Breaking Down the Medicaid Changes in H.R. 1 (the One Big Beautiful Bill Act)
On July 4, President Trump signed H.R. 1 (known as the One Big Beautiful Bill Act) into law, which will cut federal Medicaid spending by nearly $1 trillion over the next 10 years and reshape Medicaid programs nationwide. In New Hampshire, Medicaid provides health insurance coverage to over 187,000 of our residents—including children, pregnant women, people with disabilities, veterans, and older adults in nursing homes. Children represent the largest enrollment group, accounting for nearly half of all Medicaid recipients.
H.R. 1 requires states to enact work requirements, more frequent redeterminations, reductions in state provider taxes, and other harmful provisions. These federal changes come at the same time that New Hampshire has passed state-level Medicaid changes in its 2026-27 State Budget, including work requirements, premiums, and increased cost-sharing for some recipients. Together, these policy changes will impact thousands of Granite State individuals and families currently enrolled in Medicaid and CHIP (Children's Health Insurance Program).
"New Futures is alarmed by the cuts and changes to Medicaid included in H.R. 1 that was recently passed into law. The changes will not only put financial strains on working families in New Hampshire, but will leave many without necessary health care,” said Michele Merritt, President of New Futures. “These harmful cuts come at a time when Granite Staters are already rationing prescription drugs or foregoing health care altogether due to rising costs. We further emphasize that these measures will harm families, children, working individuals, veterans, people with disabilities, pregnant women, and others who depend on Medicaid for their basic health care. The stakes could not be higher."
While changes to Medicaid are coming, your coverage remains the same for now. The changes have not yet taken effect but will be implemented on specific dates in the coming months and years.
Key Changes Coming to New Hampshire Medicaid
Federal Changes - H.R. 1 (One Big Beautiful Bill Act)
Medicaid Work Requirements
The federal H.R. 1 legislation includes burdensome work requirements for Medicaid recipients, creating unnecessary barriers to health insurance and putting thousands of low-wage Granite Staters at risk of losing their coverage. New Hampshire's 2026-27 State Budget has also included work requirements for the Granite Advantage Health Care Program (also known as Medicaid expansion). New Hampshire is still finalizing the requirements and exemptions, so work requirements will not go into effect immediately.
Effective Date: To be determined
More Frequent Eligibility Redeterminations
Under current law, Medicaid enrollees must renew their eligibility and prove they still qualify for the program once a year. Starting at the end of 2026, adults who are enrolled in the Granite Advantage Health Care Program (or Medicaid expansion) will need to do these eligibility checks and paperwork every six months. This increased frequency creates more opportunities for eligible Granite State adults to lose coverage due to paperwork errors or missed deadlines, potentially leaving them without health insurance despite still qualifying for the program.
Effective Date: For renewals starting on or after December 31, 2026
Reduced Retroactive Coverage
Currently, when you apply for Medicaid, it can help pay for medical bills you had up to 90 days before you applied. Starting in 2027, this will be reduced to just one month for adults enrolled in the Granite Advantage Health Care Program (Medicaid expansion), and two months people in traditional Medicaid programs. This change will leave Granite State families on the hook for more medical debt and create additional financial hardship for those who were already struggling to access care.
Effective Date: January 1, 2027
Provider Tax Reductions
Provider taxes are a tax that health care providers pay to help fund Medicaid. These taxes will be lowered incrementally from 6% to 3.5% by 2032, significantly cutting state funding for Medicaid programs. While this may benefit some providers, it creates a funding crisis for New Hampshire's Medicaid system by removing millions of dollars in revenue. This reduction threatens the sustainability of the program and could force cuts to provider reimbursement rates, reduce available services, or shift more costs to enrollees – ultimately making health care less accessible in New Hampshire.
Effective Date: Immediately, but states have three fiscal years to transition
State Changes - New Hampshire 2026-27 State Budget
Medicaid Premiums and Cost-Sharing
Along with the federal changes to Medicaid, New Hampshire's State Legislature also implemented changes to the program in the 2026-27 State Budget. The final state budget shifts more costs to Medicaid enrollees and families by implementing premiums and increasing co-pays for some families and individuals covered by Medicaid expansion and the Children's Health Insurance Program (CHIP).
For a family of three making $68,000 per year, the monthly premium will be $230 each month, with $4 co-pays per prescription. These provisions create additional financial burdens and barriers to care that may prevent Granite State kids and adults from accessing essential health care coverage.
Effective Date: July 1, 2026
What This Means for New Hampshire
These combined federal and state policy changes represent a significant shift in how Medicaid operates in New Hampshire and across the country, creating new barriers to health care access for our residents.
The health care safety net that has protected New Hampshire families for years will be significantly weakened, creating a cascade of negative effects throughout our state's health care system and economy. This could lead to increased health care costs for everyone, emergency room overcrowding, worsened health outcomes, and broader economic impacts on the state as a whole.
New Futures remains committed to protecting access to health care for all Granite Staters and will continue to monitor the implementation of these changes while advocating for policies that ensure everyone has access to quality, affordable health care.
The NH Medicaid Matters coalition will provide more information, updates, and ways you can get involved at NHNeedsMedicaid.com.
