This bill amends the New Hampshire Granite Advantage Health Care Program by introducing community engagement and work requirements for individuals eligible for Medicaid, in alignment with federal law (Public Law 119-21, Section 71119). It adds new definitions for "applicable individuals" and "work requirements" to RSA 126-AA, requiring individuals to demonstrate compliance with these work requirements for the month prior to their Medicaid application. The Department of Health and Human Services (DHHS) is responsible for verifying compliance through documentary evidence provided quarterly, with self-attestation not being accepted. Exemptions from work requirements can only be granted based on medical certification, and the DHHS is prohibited from seeking additional exemptions without oversight committee approval. The bill also modifies the timeline for submitting documentation to the Centers for Medicare and Medicaid Services (CMS), changing the deadline from January 2026 to December 1, 2026, or within 30 days of the federal application template's publication.

Furthermore, the bill directs the DHHS to resubmit the 1115 demonstration waiver to CMS to reinstate community engagement and work requirements for Medicaid eligibility, requiring an annual report to the legislature on implementation status. While the bill does not allocate funding or authorize new positions, it anticipates significant costs for system upgrades and outreach efforts, estimating around $8.8 million in costs from FY 2026 to FY 2028. Approximately 44,310 individuals may be affected by the new requirements, with about 20,000 at risk of losing coverage. The bill acknowledges potential challenges in managing the transition and ensuring compliance, particularly given the uncertainties surrounding federal criteria and the lack of additional resources for the DHHS to implement the new provisions effectively.