NH Union Leader – June 16, 2025
By JAKE BERRY & KRISTINE STODDARD
AS THEY wrap up their work on the 2026-27 state budget, New Hampshire lawmakers still have time to protect children, families, working individuals, veterans, people with disabilities, pregnant women, and others who depend on Medicaid for their basic health care. For hundreds of thousands of Granite State individuals and families, Medicaid is a lifeline, ensuring access to care when they need it most. Currently, 12.5 percent of Granite Staters are covered by Medicaid, including 25 percent of children; 25 percent of people with disabilities; 10 percent of veterans and 68 percent of people in nursing homes.
Still, as part of their budget deliberations, legislators are considering implementing work requirements and cost-sharing provisions that could force tens of thousands of Medicaid recipients, specifically those in New Hampshire’s Medicaid Expansion (also known as Granite Advantage) and the Children’s Health Insurance Program (CHIP), to lose insurance coverage. On behalf of New Hampshire’s Medicaid Matters Coalition (NHNeedsMedicaid.com), which includes more than 70 health care, social service and community organizations from across the state, we ask that legislators remove these harmful pieces from the budget and preserve Medicaid coverage for our friends and neighbors who need it.
Speaking first to cost-shares, implementing premiums and increased pharmacy co-pays — as proposed in the Legislature’s budget — will force individuals and families enrolled in Granite Advantage and CHIP to make impossible choices between paying for their housing, food or health care. For example, current budget proposals from both the House and Senate would require adults enrolled in Granite Advantage with annual incomes between 100 and 138 percent of the federal poverty guideline (between $15,650 and $21,597) to pay premiums of up to five percent of their annual income. For these low-wage earners, even premiums capped at five percent of annual income, as currently proposed, would add up to $1,079 in yearly expenses — a considerable amount for people struggling to get by.
Implementing work requirements, also proposed within the N.H. Senate’s budget proposal, would similarly burden vulnerable Granite Staters and undermine the impact of New Hampshire’s Medicaid program, creating administrative and legal barriers that will force thousands to lose their health insurance coverage. Studies have consistently shown that work requirements are ineffective at increasing employment. They lead to significant drops in Medicaid enrollment, lost insurance coverage for vulnerable patients, and high uncompensated care for health care providers.
Further, they have created unintended financial consequences for states administering the requirements. New Hampshire experienced this firsthand in 2019 when our attempt to implement work requirements put more than half the eligible population in line to lose coverage, while costing the state more than $4 million in related administrative costs. Recent projections from the N.H. Department of Health and Human Services show work requirements would similarly cost the state between $3 million and $4.5 million per year, putting health coverage at risk for as many as 20,000 people.
As demonstrated in other states, these coverage losses caused by work requirements will likely result in thousands of people forgoing preventative care, rationing or going without needed prescriptions, or delaying other needed medical care. From a provider perspective, they would impose additional administrative burdens and increase uncompensated costs for an already strained system. This could ultimately lead to reductions in essential services, further compromising access to care for all Granite State patients.
The data is clear — cost-sharing and work requirements don’t work. These provisions will leave Granite Staters without health care, will cost millions for the state to administer, and any net savings from disenrollment will ultimately be borne by taxpayers.It is not too late for legislators to do the right thing and remove these financial burdens from the budget. The health and well-being of our state and its people depend on it.
Jake Berry, of Manchester, is vice president of policy at New Futures. Kristine Stoddard, of Bow, is senior director of New Hampshire public policy at Bi-State Primary Care Association.