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Premium Assistance Program Section 1115 Demonstration Waiver

Update: May 7, 2018
The Centers for Medicare & Medicaid Services (CMS) approved New Hampshire's request for an amendment to its section 1115 demonstration project, entitled "New Hampshire Health Protection Program Premium Assistance" (Project Number l l-W-00298/1) in accordance with section 1115(a) of the Social Security Act (the Act).

This approval is effective May 7, 2018, through December 31, 2018, upon which date, unless extended or otherwise amended, all authorities granted to operate this demonstration will expire. CMS's approval is subject to the limitations specified in the attached expenditure authorities, waivers, and special terms and conditions (STCs). The state will begin implementation of the community engagement requirement added through this amendment no sooner than January 1, 2019, assuming the state fulfills the requirements outlined within the STCs to continue the demonstration beyond December 31, 2018, and contingent upon the reauthorization of the program by the New Hampshire legislature.

Summary of Demonstration
Under the NHHPP Premium Assistance demonstration, New Hampshire uses premium assistance to support the purchase of health insurance coverage for beneficiaries eligible under the new adult group provided via certain qualified health plans (QHPs) doing business in the individual market through the Marketplace. The demonstration affects individuals in the new adult group covered under Title XIX of the Social Security Act who are adults from age 19 up to and including age 64 with incomes up to and including 133 percent of the federal poverty level (FPL) who are neither enrolled in (nor eligible for) Medicare or enrolled in the state’s Health Insurance Premium Payment (HIPP) program.

Proposed Amendment
The proposed amendment seeks to effect the following modification:
Modify eligibility to require that newly eligible adults who are unemployed be eligible to receive benefits if DHHS finds that the individual is engaging in work or a combination of other clearly outlined activities for at least 20 hours per week upon application of benefits, 25 hours per week after receiving 12 months of benefits over the lifetime of the applicant and 30 hours per week after receiving 24 months of benefits over the lifetime of the applicant.

Update: November 3, 2017
On November 2, 2017, CMS notified the Department that CMS had completed a preliminary review of the amendment request Adobe Acrobat Reader Symbol and determined that the Department’s amendment request has met the requirements for a complete amendment. The federal public comment period is open from November 2, 2017 through December 2, 2017. The amendment is posted on the website.

Opportunity for Public Input
Public comments may be submitted until midnight on September 29, 2017.

Comments may be submitted by email to, or by regular mail to:

Dawn Landry
NH Department of Health and Human Services
129 Pleasant Street
Concord, NH 03301-3857

Public Hearings

The State will host two public hearings during the public comment period.

  • September 14, 2017
    1:00 - 2:30
    Manchester Health Department
    1528 Elm St
    Manchester, NH 03010
  • September 21, 2017
    11:00 – 12:30
    New Hampshire Department of Health and Human Services
    Brown Auditorium
    129 Pleasant St,
    Concord, NH 03301

Waiver and Expenditure Authorities
Existing waiver and expenditure authorities will be not modified.


On March 27, 2014, Governor Maggie Hassan signed into law Senate Bill 413, an Act relative to health insurance coverage (the “Act”), (2014 NH Laws Chap. 3) establishing the New Hampshire Health Protection Program to expand health coverage in New Hampshire for adults with incomes up to 133% of the Federal Poverty Level. The New Hampshire Health Protection Program includes several components: (1) a mandatory Health Insurance Premium Payment Program (HIPP) for individuals with access to cost-effective employer-sponsored insurance; (2) a bridge program to cover the new adult group in Medicaid managed care plans through December 31, 2015; and (3) a mandatory individual qualified health plan (QHP) premium assistance program beginning on January 1, 2016. The New Hampshire Department of Health and Human Services, as the single state Medicaid agency, seeks Section 1115 Waiver authority from the Centers for Medicare and Medicaid Services to implement the third part of the new law, the mandatory QHP premium assistance program.

Under the Demonstration, the State will implement a mandatory premium assistance program (“Premium Assistance Program” or “Program”) through which the State will purchase QHPs that have been certified for sale in the individual market on the federally facilitated New Hampshire Health Insurance Marketplace for the new adult group. The Demonstration intends to use private market insurance to ensure consistent access to coverage, rationalize provider reimbursement, and enhance integration and efficiency of public and private coverage in New Hampshire. Ultimately, the Demonstration will provide truly integrated coverage for low-income New Hampshire residents regardless of their income or source of coverage.

This page contains material developed by the Department regarding its application for a Section 1115 Demonstration Waiver. Contents include public notices, draft application documents, and dates, times, and locations for related public hearings. To learn more about Section 1115 Demonstration Waivers, please visit the CMS website.

Premium Assistance Carrier Information

Review of Documents and Submission of Documents
This notice, waiver documents, and information about the New Hampshire Health Protection Program (NHHPP) Premium Assistance Demonstration are available below. To reach all stakeholders, non-electronic copies of all the aforementioned documents are available by contacting the Department of Health and Human Services, Dawn Landry.

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

copyright 2016. State of New Hampshire