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NH Health Protection Program - Providers
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. As of January 1, 2016, most NHHPP recipients are in the Premium Assistance Program (PAP) and enrolled in one of the five 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 Premium Assistance Program for more information.

Effective January 1, 2017, Providers must contract with the 4* Qualified Health Plans listed below in order to provide services to NHHPP recipients through the Premium Assistance Program.

Qualified Health Plans

  • Ambetter, from New Hampshire Healthy Families
  • Anthem Blue Cross Blue Shield
  • Harvard Pilgrim Health Care of New England
  • Minuteman Health

Community Health Options will no longer be available as a Qualified Health Plan in New Hampshire after December 31, 2016. All Community Health Options enrollees will either select a new health plan during the 2016 Open Enrollment process or be automatically assigned to one of the other remaining health plans for plan coverage effective January 1, 2017.

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. 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
If a NHHPP member is declared medically frail, that member is enrolled in one of Medicaid’s Managed Care Organizations and receives the SUD benefit under the Alternative Benefit Plan (ABP). For PAP members, each Qualified Health Plan offers 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
Providers will receive the fees posted on the below NHHPP-MCO fee schedule for all NHHPPP medically frail members who are in a Managed Care Plan (MCO) under the Alternative Benefit Plan. For the medically frail in the Standard Medicaid plan under an MCO, providers will be reimbursed at the MCO’s Standard Medicaid rate. While newly-enrolled NHHPP recipients are in NH Medicaid Fee-for-Service, providers will be reimbursed at the Standard Medicaid rate.

NHHPP Member Eligibility
It 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
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