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. The waiver aims to implement community engagement and work requirements as eligibility conditions for the Granite Advantage Health Care Program. Before submission, the proposed waiver must be approved by the fiscal committee of the general court. Starting November 1, 2025, the department is also mandated to provide an annual report to key legislative leaders and the governor regarding the waiver application and the implementation of community engagement requirements.

While the bill does not allocate funding or authorize new positions, it outlines potential costs associated with implementing the community engagement work requirements, including system upgrades and personnel expenses. The Department anticipates significant expenditures, estimating around $8.8 million in total funds for FY 2026, with ongoing costs in subsequent years. The bill introduces new community engagement requirements for approximately 44,310 Medicaid beneficiaries, with an estimated 20,000 non-medically frail Granite Advantage members potentially losing coverage. This could lead to an annual expenditure reduction of about $171,040,800, although any savings may be offset if these individuals transition to other Medicaid eligibility groups, which would incur higher costs for the state. The Department has raised concerns about the feasibility of the timeline for resubmission due to the need for federal guidance and public hearings.