hampshire
The income limits below apply to the major Medicaid categories in New Hampshire. The Granite Advantage limits have not changed, but the premium structure has.
Granite Advantage (Medicaid Expansion) Income Limits
| Household Size | Monthly Income Limit (138% FPL) | Annual Income Limit |
|---|
| 1 | $1,732 | $20,783 |
| 2 | $2,343 | $28,116 |
| 3 | $2,954 | $35,449 |
| 4 | $3,566 | $42,782 |
Other NH Medicaid Categories
| Category | Income Limit |
|---|
| Children (up to age 18) | 323% FPL |
| Pregnant women | 201% FPL |
| Nursing Home / Long-Term Care (single applicant) | $2,982/month |
Children and pregnant women are not affected by the new premiums or work requirements. Those changes apply specifically to the Granite Advantage (expansion) population.
New Costs Starting July 1, 2026
Starting July 1, 2026, Granite Advantage enrollees with household income at or above 100% FPL will pay monthly premiums. The amount depends on household size and income level.
Monthly Premiums for Granite Advantage Enrollees
| Income Level | Monthly Premium (Household of 1) | Monthly Premium (Household of 3) |
|---|
| 100% to 138% FPL | $60 to $100 | ~$90 |
| 255% FPL and above | $190 to $270 | ~$233 |
Note: People with income below 100% FPL are not subject to premiums. This generally covers people between $0 and approximately $15,060 per year for a single person in 2026.
In addition to premiums, Granite Advantage enrollees at or above 100% FPL are now subject to a $4 per prescription cost-sharing requirement that is already in effect.
Starting October 1, 2028, further cost-sharing changes will take effect. The state plans to charge up to $35 per service, capped at 5% of annual household income, for those above 100% FPL. Primary care, prenatal care, mental health services, and emergency care will remain exempt from those charges.
Work Requirements: Timeline and Rules
New Hampshire's state budget requires the state to implement a work requirement for Granite Advantage enrollees by December 31, 2026. Here is what the state law specifies:
Who must comply: Adults ages 19 to 64 enrolled in Granite Advantage.
What counts: At least 100 hours per month of work, job training, education, community service, or other approved activities.
Who is exempt:
- Parents with dependent children
- Individuals with disabilities
- Pregnant or postpartum women
- Others meeting specific exemption criteria
New Hampshire attempted to implement a similar work requirement in 2018. That effort was suspended after the state found that roughly 17,000 enrollees stood to lose coverage because they failed to submit paperwork, not because they were actually ineligible. That history is relevant context for evaluating how the 2026 implementation will go.
Federal Work Requirements in 2027
The federal "One Big Beautiful Bill Act" (enacted 2025) adds work requirements for Medicaid expansion populations in all states starting in 2027. Under the federal rules:
- Enrollees must work, volunteer, attend school, or earn at least $580 per month
- This applies to adults ages 19 to 64 who are not otherwise exempt
- Exemptions mirror those in the state law above
Because New Hampshire's state requirement must be in place by the end of 2026 and the federal requirement kicks in in 2027, Granite Advantage enrollees will face both sets of requirements. The state rules are slightly stricter on hours (100 per month versus the federal threshold equivalent).
More Frequent Eligibility Reviews Starting 2027
Under both the New Hampshire state law and the federal rules, Granite Advantage enrollees will have their eligibility reviewed every six months starting in 2027, instead of once per year. This doubles the frequency of administrative contact enrollees must maintain to stay covered.
Missing a renewal form or failing to respond to a review can result in losing coverage, even for people who are still eligible. Enrollees should make sure their mailing address and contact information are up to date with NH EASY (the state's benefits portal) to avoid losing coverage due to a missed notice.
Who Is NOT Affected by These Changes
Not all Medicaid enrollees in New Hampshire are affected by the new premiums and work requirements. These groups are largely unaffected:
- Children under 19 enrolled in NH Medicaid or CHIP
- Pregnant women
- Elderly and disabled adults enrolled in traditional Medicaid (not Granite Advantage)
- Long-term care Medicaid recipients
- Granite Advantage enrollees with income below 100% FPL (no premiums, but work requirements still apply when implemented)
How to Apply for New Hampshire Medicaid in 2026
If you are not yet enrolled, here are the steps to apply for Granite Advantage or another NH Medicaid category.
Step 1: Check your eligibility. Use the Benefits Navigator screener at benefitsusa.org/screener to get a quick estimate of whether you qualify based on your income, household size, and state. You can also check the NH DHHS eligibility page.
Step 2: Gather your documents. You will need:
- Proof of identity (driver's license, passport, or other government ID)
- Proof of New Hampshire residency (utility bill, lease, or similar)
- Proof of income (pay stubs, tax returns, or employer letter)
- Social Security numbers for all household members applying
Step 3: Apply online through NH EASY. The NH EASY portal at nheasy.nh.gov lets you apply online for Medicaid, SNAP, child care assistance, and other programs in one place. You can create an account, submit your application, and track its status online.
Step 4: Apply by phone or in person. If you cannot apply online, call the NH DHHS Customer Service Center at 844-275-3447 (844-ASK-DHHS). You can also visit your local DHHS district office.
Step 5: Respond to any requests for additional information. After you submit your application, DHHS may ask for additional documentation. Responding quickly helps avoid delays.
Step 6: Receive your determination. Most applicants receive a decision within 45 days. If approved, you will be enrolled in a managed care plan. If denied, you have the right to appeal.
What to Do If You Are Already Enrolled
If you are already in Granite Advantage, here are the most important actions to take:
-
Update your contact information in NH EASY. With more frequent renewals starting in 2027, you need to receive every notice. Log in at nheasy.nh.gov and confirm your address, email, and phone number.
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Understand your premium obligation. If your income is at or above 100% FPL, you will owe a monthly premium starting July 1, 2026. Failing to pay premiums could lead to a lock-out period.
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Watch for work requirement notices. The state must notify enrollees before implementing work requirements. Watch for mail from DHHS explaining what you need to document.
-
Know your exemptions. If you have a disability, are a parent of dependent children, or are pregnant or postpartum, confirm that your exemption status is documented in your case file.
Resources and Support
- NH EASY (online benefits portal): nheasy.nh.gov
- NH DHHS Customer Service: 844-275-3447
- NH Medicaid Matters (advocacy and updates): nhneedsmedicaid.com
- New Futures (policy advocacy): new-futures.org
- Benefits Navigator screener: benefitsusa.org/screener
- NH state benefits overview: benefitsusa.org/states/nh
Frequently Asked Questions
Is New Hampshire Medicaid expansion being repealed in 2026?
No. Granite Advantage, New Hampshire's Medicaid expansion program, is not being repealed. It continues to cover adults ages 19 to 64 with incomes up to 138% FPL. What has changed are the premiums and administrative requirements attached to the program.
When do premiums start for Granite Advantage?
Premiums start July 1, 2026 for enrollees with household income at or above 100% FPL. The amount ranges from $60 to $100 per month depending on household size, with higher premiums for those above 255% FPL.
Do I have to work to keep my Medicaid in New Hampshire?
Work requirements for Granite Advantage enrollees are required to be implemented by December 31, 2026. Adults ages 19 to 64 must document at least 100 hours per month of work, training, education, or community service, with exemptions for parents, people with disabilities, and pregnant or postpartum individuals. Federal work requirements under the One Big Beautiful Bill also take effect in 2027.
What is the income limit for Granite Advantage in 2026?
The income limit is 138% of the federal poverty level. For a single person, that is approximately $1,732 per month or $20,783 per year in 2026. For a household of two, the limit is approximately $2,343 per month.
How do I apply for NH Medicaid?
Apply online through NH EASY at nheasy.nh.gov, by phone at 844-275-3447, or in person at a local DHHS district office. You will need proof of identity, residency, income, and Social Security numbers for everyone in your household applying for coverage.
Will I lose my Medicaid if I miss a renewal?
Possibly, yes. Starting in 2027, eligibility reviews shift from annual to every six months. Missing a renewal notice or failing to respond can result in losing coverage even if you are still eligible. Keep your contact information current in NH EASY to avoid this.
Are children and pregnant women affected by the new premiums and work requirements?
No. Premiums and work requirements apply specifically to Granite Advantage enrollees, which is the expansion population (adults 19 to 64). Children covered under NH Medicaid or CHIP, and pregnant women, are not subject to these new conditions.
What is the One Big Beautiful Bill and how does it affect New Hampshire Medicaid?
The One Big Beautiful Bill Act was federal legislation enacted in 2025 that added new requirements to Medicaid expansion programs nationwide. For New Hampshire, it means that starting in 2027, Granite Advantage enrollees must meet work or activity requirements (work, volunteer, attend school, or earn at least $580 per month) and will have their eligibility reviewed every six months instead of annually.
