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NH Medicaid Providers

New Hampshire Medicaid is making changes to the Medicaid program. This initiative – called Care Management – will transition NH Medicaid to a managed care model of administration. Care Management is designed to offer NH Medicaid clients options and support in managing their health care.

The Department of Health and Human Services has contracted with two health plans. These health plans will cover all current Medicaid benefits and will offer additional wellness and prevention services. The two health plans are:

New Hampshire Healthy Families
Well Sense Health Plan

Most Medicaid recipients will be required to select a plan or else be assigned to one. In the first year, a minority of Medicaid clients will have the option of enrolling in the Care Management programs or opting out. To ensure that your clients have continuity of care, you are encouraged to enroll with both health plans. DHHS will use the Health Plan provider networks to assist those Medicaid recipients who request help in making their selection of a plan. Your clients may also call you to see if you have enrolled in the health plan they are considering.

For your clients with more complex medical needs, the health plans will offer care management services. A care manager will work closely with the client to secure a variety of services based on their needs in collaboration with you and your colleagues.

On this web page you will find information that is important for your clients and your practice on:

What's New …

Reinstatement of Pharmacy Co-Pays for New Hampshire Medicaid and NH Health Protection Program (NHHPP) begins November 1, 2014

Effective November 1, 2014, pharmacy co-pays will be reinstated for Medicaid and NHHPP
recipients, including those enrolled with Well Sense Health Plan and New Hampshire Healthy Families. Recipients with income over 100% of the Federal Poverty Level will be charged a pharmacy copayment unless the individual is exempt for any of the following reasons:

  • Under age 18
  • Pregnant or in the 60-day postpartum period
  • Approved for Nursing Facility Services
  • Approved for Home and Community-Based Care Services
  • Approved for Breast and Cervical Cancer Program (BCCP)

There are no pharmacy co-pays for recipients at or below 100% of the Federal Poverty Level. Recipients will receive a letter from DHHS outlining their co-payment responsibilities. Co-payment amounts for recipients who are above 100% of the FPL and not exempt are:

Co-pay Table

Pharmacy providers with questions should call the appropriate provider relations unit:

  • Magellan (Fee-for-Service Medicaid)
  • Well Sense Health Plan
    Envision Rx
    1-877-957-1300, option 3
  • New Hampshire Healthy Families
    US Script
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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852

copyright 2010. State of New Hampshire