In June 2019, New Hampshire began requiring beneficiaries to report work and community engagement hours as a condition of eligibility for its Medicaid expansion program, Granite Advantage, becoming the second state to do so following Arkansas’ work requirements implemented a year earlier. Though state officials implemented numerous strategies to try and avoid the problems experienced in Arkansas – where over 18,000 Medicaid adults were disenrolled in the first six months of Arkansas Works – they found themselves at nearly the same end point: on the brink of disenrolling a large share of the state’s Medicaid expansion population. Moreover, New Hampshire reached this point in a fraction of the time, facing the prospect of disenrolling up to 17,000 beneficiaries after just two months, a startling 67 percent of those subject to the requirements. However, state officials suspended the program before this occurred, and federal courts subsequently halted the program indefinitely. We studied New Hampshire’s Medicaid work requirement program to understand how it was implemented and why it, like Arkansas’s, apparently failed to protect coverage and promote work. This case study, based on a series of key informant interviews and focus groups with Medicaid beneficiaries, builds on our prior Arkansas-focused study to provide additional evidence of the numerous problems associated with implementing Medicaid work requirements, exploring issues related to outreach, work supports, reporting systems, exemptions, and implications of coverage loss.
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