When do Medicaid work requirements start in New Hampshire?

Federal work requirements for Granite Advantage, New Hampshire's Medicaid expansion program, begin in January 2027. Adults 19 to 64 must document 80 hours a month of work or other qualifying activity unless exempt, and New Hampshire will check compliance at least every three months.

Who is exempt from New Hampshire's Medicaid work requirement?

Federal law exempts groups including people who are medically frail or have a disability meeting certain definitions, parents or guardians of a child under 14 or of a child with a disability, some caregivers of people with disabilities, and pregnant or postpartum people. In New Hampshire, a medical frailty exemption requires a statement from a medical provider, and the state may use existing records to keep exempt people enrolled automatically.

New Hampshire: up to 29,000 may lose Medicaid by 2028

Up to 29,000 New Hampshire adults could lose Medicaid by 2028 under work rules starting January 2027, a think tank said Oct. 20, 2026. The state will require documents, not self-attestation, and checks every quarter.

policy · new-hampshire · medicaid · work-requirements · eligibility · medical-frailty

AlexiusHoratius, Wikimedia Commons, CC BY-SA 3.0

Direct Support News desk · October 20, 2026 · Updated October 21, 2026 · 1 min read

New Hampshire could have 23,000 to 29,000 fewer adults in Granite Advantage, its Medicaid expansion program, by 2028 once federal work requirements start in January 2027, according to an issue brief the New Hampshire Fiscal Policy Institute (NHFPI) released Oct. 20, 2026. The Concord Monitor reported the findings.

The brief, by senior policy analyst Jessica Williams, uses Urban Institute estimates of 14,000 to 29,000 coverage losses and says New Hampshire's choices put it toward the upper end. Under a 2026 state law, Granite Advantage adults must:

show documents proving they meet the requirement, rather than attesting, which federal law allows in the first year;
prove compliance at least quarterly, not every six months (NHFPI says only Indiana had also planned quarterly checks as of March 2026);
get a provider's statement to claim the medically frail exemption.

People who fall short get a 30-day grace period before the state may disenroll them. The state must send CMS its implementation plan by Dec. 1, 2026. Almost 48,000 people were enrolled in Granite Advantage at the end of September, the Monitor reported, citing state data.

Why this matters for providers and DSPs

Federal rules exempt people with disabilities who meet certain definitions and some family caregivers, but proving an exemption takes paperwork. Direct support professionals whose wages leave them eligible for Granite Advantage will need documented work hours every quarter to keep coverage. Agencies can help by making pay stubs and hour records easy to get. See which states won't accept self-attestation of medical frailty.

Common questions

When do Medicaid work requirements start in New Hampshire?: Federal work requirements for Granite Advantage, New Hampshire's Medicaid expansion program, begin in January 2027. Adults 19 to 64 must document 80 hours a month of work or other qualifying activity unless exempt, and New Hampshire will check compliance at least every three months.
Who is exempt from New Hampshire's Medicaid work requirement?: Federal law exempts groups including people who are medically frail or have a disability meeting certain definitions, parents or guardians of a child under 14 or of a child with a disability, some caregivers of people with disabilities, and pregnant or postpartum people. In New Hampshire, a medical frailty exemption requires a statement from a medical provider, and the state may use existing records to keep exempt people enrolled automatically.

New Hampshire: up to 29,000 may lose Medicaid by 2028

Why this matters for providers and DSPs

Common questions

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