NH Medicaid

NH Medicaid

NH Medicaid (Medical Assistance) is a federal and state-funded health care program that serves a wide range of individuals and families who meet eligibility requirements. The program provides access to needed health services, including transportation, as well as services for developmentally disabled individuals, persons with acquired brain disorders, and services at community mental health centers.

The Department of Health and Human Services (DHHS) determines Medicaid financial eligibility and all non-financial eligibility, including disability determinations. These are the most common eligibility pathways for families of children and youth with special health care needs:

  • pregnant women 
  • parents/caretakers/relatives 
  • infants and children under the age of 19 
  • former foster care children
  • individuals requiring long-term care services
  • individuals with blindness and/or disabilities
  • individuals age 19 and under 65 (Granite
    Advantage Health Care Program)
  • refugees and non-citizens

Please refer to the NH Department of Health and Human Services for additional information on NH Medicaid, and refer to the Bureau of Family Assistance Program Fact Sheet in the Medicaid resources section below for specific income requirements for the various programs.

NH Medicaid Resources

NH Managed Care Resources

NH Medicaid programs

Children’s Medicaid (CM) provides health and dental coverage for children under age 19 whose family income is less than or equal to 196% of the federal poverty guidelines.

Children’s Expanded Medicaid (CHIP) provides the same health benefits as Children’s Medicaid for children under age 19; the financial eligibility is 196% up to but not more than 318% of the federal poverty guidelines.

Home Care for Children with Severe Disabilities (HCCSD), often called “Katie Beckett,” is for children under age 19 whose medical disabilities are so severe that they qualify for institutional care but are being cared for at home. Only the child’s income and resources are counted towards eligibility for this program.

Aid to the Needy Blind (ANB) is available for individuals of any age who are legally blind. Eligibility is based on income, resources, and living arrangements.

Granite Advantage Health Care Program is for individuals who are at least age 19 but younger than age 65, who are not eligible to be enrolled in any mandatory Medicaid coverage (such as Aid to the Permanently and Totally Disabled (APTD) or ANB) and whose household income is at or below 133 percent of federal poverty guidelines.

Aid To The Permanently Disabled (APTD) is for individuals who have a medical condition that prevents gainful employment and is expected to last for at least 48 months or result in death. Income and resource limits also apply.

Medicaid for Employed Adults with Disabilities (MEAD) provides Medicaid coverage to working adults with disabilities who would not otherwise be financially eligible for Medicaid. MEAD was designed to allow individuals with disabilities to increase their working income and have higher resource limits.

In and Out Medical Assistance helps individuals whose income is insufficient to pay their medical bills but is too high to qualify for Medicaid. Individuals are given a spenddown, similar to an insurance deductible. When qualifying medical expenses add up to the spend-down amount, Medicaid can then help pay for bills incurred for the duration of the spend-down period. Learn more about this program in the Medicaid resources section on this
page.

Health insurance navigators

There are health insurance navigators to help individuals and families navigate health insurance. While geared toward the Marketplace, they can also be a good resource for families who are transitioning between Medicaid and the Marketplace. One of the resources NH Family Voice consults with regularly is Health Market Connect. You can learn more about them at http://www.hmcnh.com.

Applying for NH Medicaid

NH DHHS offers NH EASY, New Hampshire’s Electronic Application System. You can search for
services, apply or reapply for assistance, check eligibility, report changes, and track your application status through NH EASY.

Applications can also be completed at field offices called District Offices. Here is a list of locations
throughout the state.

When you receive NH Medicaid

The majority of individuals who are approved for NH Medicaid are required to enroll with a managed care organization or Medicaid Health Plan. There are currently three Health Plans. While each plan covers the same services as NH Medicaid, it has its own network of providers and plan rules.

  • AmeriHealth Caritas NH – Member Services: 1-833-704-1177
  • New Hampshire Healthy Families – Member Services: 1-866-769-3085
  • Well Sense Health Plan – Member Services: 1-877-957-1300

Most individuals who are enrolled in NH Medicaid are enrolled in a Medicaid Health Plan (managed care organization). Individuals who are not mandatory enrollees are covered by Medicaid Fee for Service (FFS), and have to use NH Medicaid enrolled providers. Find a NH Medicaid provider.

What you should know about your health plan

Understanding your health insurance plan and how to use it:

  •  Know what you may have to pay. Review your Summary of Benefits to see which expenses are covered under your plan and costs you may need to pay (copays, coinsurance, deductibles). Contact your insurance provider if you have questions. 
  • Find out which providers are in your plan’s network. Be sure to check if all of your current doctors are in network. If they are not, identify your plan’s policy and cost regarding the use of out-of-network providers.
  • Learn about prescription drug coverage. What medications are on the formulary? How much is allowed at renewal? What pharmacies are in-network? Is mail order an option? 
  • Identify any referral and prior authorization requirements. Some plans may not cover the cost of the services without a referral or prior authorization. 
  • Know the enrollment period and plan renewal date. (If you met your deductible in June, scheduling other procedures before the plan renews when possible makes sense.) 
  • Many health insurance plans provide an “Explanation of Benefits” (EOB) after you visit the doctor or have an appointment. The EOB has specific information about your plan, appointment, and what you and the plan will pay. If you find an error, call your insurance company and wait for the provider’s bill. If you find a difference between the amount owed on an EOB and a bill, follow up with both the insurance company and the billing department. 
  • Rest assured, you have the right to appeal a denial of service or refusal to authorize service.  There may be multiple levels of appeal available. Be aware of the timelines that apply. 
  • Inquire whether case or care management is an available service from your plan.