New Hampshire is updating its guidance for Granite Advantage recipients before Medicaid work requirements are scheduled to begin Jan. 1. The state Department of Health and Human Services said federal guidance has broadened the definition of medical frailty, an exemption that can allow some people to keep coverage without documenting work, volunteer service or school enrollment.
Granite Advantage is New Hampshire’s expanded Medicaid program for people who meet income limits. Under the changes described by DHHS, recipients in 2027 generally will have to work, volunteer or attend school to continue receiving benefits unless they qualify for an exemption.
Automatic reviews planned
Jonathan Ballard, the department’s chief medical officer, said during a webinar this week that DHHS is working to help medical providers identify patients who qualify automatically. The department is focusing on people with disabilities and serious medical conditions who may meet the medical frailty criteria without submitting separate proof of work activity.
“It is recommended that we make it as little burdensome on the beneficiary and on the medical providers as possible,” Ballard said.
The state plans to use information already connected to Medicaid claims to make some exemption determinations. DHHS said its review will include:
- Diagnosis codes submitted by health care providers;
- Prescription coverage information; and
- Use of medical equipment such as wheelchairs, mobility devices and respiratory equipment.
Those data points will be used to identify people who meet the legal criteria for medical frailty and automatically assign an exemption status, according to the department. Ballard said the approach is intended to reduce the paperwork required from beneficiaries and providers.
Federal definition changed after court ruling
The change follows an Oct. 29 ruling by a federal judge who found that the Trump administration’s interpretation of medical frailty was too narrow. DHHS is now communicating the updated information to medical providers so they can help patients whose health conditions qualify under the expanded definition.
People who are not automatically identified as exempt may still have a provider or submit an individual statement to DHHS if they believe they meet the medical frailty requirements. The department is using the provider outreach effort to explain how that process will work as the Jan. 1 implementation date approaches.
Ballard said the state received notice of the change shortly before the webinar, adding that DHHS had learned of it “eleven days ago.” The department’s work is focused on translating the federal guidance into the claims reviews, provider submissions and exemption determinations that will be used for Granite Advantage recipients.
