This bill requires the New Hampshire Department of Health and Human Services to resubmit a Section 1115 demonstration waiver to the Centers for Medicare and Medicaid Services (CMS) by January 1, 2026, focusing on community engagement and work requirements for eligibility in the Granite Advantage Health Care Program. The proposed waiver must receive approval from the fiscal committee of the general court before submission. Starting November 1, 2025, the department is also mandated to provide annual reports to key legislative leaders and the governor regarding the waiver application and the implementation of community engagement requirements. The bill introduces new legal language to facilitate these processes while indicating that no new funding or positions will be allocated for this initiative.

The bill outlines potential costs associated with implementing the work requirements, estimating annual expenses between $7.7 million and $8.8 million for the first three fiscal years, with a significant portion expected to be funded by federal sources. It is projected that up to 20,000 non-medically frail individuals may lose their Medicaid coverage due to the new requirements, which could lead to cost savings for the state but also potential increased expenditures if these individuals transition to other Medicaid eligibility groups. The Department has raised concerns about the feasibility of the bill's implementation due to resource limitations and uncertainties regarding federal guidelines. Overall, the bill aims to enhance community engagement among Medicaid beneficiaries while addressing the associated administrative and financial challenges.