This bill amends the New Hampshire Granite Advantage Health Care Program to introduce community engagement and work requirements for individuals eligible for the state's expanded Medicaid program. It adds new definitions for "applicable individuals" and "work requirements" in RSA 126-AA, aligning with federal law (Public Law 119-21, Section 71119). The bill stipulates that individuals must demonstrate compliance with work requirements for the month prior to their application, with the Department of Health and Human Services (DHHS) responsible for verifying compliance through documentary evidence rather than self-attestation. Exemptions can only be granted based on specific medical certifications, and the DHHS is restricted from expanding exemption definitions without oversight committee approval. Additionally, the timeline for the DHHS to submit documentation to the Centers for Medicare and Medicaid Services (CMS) is modified, 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, with an annual report to the legislature on implementation status. While the bill does not allocate funding or authorize new positions, it anticipates significant costs related to 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 resources for the DHHS to effectively implement the new provisions.