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CMS approved New Hampshire's spending plan for approximately $205 million in federal Rural Health Transformation Program funding awarded in late 2025. The GO-NORTH initiative will fund rural health infrastructure and service delivery improvements across the state. The approval allows New Hampshire to begin deploying federal dollars for rural provider support and access expansion. Medicaid managed care organizations operating in rural New Hampshire counties should anticipate changes in provider networks and potential care delivery model shifts as these federal investments take effect.
A federal judge has scheduled a November 2026 trial to determine whether New Hampshire's Choices for Independence program violates federal law by failing to provide adequate home and community-based services for elderly individuals and people with physical disabilities. The case centers on allegations that the state's LTSS program forces beneficiaries into institutional settings in violation of the Americans with Disabilities Act and the Supreme Court's Olmstead decision. The trial outcome could establish precedent for evaluating HCBS adequacy and state compliance with federal integration mandates. U.S. District Judge Paul Barbadoro will hear evidence on whether the program meets federal standards for community-based care.
In June 2025, Governor Kelly Ayotte signed New Hampshire's two-year budget cutting $51 million from the Department of Health and Human Services and imposing new Medicaid copays and premiums on certain recipients. The budget also reduced Department of Corrections funding by $10 million and cut support for the state university system. The policy changes affect Medicaid beneficiaries and state health services delivery. Managed care organizations operating in New Hampshire will need to implement the new cost-sharing requirements and adapt to reduced state DHHS capacity.
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