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 an annual report to key legislative leaders and the governor regarding the waiver application and the implementation of community engagement requirements. The bill does not allocate funding or authorize new positions but outlines potential costs associated with implementing these requirements, including system upgrades and personnel expenses.

The legislation introduces new community engagement requirements for Medicaid beneficiaries, estimating that around 44,310 individuals will be subject to these requirements, while 14,903 will be exempt. The Department anticipates that approximately 20,000 non-medically frail Granite Advantage members may lose coverage, potentially reducing annual expenditures by about $171,040,800. However, this could lead to increased costs if these individuals transition to other Medicaid eligibility groups, necessitating a higher state general fund contribution. The bill emphasizes the challenges of implementation, particularly the need for federal criteria to be established before the waiver resubmission process can begin, and it highlights the lack of authority for new positions or appropriations to support the administration of these changes.