New Hampshire is entering one of the most consequential years for Medicaid in recent history. From Berlin to Nashua and everywhere in between, Granite State families are feeling the strain of rising health care costs, and Medicaid is often their only pathway to access the care they need. Yet a new wave of state and federal policy changes threatens to push thousands of Granite Staters off their health insurance.

Without action, an estimated 18,000 Granite Staters enrolled in the Granite Advantage Health Care Program — New Hampshire’s Medicaid Expansion — will face new requirements that make it harder to stay covered and access critical primary, preventative and behavioral health services, among others:

  • Granite Advantage enrollees with incomes at or above 100% FPL ($15,960 for a single person and $27,320 for a family of three) will face higher prescription costs and new monthly premiums.
  • Most Granite Advantage adults ages 19–64 will be required to meet work requirements of at least 80 hours per month.
  • Granite Advantage enrollees will face twice‑a‑year eligibility checks, instead of annual renewals, creating new administrative hurdles that can lead to coverage loss.
  • Retroactive coverage will be reduced – from 90 to 30 days for Granite Advantage enrollees, and 90 to 60 days for other Medicaid enrollees.

These changes come just as thousands of families have lost their enhanced ACA premium tax credits, which expired at the end of 2025. Marketplace premiums have risen sharply, leaving many low‑ and moderate‑income households with no affordable coverage option.

As members of the NH Medicaid Matters Coalition — more than 80 health care providers, advocates, and community organizations — we work directly with patients affected by these decisions. Communities deserve clear, accessible information about what is changing, why, and what families can do to protect their coverage.

That is why our coalition is planning a series of local discussions, which started last week in Derry. In nearly every county, more than 10% of residents rely on Medicaid. Granite Advantage enrollees live in all 10 counties. Every elected official represents constituents who will feel these changes.

Over the next 12 months, our Coalition will host these Community Conversations in every corner of our state. We will bring together local families, health care providers, and other stakeholders to discuss the coming changes and the impacts they will have on the health and well-being of our state, our families, and our communities. 

Each of these sessions is open to the public and will feature brief presentations followed by an open Q&A, with most of the time dedicated to hearing directly from attendees. They will be livestreamed, and snacks and childcare will be provided when possible. Local providers will be available for one‑on‑one conversations. These events are open to all members of the public who want to listen, learn, and ask questions – register here.

To so many Granite Staters, Medicaid is more than a policy matter: It’s what makes the difference between getting critical health care and going without. The program is also a primary economic driver, delivering hundreds of millions of dollars to our state each year. Yet, with the changes coming to Medicaid, New Hampshire could be in line to lose more than a billion dollars in federal Medicaid funding over the next decade.

As these critical changes unfold, every Granite Stater deserves the information they need to stay healthy.

Visit nhneedsmedicaid.com and our Facebook page to learn more and get involved.

Emily Lawrence is director of advocacy for Waypoint. She lives in Derry, N.H. Kristine E. Stoddard, is senior director of NH public policy for Bi-State Primary Care Association, which serves Vermont and New Hampshire. She lives in Bow, N.H.