In December 2013, New Hampshire began the statewide transition to risk-based managed care in its Medicaid program. This report provides an overview of managed care implementation for Medicaid acute care services, drawing upon a case study conducted in July 2014. We found that initial implementation of managed care went relatively smoothly, due in part to the state’s active oversight role. However, both providers and Medicaid beneficiaries reported significant problems with prior authorization processes. As Medicaid managed care continues to evolve in New Hampshire, we will continue monitoring these and other issues as part of an ongoing evaluation.