What's at Stake?
The federal government is proposing budget cuts to the Medicaid program, threatening health care access for millions of Americans and hundreds of thousands of Granite Staters who depend on this vital program. The proposed cuts amount to $2.5 trillion, or one-third of Medicaid funding, over the course of 10 years.
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In New Hampshire, Medicaid is jointly funded by the federal government and our state government. The proposed federal budget cuts would significantly reduce the federal government's contribution to our Medicaid programs, putting them at severe risk. While we understand there are difficult budget decisions to make, these cuts are being rushed. Making big cuts in a hurry to health care programs that cover lots of our children, older adults, and people who need health care is harmful to both our state's health and our economy.
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Learn more about the potential changes to federal Medicaid policy from New Hampshire Fiscal Policy Institute.
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Medicaid Funding in NH
In New Hampshire, Medicaid is jointly funded by the federal government and our state government. In dollar terms, it is the single largest program our state operates, and the single largest revenue we get from the federal government.
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The federal government pays 50% of the cost of traditional Medicaid, and NH pays the remaining 50%.
90%
The federal government pays 90% of the cost of Medicaid expansion, and NH pays the remaining 10%.
The proposed federal budget cuts would significantly reduce the federal government's contribution to our Medicaid programs, putting them at severe risk and shifting the financial burden to our state. New Hampshire already has immense budget considerations, with low revenues and few resources to fill the gap.
An Immediate Threat: The Trigger Law
New Hampshire has a trigger law for Medicaid expansion. By law, we require Medicaid expansion to receive 90% federal funding in order for the program to exist in our state. This means that if federal funding drops below 90%, the entire Medicaid expansion program would end in 180 days.
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This would put the 60,117 New Hampshire residents who are currently enrolled in Medicaid expansion at risk of losing their health insurance coverage, and shift substantial costs to our state. ​We would be left with little time to develop alternative coverage solutions, and our health care system would face sudden disruption as patients lose their access to care.​​​
What We Stand to Lose
If there are big cuts to Medicaid, there will be larger consequences along with taking health care away from the very people the program was intended to help. We could see:
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Health Care Facility Closures: Our rural hospitals and community health centers rely heavily on Medicaid reimbursements. Funding cuts could force many to reduce services or close entirely, creating health care deserts in our already underserved areas.
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Increased Uninsured Rates: When people lose health insurance, they often delay or forego necessary care, leading to worse health outcomes and more expensive emergency treatments later. New Hampshire's 10-Year Mental Health Plan includes Mission Zero to end emergency department boarding, but this progress will be undermined if rising uninsured rates drive more patients to our emergency rooms.
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Economic Impact: Medicaid supports thousands of health care and other jobs and contributes billions to our economy. Cuts could result in job losses, reduced economic activity, and increased financial strain on families and communities.
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Medicaid cuts will affect everyone in New Hampshire.
At a time when 71% of Granite Staters report struggling with health care costs in the past year, our focus should be on improving access and affordability, not rushed cuts that will ultimately raise costs for us all.
More State-Level Impacts
In addition to the proposed federal cuts to Medicaid, New Hampshire faces state-level issues that would negatively impact our Medicaid program if passed. These issues include 2025 legislation and 2025-2026 state budget proposals.
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The New Hampshire Legislature is considering Senate Bill 134, which would set burdensome work requirements for Medicaid Expansion. Work requirements would create unnecessary barriers to care and put thousands of low-income Granite Staters at risk of losing their health insurance.
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Governor Kelly Ayotte's budget proposal included monthly premiums and increased pharmacy co-pays for some families covered by Medicaid. If these premiums and co-pays are imposed, about 10% of families with children in Medicaid and 20% of adults in Medicaid expansion would have to pay the premiums and co-pays. For a family of three making $68,000 per year, the monthly premium could be over $280 each month. A single individual on Medicaid expansion making around $15,000 per year could also be subjected to these costs.