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Select Medicaid Care Management Program Policies

The New Hampshire Health Protection Program (NHHPP), which started on August 15, 2014, is a health care program for low-income New Hampshire residents ages 19 through 64. Most NHHPP recipients are in the Premium Assistance Program (PAP) and enrolled in one of the three commercial Qualified Health Plans (QHP) listed below. The Department of Health and Human Services (DHHS), using Medicaid funds, pays the QHP’s monthly premium and yearly deductible for all PAP members and pays the copays for most PAP members. For PAP members with an income above 100% of the federal poverty level, the QHP charges copays which were set by DHHS. Please visit the Premium Assistance Program page for a listing of the copays.

Effective January 1, 2018, Providers must contract with the three Qualified Health Plans listed below to provide services to NHHPP recipients through the Premium Assistance Program.

Qualified Health Plans Telephone Number
Ambetter, from New Hampshire Healthy Families 1-844-265-1278
Anthem Blue Cross Blue Shield 1-855-854-1438
Harvard Pilgrim Health Care of New England 1-800-708-4414

Medically Frail
NHHPP recipients who have special health care needs may indicate on their application, or when their medical condition changes, that they are medically frail. Once deemed medically frail, the member will be moved to one of Medicaid’s Managed Care Organizations (MCO) on the first of the following month: New Hampshire Healthy Families or the Well Sense Health Plan. Medically frail members may choose to receive services under the Alternative Benefit Plan (ABP) or under the Standard Medicaid plan.

Substance Use Disorder (SUD) Benefit
Medicaid’s Managed Care Organizations and the Qualified Health Plans offer a SUD benefit. Providers should check with the member’s QHP for a complete list of SUD services covered by that plan.

Fee Schedule for NHHPP Medically Frail Members in the Alternative Benefit Plan
The New Hampshire Health Protection Program’s fee schedule for its medically frail members in an MCO matches the standard Medicaid fee schedule. See the NHHPP-MCO Fee Schedule for Alternative Benefit Plan.

NHHPP Member EligibilityIt is important that providers confirm eligibility and QHP or health plan enrollment in the NH Medicaid Management Information Systems’ (MMIS) online portal prior to providing services to New Hampshire Health Protection Program (NHHPP) recipients. MMIS is the software system that maintains eligibility information for all NH Medicaid and NHHPP recipients.

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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852

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