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NH Medicaid is New Hampshire’s Medicaid program, which helps low-income families receive more affordable healthcare services. New Hampshire Medicaid enrollees can receive coverage for numerous types of treatments and services, including routine medical care, diagnostics, and hospice services.
NH Medicaid is available to New Hampshire residents who meet various eligibility requirements, which include adults with low incomes, pregnant women, people with disabilities, and those over 65 years old. In the United States, each state has its own Medicaid program that aims to help low-income and other qualified individuals afford medical coverage. In New Hampshire, the NH Medicaid program is available to eligible individuals and covers a wide range of medical expenses. Below, you can learn more about what the program covers, what it doesn’t, and how to apply for NH Medicaid. To prevent shouldering the debt of unexpected medical expenses, many New Hampshirites extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
First, what is NH Medicaid coverage?
The New Hampshire Medicaid program receives funding from the federal government and the state of New Hampshire. With this funding, NH Medicaid can help certain individuals pay for essential health care services. As of June 2023, New Hampshire Medicaid has 251,681 enrollees.
NH Medicaid is also a managed care service, which means that rather than the state program paying doctors and clinics directly, it has enrollees pick one of three insurance plans provided by different Managed Care Organizations:
To put it simply, when you enroll in NH Medicaid, you pick one of these three private insurance plans to provide your coverage. While they all offer the same basic Medicaid coverage, each has a different network of doctors and additional benefits, which we’ll explain below.
The image above is an example of what your Medicaid card would look like should you choose nh healthy families as your carrier. The other plans cards would differ in appearance, but the information present would basically be the same.
Like any other health insurance, NH Medicaid will send you a card upon acceptance that acts as proof of your enrollment and coverage.
Additionally, your NH Medicaid card will have your Medicaid number, which shows that you are an NH Medicaid member. You’ll use this number to enroll in or change your Managed Care Organization provider and renew your Medicaid coverage.
You can apply for NH Medicaid in two ways: online or in person.
With the NH EASY Gateway to Services online application system, you can easily check your eligibility, explore health plans, contact customer service, and, of course, apply for New Hampshire Medicaid. To apply online, go to the digital application website and click the “Apply Now” button on the top left side. Next, you’ll come to the “Apply for Benefits” page, which gives you step-by-step application instructions.
If you prefer to apply in person, you can do so by printing your application and visiting one of the DHHS District Offices. You can also call the New Hampshire Department of Health and Human Services directly at 1-844-ASK-DHHS to ask questions or learn more about NH Medicaid services and the application process.
Before starting the New Hampshire Medicaid application, you first need to determine whether you’re even eligible. Medicaid in any state is notorious for having incredibly strict income and resource eligibility requirements, making it difficult for many to qualify and receive coverage. So, who is eligible?
First, you must be a legal New Hampshire resident. You also need to be a U.S. permanent resident, national, citizen, or legal alien. In addition to these legal requirements, you must satisfy financial eligibility requirements and need health care assistance.
It’s a common misconception that NH Medicaid is available to anyone with low or very low income, but you must also have specific medical or health insurance needs. For example, if you have a low income and are looking for medical coverage assistance, you must also be 65 years old or older, pregnant, disabled, or blind to qualify for NH Medicaid.
You may also be eligible if you are the legal guardian or parent of a child with a disability or have someone else in your home with a disability. If you meet the various health-related requirements for NH Medicaid medical assistance eligibility, you must determine whether you meet the income requirements.
You must have low or very low income to qualify for Medicaid, so what does New Hampshire consider low income? It depends on how many people are in your house.
Here are the annual NH Medicaid income limits for 2023 per household size:
The annual incomes listed above are the maximum amounts that qualify for NH Medicaid, so if your home has four people and your annual household income is $40,000, you will likely not be eligible.
What if your house has more than eight people? In this case, you will add $6,836 for every additional person to get the maximum qualifying income. For instance, if you have a household of ten people, you’ll use the following equation:
67,245 + 6,836 + 6,836 = $80,917 (annually)
As previously mentioned, your New Hampshire Medicaid card acts as your proof of coverage, so it’s essential to keep your card in a safe place. If New Hampshire Medicaid approves your application, you will receive a letter in the mail notifying you. The application process typically takes between 45 and 90 days.
When you first apply for NH Medicaid, you will have the chance to choose your MCO. If you don’t pick one when applying, NH Medicaid will automatically enroll you in one. You will receive another card from your chosen Managed Care Organization in addition to your basic Medicaid card.
If you don’t like the MCO the Medicaid program picks for you, you have 90 days after the start of your coverage to change plans. Otherwise, you will have to wait until the annual enrollment period to make any changes.
Before the global pandemic of 2020, Medicaid enrollees had to renew their plans every year to maintain coverage. However, the federal government paused renewal requirements when COVID-19 entered the scene, which meant that all Medicaid members received continuous coverage without having to complete the typical renewal paperwork every year.
Although the continuous enrollment lasted three years, you will now have to complete the renewal paperwork to maintain your Medicaid coverage. How do NH Medicaid renewals work?
DHHS will send you yellow letters as reminders about your Medicaid renewal dates. It is essential that you complete your renewal and redetermination forms by the deadline, or you could lose your Medicaid coverage. Fortunately, the renewal process is similar to the original application.
You can renew your Medicaid card online via the NH Easy Gateway or by visiting one of the District Offices. You can also print your redetermination paperwork and mail your completed documents to this address:
Centralized Scanning Unit, PO Box 181, Concord, NH 03302
One of the benefits of New Hampshire Medicaid is that it covers a wide range of medical services and treatments, from routine preventative care to vision services. However, since NH Medicaid uses Managed Care Organizations to provide coverage, you can enjoy additional benefits depending on the plan you enroll in. Let’s look at what New Hampshire Medicaid covers and what it doesn’t.
Thanks to the New Hampshire Smiles program, you or your child can receive dental coverage by enrolling in Medicaid. Here’s a quick breakdown of what children and adults can receive through the New Hampshire Medicaid dental program:
While a $1500 per year coverage limit is generous, it may not suffice for those who anticipate requiring more visits to the dentists; especially when more serious problems are involved. Investing in private dental plans in New Hampshire is advisable.
The NH Medicaid Pharmacy Benefit Program helps Medicaid enrollees pay for their prescription medications and some over-the-counter drugs. However, it’s crucial to remember that Medicaid does not cover everything, so you need to ask your doctor about your prescription coverage. Since Magellan Rx Management is New Hampshire Medicaid’s Pharmacy Benefits Administrator, you’ll need to check its Preferred Drug List to see whether you can receive coverage for your medications.
If you’re taking a drug and can’t find it on the list above, you don’t necessarily have to go without coverage. You can complete a Non-Preferred Drug Approval form to request coverage for certain medications not on the Preferred Drug List.
Additionally, NH Medicaid covers some over-the-counter medications but not all. Generally, it only covers medically necessary and generic OTC drugs, so you likely won’t receive coverage for vitamins, cold medicine, or medications that help address discomfort.
NH Medicaid members can receive coverage for numerous additional services that help improve their overall health and well-being. Here are a few examples of the extended healthcare benefits New Hampshire Medicaid covers:
Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
In addition to these, your Managed Care Organization may provide additional benefits to round out your coverage. For a list of available benefits, contact your Managed Care Organization.
Typically, Medicaid will not cover any services outside of the state. While you can use your NH Medicaid membership to get rides to and from your doctors’ appointments, they must be in the state. However, Medicaid has four exceptions to this:
Even in those instances are on a case-by-case approval. If you are traveling outside of New Hampshire for leisure, always invest in proper travelers insurance.
Students and seniors are welcome to apply for NH Medicaid as long as they meet the various eligibility requirements. However, Medicaid does not offer coverage specifically for students or seniors.
If you are a senior (age 65 or older) and meet the income requirements, you could also receive coverage for long-term care. Essentially, New Hampshire Medicaid covers three categories of long-term senior care:
Each category of long-term senior care has different income and function requirements that determine eligibility. For example, a single individual may be eligible for Nursing Home Care if their income is less than $2,742 per month and their assets are worth less than $2,500 in total. They must also medically require the level of care that nursing homes typically provide.
Medicaid is available to anyone who meets the eligibility requirements, including American Indians and military members.
If you’re an American Indian, you could take advantage of NH Medicaid coverage as well as other programs. For example, if you enroll in the Indian Health Service, urban Indian programs, or tribal health programs, you don’t have to pay any enrollment fees or premiums for Medicaid. Neither will you be responsible for copays or other out-of-pocket costs.
Active duty military members and their families have the unique challenge of moving every few years, which can make it difficult to enroll in certain state-funded programs. Fortunately, military members are eligible for Medicaid waivers, which allow them to enroll family members with special needs and get on the state waiver list sooner.
New Hampshire Medicaid covers several essential medical services plus additional benefits, giving you well-rounded coverage and an easier way to manage your health, but what doesn’t it cover? Here are some services and treatments that you won’t receive coverage for with Medicaid:
It is also important to note that Medicaid in New Hampshire will only cover anywhere between $400-$700. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
From dental to vision, NH Medicaid covers numerous services and treatments to help you receive more affordable and well-rounded health care. Here are the basic services it covers.
| Dental | |
|---|---|
| Through the NH Smiles Program, you can receive the following essential dental services: | |
| X-rays and Exams | Yes, NH Medicaid covers the costs for your routine dental exams and X-rays. |
| Cleanings | Yes |
| Fillings | Yes |
| Wisdom Teeth | Yes, the NH Smiles Program covers various oral surgeries, including wisdom teeth removal and other extractions. |
| Vision | New Hampshire Medicaid also covers the following vision services: |
|---|---|
| Eye Exams | You can receive routine eye exams to check your vision and overall eye health. |
| Glasses | NH Medicaid covers one refraction every year to determine whether you need glasses, as well as one pair of glasses. |
| Laser Eye Surgery | Medicaid often does not cover laser eye surgery since you can rely on glasses or contacts to correct your vision. However, you might receive coverage if your doctor deems this procedure medically necessary. |
| Surgery | Medicaid only covers medically necessary surgeries: |
|---|---|
| Rhinoplasty | NH Medicaid will not cover rhinoplasty if you want it for cosmetic purposes. However, you might receive coverage if you need this surgery for medically necessary reasons, such as to fix breathing issues or an injury. |
| Breast Reduction | Similar to rhinoplasty, Medicaid will only cover breast reduction surgery if your doctor deems it medically necessary. |
| Hospital | With NH Medicaid, you can receive coverage for the following hospital services: |
|---|---|
| Hospital stays | Medicaid covers the cost of your hospital stay and related services. It also pays for 12 outpatient visits annually. |
| Ambulance transportation | NH Medicaid covers ambulance transportation in emergencies. It also covers up to 12 wheelchair van services each year. |
| Giving birth | With NH Medicaid, you can receive coverage for a certified midwife, pregnancy and maternity services, and hospital services during birth. It also helps pay for newborn home visits. |
| Sexual Health | NH Medicaid will cover some services related to sexual health as long as they are referred by a doctor. |
|---|---|
| Gynecologist visits | Yes, if referred by a physician. |
| Erectile Dysfunction | Yes, if treated and diagnosed by a physician. |
| Birth Control | Yes, upon eligibility and through the Family Planning Medical Assistance Program. |
| Fertility Treatment | Only through group benefits plans. Currently, there is no assistance for medicaid recipients to receive fertility treatment. |
| Specialist Services | NH Medicaid offers coverage for several specialist services, but only if they are medically necessary: |
|---|---|
| Dermatology | If your primary care physician refers you to a dermatologist for medically necessary reasons, Medicaid may cover your dermatology appointment. However, New Hampshire Medicaid typically won’t cover most dermatology services, especially cosmetic procedures. |
| Physiotherapy | Medicaid may cover physiotherapy services if your primary care provider deems them medically necessary. Additionally, NH Medicaid pays for physical therapy services, occupational therapy, and other similar services. |
| Massage Therapy | If your doctor prescribes massage therapy, NH Medicaid will likely cover it. Otherwise, you’ll have to pay for it out of pocket. |
| Podiatry and Foot Care | You can receive coverage through Medicaid to see a podiatrist, as it covers routine, preventative, and some specialty foot care. |
| Allergy Testing | NH Medicaid will cover allergy testing when medically necessary, such as if you experience severe allergy-related symptoms. |
| Sleep Physician Services and CPAP Machines | Medicaid covers the costs for multiple types of durable medical equipment, including CPAP machines, but you must have a medical necessity for these machines. |
New Hampshire Medicaid helps pay for numerous essential health care services. If you’re eligible for this program, you can receive coverage for a wider range of medical treatments and services at little to no cost. However, many Medicaid enrollees extend their coverage further by enrolling in a third-party insurance plan. You can use private insurance providers to fill the gaps in your NH Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
Whether you have a separate insurance policy through an employer or group healthcare plan, you can use it in conjunction with your Medicaid. We call this relationship the Coordination of Benefits. By combining policies, you can extend your coverage and enjoy numerous benefits, such as the ability to see out-of-network doctors, fewer or lower copays, and additional benefits.
At Insurdinary, our insurance professionals understand how crucial it is to have affordable health insurance and sufficient coverage. While New Hampshire Medicaid certainly covers plenty, it doesn’t cover everything. We also know that Medicaid’s strict eligibility requirements make it difficult for many to even qualify for coverage.
If you’re looking for affordable health insurance, you don’t have to settle for a coverage-lacking policy. Our network of insurance professionals can help you explore plans with the coverage you need and the premiums you can afford.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
