2026-223 IP Notice He-W 837

The New Hampshire Department of Health and Human Services has filed Notice Number 2026-223 proposing to readopt with amendment, repeal in part, and adopt new sections of He-W 837, the administrative rule governing the Granite Advantage Health Care Program, New Hampshire's adult Medicaid expansion under the ACA. The rulemaking is driven by Public Law 119-21, section 71119 (the "One Big Beautiful Bill Act"), which mandates that states implement community engagement requirements for adult expansion Medicaid groups effective January 1, 2027. The affected population is adults ages 19 to 64, not enrolled in Medicare, with income at or below 133% of the Federal Poverty Level. Proposed amendments to He-W 837.01 revise the definitions section by removing definitions for cure, dating violence, deficit hours, good cause, homeless, immediate family member, stalking, sexual assault, and voluntary, while updating definitions for community engagement requirement, disability, disenrollment, licensed medical professional, medically frail, noncompliant, and redetermination. New definitions are added for activities of daily living, applicable individual, caretaker relative, dependent child, eligibility period, exception, exclusion, exemption, family caregiver, specified excluded individual, and work requirements. The substantive rule sections are revised to align with the federal mandate. He-W 837.02 is updated to reflect the community engagement requirement as specified in P.L. 119-21, section 71119. He-W 837.03 is updated to include current allowable exemptions, specifically the short-term hardship exceptions under 42 CFR 435.55, which New Hampshire has opted to allow. He-W 837.05 removes activities no longer allowable and adds current qualifying community engagement activities. He-W 837.06 is updated for current reporting and verification methods. Several sections are repealed or renumbered. Previous He-W 837.07 through 837.13 are repealed as inapplicable to the current federal requirements. New He-W 837.07 addresses retroactive eligibility under 42 CFR 435.556(b) and 42 U.S.C. 1396a(a)(34). New He-W 837.08 addresses non-compliance requirements under 42 CFR 435.558. Former He-W 837.14 is renumbered 837.09 and updated to include the 90-day reconsideration period timeline for verifying compliance at renewal. The fiscal impact statement characterizes the cost effect on state expenditures as indeterminable, noting a federal grant has been received to fund system changes.