Medicaid State Plan
Information and resources for the Medicaid State Plan, required by federal Medicaid regulations, to ensure that New Hampshire will receive matching federal funds for its Medicaid program
All state Medicaid agencies are required to have an approved Title XIX/Medicaid State Plan. The state plan describes the nature and scope of its program and gives assurance that the state’s Medicaid program will operate in compliance with federal Medicaid regulations and other official federal issuances. Having an approved state plan ensures that the state will receive matching federal funds for its Medicaid program.
Amendments to the state plan are necessary for many reasons, such as changes to: eligibility, services or limits, provider types, prior authorization, and reimbursement amounts or methodologies. Details about state plan requirements, including the timing of submittals, can be found at 42 CFR 430, Subpart B. Proposed state plan amendments are submitted to the Centers for Medicare and Medicaid Services (CMS) for review and approval before posting. For access to the most up-to-date State Plan Amendment pages, please visit the Medicaid State Plan Amendments page on the CMS.gov site: Medicaid State Plan Amendments | Medicaid.gov. Through the CMS Medicaid State Plan Amendments page, you will be able to search by State (New Hampshire), date, and topic area.
The state plan does not contain extensive service details and requirements. This information is obtained through the Department’s rules listed on the State of New Hampshire Administrative Rules website or via the DHHS online eligibility policy manual. If knowledge is needed on pending state plan submissions, please contact us.
New Hampshire’s Medicaid State Plan, like all State Plans, is constantly changing and improving to ensure that its citizens are served. The plan information listed here is for informational purposes only and is not legally binding. The official New Hampshire State Plan is maintained by the Centers for Medicare and Medicaid Services, Region I, Boston, MA.
Attachment 1: Single State Agency
- Organization
- Designation and Authority
- Intergovernmental Cooperation Act Waivers
- Eligibility Determinations and Fair Hearings
- Organization and Administration
- Single State Agency Assurances
- General Administration
Attachment 2: Coverage and Eligibility
- Income and Resource Methodologies
- Eligibility Determinations of Individuals Age 65 or Older or Who Have Blindness or a Disability
- MAGI-Based Income Methodologies
- Non-MAGI Methodologies
- More Restrictive Requirements than SSI under 1902(f) - (209(b) States)
- Income/Resource Standards
- AFDC Income Standards
- Medically Needy Income Level
- Handling of Excess Income (Spenddown)
- Medically Needy Resource Level
- Mandatory Eligibility Groups
- Former Foster Care Children
- Individuals in 209(b) States Who Are Age 65 or Older or Who have Blindness or a Disability
- Parents and Other Caretaker Relatives
- Pregnant Women
- Infants and Children under Age 19
- Adult Group
- Optional Eligibility Groups
- Individuals above 133% FPL
- Optional Coverage of Parents and Other Caretaker Relatives
- Reasonable Classification of Individuals under Age 21
- Children with Non IV-E Adoption Assistance
- Optional Targeted Low Income Children
- Individuals with Tuberculosis
- Independent Foster Care Adolescents
- Individuals Eligible for Family Planning Services
- Individuals Eligible for but not Receiving Cash Assistance
- Individuals Eligible for Cash Except for Institutionalization
- Individuals Receiving Home and Community-Based Waiver Services under Institutional Rules
- Optional State Supplement Beneficiaries
- Individuals in Institutions Eligible under a Special Income Level
- Work Incentives
- Ticket to Work Basic
- Medically Needy Pregnant Women
- Medically Needy Children under Age 18
- Medically Needy Parents and Other Caretaker Relatives
- Medically Needy Populations Based on Age, Blindness or Disability
- Non-Financial Eligibility
- State Residency
- Citizenship and Non-Citizen Eligibility
- Eligibility and Enrollment Processes
- Eligibility Process
- Presumptive Eligibility
- Presumptive Eligibility for Children under Age 19
- Parents and Other Caretaker Relatives - Presumptive Eligibility
- Presumptive Eligibility for Pregnant Women
- Adult Group - Presumptive Eligibility
- Presumptive Eligibility for Family Planning
- Presumptive Eligibility by Hospitals
- Individuals Needing Treatment for Breast or Cervical Cancer - Presumptive Eligibility
- Continuous Eligibility
- Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage
- Continuous Eligibility for Children
Attachment 3.1-A to Attachment 3.1-I: Amount, Duration, Scope, and Types of Covered Services
- 3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
- 3.1-B Amount, Duration, and Scope of Services Provided Medically Needy Group(s)
- 3.1-C Standards and Methods of Assuring High Quality Care
- 3.1-D Assurance of Medical Transportation
- 3.1-E Standards for the Coverage of Organ Transplant Services
- 3.1-F Managed Care Conditions and Requirements
- 3.1-I 1915(i) State Plan Home and Community Based Services Administration and Operation
Attachment 3.1-L New Hampshire Alternative Benefit Plan: Identifies and Defines the Adult Eligibility Group That Receives their Medicaid Coverage through an Alternative Benefit Plan (ABP)
Alternative Benefit Plan (ABP) 1-11
- ABP1: Alternative Benefit Plan Populations
- ABP2a: Voluntary Benefit Package Selection Assurances - Eligibility Group Under Section 1902(a)(10)(A)(i)(VIII) of the Act
- ABP3: Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package
- ABP4: Alternative Benefit Plan Cost-Sharing
- ABP5: Benefits Description
- ABP7: Benefits Assurances
- ABP8: Service Delivery Systems
- ABP9: Employer Sponsored Insurance and Payment of Premiums
- ABP10: General Assurances
- ABP11: Payment Methodology
Attachment 4.11-A to Attachment 4.40-E: Reimbursement, Quality Control and Title VI Civil Rights
- 4.11-A Standard Setting Authority for Distributions
- 4.14-B Methods for Control of the Utilization of Intermediate Care Facility (ICF) Services
- 4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and Title V Grantees
- 4.17-A Liens and Adjustments or Recoveries
- 4.18-C Charges Impose on the Medically Needy
- 4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
- 4.18-E Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals
- 4.19-A Methods and Standards for Establishing Payment Rates – Inpatient Hospital Care
- 4.19-B Methods and Standards for Establishing Payment Rates - Other Types of Care
- 4.19-C Standards for Payment of Reserved Beds During Absence from Long-Term Care Facilities
- 4.19-D Methods and Standards for Establishing Payment Rates Prospective Reimbursement System for Long-Term Care Facilities
- 4.19-E Definition of a "Claim"
- 4.22-A through 4.22-C Requirements for Third Party Liability (TPL)
- 4.30 Sanctions for Psychiatric Hospitals
- 4.32-A Income and Eligibility Verification System Procedures Requests to Other State Agencies
- 4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
- 4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
- 4.35-A through 4.35-H Enforcement of Compliance for Nursing Facilities
- 4.38 Disclosure of Additional Registry Information
- 4.39 Definition of Specialized Services & Categorical Determinations
- 4.40-A through 4.40-E Eligibility Conditions and Requirements
Attachment 5: Personnel Administration
- Personnel Administration Attachments 5.1 and 5.3
- 5.1 Standards of Personnel Administration
- 5.3 Training Programs; Subprofessional and Volunteer Programs
Attachment 6: Financial Administration
- Financial Administration Attachments 6.1 through 6.3
- 6.1 Fiscal Policies and Accountability
- 6.2 Cost Allocation
- 6.3 State Financial Participation
Attachment 7.1 – 7.7-C: General Provisions
- General Provisions 7.1 - 7.4
- 7.1 Plan Amendments
- 7.2 Nondiscrimination
- 7.2-A Methods of Administration-Civil Rights
- 7.3 Governor Review of State Plan Amendments
- 7.4 State Governor’s Review
- 7.7-A, 7.7-B, and 7.7-C were in effect from March 11, 2021, through the end of the COVID-19 Public Health Emergency:
- 7.7-A Vaccine and Vaccine Administration at Section 1905(a)(4)(E) of the Social Security Act
- 7.7-B COVID-19 Testing at section 1905(a)(4)(F) of the Social Security Act
- 7.7-C COVID-19 Treatment at section 1905(a)(4)(F) of the Social Security Act