“In the past several months, we have seen significant progress toward eliminating hospital emergency boarding for psychiatric patients, but that progress will likely stall if more people lose their ability to pay for treatment, medication, and help with social determinants of health.” (Getty Images)
The 60-year-old Medicaid system, signed into law by President Lyndon B. Johnson in 1965, ensures that individuals have access to critical mental health and substance use treatment, along with primary care. In 2025, the Medicaid system serves about 184,000 individuals in New Hampshire, or 13 percent of the state’s population.
Most people understand what Medicare is but not necessarily Medicaid. While Medicaid and Medicare were signed into law as a package in 1965, the programs are different and distinct. Medicaid is a federal-state partnership intended to provide health insurance coverage to children, women who are pregnant, people with low incomes, and those who may have a disability. New Hampshire’s 10 nonprofit community mental health centers (CMHCs) receive the largest amount of their total revenue from the Medicaid program — between 70 and 90 percent — which enables us to provide care to over 55,000 children and adults annually.
The New Hampshire Legislature is now deliberating bills that propose deeply concerning changes to the Medicaid program, including the imposition of work requirements.
The work requirement bill targets individuals in the Medicaid expansion program — aka the Granite Advantage program — by requiring validation from employers, raising privacy concerns and creating unnecessary stress, particularly for someone with a mental illness. The majority of Granite Advantage enrollees already work, or have appropriate exemptions, yet under the proposed legislation, all enrollees would need to take on more paperwork and run the risk of losing coverage if the paperwork cannot be gathered, validated, or filed in a timely fashion.
There are also proposals being considered by legislative budget writers to impose a monthly premium on Medicaid enrollees and double the copays for prescriptions. While the governor’s spokesperson calls these increases “nominal,” members of the House Finance Committee who have publicly pushed back have said these proposals will “put a financial strain on families, noting that a single parent with two children making around $68,000 could have to come up with an extra $283 a month.” This represents a car payment, food, rent, or child care expenses for a low-income family.
Unlike other states, New Hampshire law mandates that the Granite Advantage program will terminate in 6 months if the federal match for Medicaid drops below 90 percent. (The Granite Advantage program has an enhanced federal match.) There are over 58,000 individuals enrolled in Granite Advantage in 2025. Many of those in this population receive care from community mental health centers, and many will be cut out of the safety net if the federal government chooses to make that change. Others will still be eligible for services, which means centers will be bound to provide continuing care even without Medicaid coverage; this will add to the crushing burden of uncompensated care the CMHCs are already experiencing.
This is the framework to consider as changes to the Medicaid system are being discussed by policymakers in Washington and in Concord. But the impact on revenue is only one part of the story here. There will also be an extended impact on community resources, hospital emergency departments, and first responders if the current Medicaid expansion group loses coverage.
In the past several months, we have seen significant progress toward eliminating hospital emergency boarding for psychiatric patients, but that progress will likely stall if more people lose their ability to pay for treatment, medication, and help with social determinants of health.
Since 2023, the CMHCs have worked collaboratively with the New Hampshire Department of Health and Human Services on the Mission Zero initiative, intended to eliminate ER boarding. Mission Zero includes: (1) expansion of certified community behavioral clinics; (2) location-based centers for crisis stabilization; (3) care traffic control coordination; (4) expansion of DRF beds; (5) expansions in step-down less-restrictive care; and (6) landlord incentives to expand places to remain stably housed. All the work invested in Mission Zero by the state and by the CMHCs is in jeopardy if the Medicaid system is undermined and weakened.
Proposals to dismantle Medicaid and the safety net under the guise of “fiscal responsibility” are misguided and the potential consequences to the citizens of our state are enormous. We have done great work together to support those living with mental illness and addiction over the past several years. We are seeing improvements — let’s not go backward. The New Hampshire Community Behavioral Health Association, representing the CMHCs, strongly opposes any effort to make critical mental health services less accessible to the people we serve.