Thousands of Granite Staters face changes to their health care coverage as state and federal mandates set sweeping work and community engagement rules.

Jul 21, 2026

New rules will impact Medicaid enrollees, effective Jan. 1, 2027. The changes —detailed in a public educational toolkit released by disability advocacy organization ABLE NH—will require many low-income adults enrolled in the Granite Advantage Health Care Program to complete 80 hours per month of qualifying activities or secure an explicit exemption to maintain their coverage.

Policy experts, state officials, and grassroots advocates are urging beneficiaries and healthcare providers to prepare well before the mandate takes effect. ABLE NH

Understanding the Mandate

The impending rules target working-age adults between the ages of 19 and 64 who receive coverage under New Hampshire’s Affordable Care Act (ACA) expansion program, Granite Advantage.

To remain eligible, enrollees who are not exempt must document roughly 20 hours per week (80 hours per month) across a range of approved activities, including:

Employment & Self-Employment: Paid work or wage-earning efforts.
Education: Attending high school, higher education, or vocational training at least half-time.
Community Engagement: Volunteer work or structured community service.
Workforce Development: Participation in job training programs or state workforce development initiatives.

Enrollees can blend multiple activities—such as combining part-time work with volunteer hours or job training—to meet the 80-hour monthly threshold.

Who Is Exempt?

A central focus of the state’s outreach campaign is ensuring that residents who qualify for exemptions understand how to claim them. The work requirements generally do not apply to individuals receiving Medicaid due to a formal disability, Supplemental Security Income (SSI), or a disability waiver.

Additionally, enrollees may qualify for an exemption if they meet specific criteria, including:

Being under 19 or age 65 and older.
Serving as the primary caregiver for a child under 14 or a person with a disability.
Participating in active substance use treatment or rehabilitation.
Meeting the state's criteria for being medically frail.

The "medically frail" category encompasses individuals with serious physical, intellectual, developmental, or mental health conditions. However, advocates caution that qualifying for an exemption is not automatically granted; many beneficiaries will need to proactively submit medical documentation or self-attestation paperwork to the New Hampshire Department of Health and Human Services (DHHS).

How Stakeholders Can Prepare

With implementation set for early 2027, disability advocates and state officials emphasize several practical steps for enrollees, healthcare providers, and policymakers.

For Medicaid Enrollees

Verify Coverage: Check plan cards, log into NH EASY, or contact a service coordinator to confirm whether your coverage falls under Granite Advantage or traditional disability Medicaid.
Update Contact Details: Ensure your current mailing address, phone number, and email are on file with DHHS to avoid missing critical notices.
Build a Paper Trail: Maintain organized copies of pay stubs, volunteer logs, school schedules, training certificates, and medical records to verify qualifying hours or substantiate exemption claims.

For Providers and Advocates

Document Health Status: Healthcare providers are encouraged to assist patients by maintaining clear records of evaluations and medical conditions that could support a medically frail designation.
Engage in Advocacy: Disability organizations like ABLE NH are urging state lawmakers to adopt a broad, flexible list of medically frail conditions, maintain self-attestation options, and allow adequate time for paperwork submission to prevent eligible Granite Staters from losing coverage due to administrative hurdles.

For further details on eligibility and upcoming administrative guidance, enrollees and providers can visit the New Hampshire DHHS Stay Covered NH Portal.