Oversight committee adopts initial steps to implement SB 134’s Medicaid work requirements

Chairman Pearson convened the Health and Human Services Oversight Committee on June 26 to consider how New Hampshire will implement changes under Senate Bill 134 now that the federal government published an interim final rule on June 1.

The committee approved three initial policy decisions the Department of Health and Human Services recommended. Olivia May, Deputy Medicaid Director, told members the interim final rule aligns closely with the statute and that the department recommends adopting all four optional short-term hardship exceptions, using a one-month assessment inside the six-month eligibility cycle for verification, and initially applying a claims-based algorithm to identify medical frailty while refining the approach over the coming year.

Why it matters: these choices determine how broadly exemptions from community engagement (work) requirements will be available, how frequently beneficiaries will be asked to verify compliance, and how the department will identify people with serious health needs who should not be subject to participation rules. May said adopting the exceptions would prevent some eligible people from losing coverage during clinical episodes and that the department must be careful in defining terms such as "extensive" out-of-state travel for medical care.

What the committee decided: On the first item, May described four optional short-term hardship exceptions—(1) inpatient or institutional care at application or renewal, (2) presidentially declared emergencies, (3) counties with sustained unemployment above 8% or 1.5× national rate, and (4) extensive out-of-state travel for complex care. The department recommended adopting all four; members asked for clear operational definitions before implementation. The chair separated the items and put item 1 to a vote; the motion carried.

On verification cadence, May recommended aligning assessment with the 2027 shift to six-month redeterminations and using a single one-month assessment window to avoid overlapping verification cycles and operational risk. Committee members raised concerns about beneficiary documentation burdens and departmental staffing; May noted one state (Indiana) has publicly said it would hire hundreds of staff to support more frequent verifications. The committee voted to accept the department's recommendation.

On medical frailty, Dr. Jonathan Ballard, DHHS chief medical officer, urged a pragmatic approach: use claims and other ex parte clinical indicators (infusions, frequent ED visits, hospitalizations, durable medical equipment, specialty drugs) to flag probable frailty and apply automated exemptions where appropriate, while asking beneficiaries at application/renewal whether a provider has indicated a disabling condition. Ballard said this method avoids the substantial cost of statewide individual assessments—some other states have hired dozens to hundreds of clinical staff to perform manual reviews. The committee approved the department’s criteria and asked the department to report back as algorithms are refined.

Votes and next steps: The committee recorded roll-call approvals for the items the department presented and invited DHHS to return with draft administrative rules and implementation frameworks. May said the department aims to seek approval on related administrative rules by December to meet federal timelines.

Quotes: "We would recommend a one-month assessment in that six-month period and aligning the timing with the 6-month redetermination process," Olivia May said. Dr. Ballard said the department will "use claims data with the underlying serious or complex condition with additional data that may indicate functionality" to identify medical frailty.

What remains unresolved: Members asked for precise operational definitions (for example, what counts as "extensive" travel for care), asked the department to model staffing impacts, and requested follow-up briefings as the department develops administrative rules and refines algorithm parameters. The department committed to returning with rule frameworks and operational detail.

Ending: The committee’s votes move the state from statute toward implementation; DHHS will present draft administrative rules and updated operational plans in the coming months.