Waiver History

The initial waiver was approved in 2014 through December 2018. It included a private option and a voluntary work referral program. In May 2018, CMS approved an amendment to add a work requirement.  In August 2018, the state submitted a waiver request to CMS to end the private option, extend the work requirement for five additional years, omit retroactive eligibility, instate an asset test, and require added identification for citizenship and residency. CMS approved the work requirement extension, request to omit retroactive coverage, and private option termination on November 30, 2018. Requests to add an asset test to Medicaid expansion and require additional citizenship documentation were not approved. See CMS’s approval letter. On March 20, 2019, a lawsuit was filed in the U.S. federal district court to challenge CMS’s approval of the work requirement waiver.


Comments Submitted

Population Covered

The New Hampshire waiver covers the Medicaid expansion new adult populations, childless adults (19-64) with incomes below 138 percent of the federal poverty line.


Other Resources

Work Requirement

All expansion enrollees must participate in 100 hours per months of “community engagement” activities (employment, education, job skills training or community service) starting January 1, 2019. Enrollees who do not meet the requirement for 1 month will have enrollment suspended until they can demonstrate that they meet the requirement. Medically frail are exempted as are additional individuals, including caretakers, people with serious illnesses, people with disabilities, pregnant women.


The state can vary cost-sharing based on income (higher cost-sharing for individuals with incomes above poverty who are not medically frail).

Retroactive Coverage

The state has approval to omit Medicaid retroactive coverage. Coverage beings as of date of application.