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.
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.
- The plan information listed here is for informational purposes only, and is not legally binding. The official plan is maintained by the Centers for Medicare and Medicaid Services, Region I, Boston, MA.
- Although most state plan pages are replaced with an entirely new and updated page when they are superseded, please note that pages related to eligibility and the Affordable Care Act are an exception to this process. These pages either superseded entire pages or partial pages. For reference the superseding document is included in these pages.
The following State Plan files are posted as of 04/25/2019 and will be updated as approvals occur:
- Section 1: Single State Agency Organization
- Section 2: Coverage and Eligibility
- Section 3: Services: General Provisions
- Section 4: General Program Administration (4.1 - 4.4.1)
- Section 5: Personnel Administration (5.1 - 5.3)
- Section 6: Financial Administration (6.1 - 6.3)
- Section 7: General Provision (7.1 - 7.4)
- Attachment 2.1-A - 2.6-A (pending)
- Attachments 3.1-A - 3.1-F and 3.1-I
- Attachment 3.1-A: Services, Categorically Needy
- Attachment 3.1-B: Services, Medically Needy
- Attachment 3.1-C: Standards and Methods of Assuring High Quality Care
- Attachment 3.1-D: Assurance of Medical Transportation
- Attachment 3.1-E: Coverage of Organ Transplant Services
- Attachment 3.1-F: Managed Care
- Attachment 3.1-I: 1915(i) State Plan Home and Community Based Services
- Attachment 3.2-A: Coordination of Title XIX with Part B of Title XVIII
- Attachments 4.11-A - 4.40-E, excluding 4.19-A, B and D (see Payment-Related Attachments below), but including:
- Attachment 4.19-C: Reserve Bed Days
- Attachment 4.22-A and 4.22B: Third Party Liability
- Attachment 4.22-C: Health Insurance Premium Payment (HIPP) Program
- Various other Attachments Referenced in Section 4
- Payment-Related Attachments
- Attachment 4.19-A: Payment for Inpatient Hospital Services
- Attachment 4.19-B: Payment Rates (except for inpatient hospital and nursing home reimbursement)
- Attachment 4.19-D: Nursing Home Reimbursement
- Attachment 7.2-A - 7.3
- Alternative Benefit Plan (ABP1 - ABP11)
- Medicaid Premiums and Cost Sharing (G1 - G3) and Attachment 4.18-A & 4.18-C
Modified Adjusted Gross Income (MAGI) Eligibility & Methods
- 13-0017: MM1 MAGI
- 13-0018: MM2 Eligibility
- 13-0019: MM3 MAGI Income Methodology
- 13-0021: MM5 Residency
- 13-0022: MM6 Citizenship and Non-Citizen Eligibility
- 13-0023: MM7 Hosp PE
- 14-0004: Adult Group
- 18-0018: MACPro Authorized Representatives
New Hampshire’s Medicaid State Plan, like all State Plans, is constantly changing and improving to ensure that its citizens are served.