As we move into 2026, the Granite State is navigating a period of “unprecedented disruption” in the healthcare market. The headlines have been dominated by the significant market shifts: Anthem Blue Cross Blue Shield and Martin’s Point Health Care have officially exited the individual Medicare Advantage market statewide.
For Home Healthcare Providers New Hampshire, this isn’t just a corporate transition; it’s an operational reset. Approximately 77,000 residents are transitioning to new coverage, and for home care agencies, this means a massive wave of re-credentialing, authorization updates, and potential “gaps in care” that must be managed with clinical precision.
Navigating the MCO Transition with Confidence
While the exit of these major carriers creates uncertainty, the New Hampshire Medicaid Managed Care (MCM) landscape remains anchored by three primary entities: AmeriHealth Caritas, NH Healthy Families, and WellSense Health Plan.
The challenge for agencies in 2026 is the “transition of care” protocol. When a patient moves from a discontinued Anthem or Martin’s Point plan to a remaining carrier, authorizations do not always migrate automatically. Agencies must be proactive in securing new prior authorizations to ensure that services and reimbursements are not interrupted.
To stay ahead of these administrative hurdles, local providers are increasingly relying on specialized myEZhome care software. A centralized system allows you to track every patient’s payer status in real-time, flagging those impacted by the 2026 exits so you can secure new contracts and authorizations before the first visit of the month.
New Federal and State Mandates for 2026
Beyond the carrier exits, New Hampshire is grappling with the implementation of the federal One Big Beautiful Bill Act (OBBBA). This law introduces stricter eligibility checks and work requirements for Medicaid expansion recipients (Granite Advantage Health Care Program).
For home care agencies, this adds a layer of “eligibility risk.” If a patient loses their Medicaid coverage because they failed an eligibility check or a work requirement, the agency may find itself providing uncompensated care.
Essential Operational Safeguards:
- Real-Time Eligibility Tracking: Your EHR must perform batch eligibility checks at least weekly to catch coverage lapses before the caregiver arrives at the home.
- Prior Authorization Management: With NH Healthy Families implementing new, faster prior authorization response times as of January 1, 2026, your team needs to be equipped with digital tools to submit and track these requests instantly.
Maintaining Compliance in a High-Stakes Environment
As the state budget adjusts and provider taxes are reduced, the New Hampshire Department of Health and Human Services (DHHS) is shifting its focus toward “Value-Based Outcomes.” This means that agencies will increasingly be judged and paid based on their ability to prevent hospital readmissions and maintain patient stability in the home.
Compliance is no longer just about filling out forms; it is about data integrity.
- Electronic Visit Verification (EVV): In 2026, there is zero tolerance for manual timesheets. An integrated EVV system is required to provide the GPS-verified “proof of care” that Medicaid auditors demand.
- Security and Privacy: With the surge in digital data sharing between agencies and the remaining MCOs, ensuring your infrastructure is fully hipaa compliant is your best defense against both cyber threats and regulatory fines.
Building a Resilient Future for Granite State Care
The 2026 roadmap for New Hampshire home care is one of consolidation and technical maturity. The “Anthem-Martin’s Point Exit” serves as a wake-up call: agencies cannot rely on a stagnant payer mix. Resilience comes from being able to pivot quickly to new contracts and demonstrate clinical value through transparent data.
By unifying your scheduling, billing, and clinical documentation into a single platform like myEZcare, your agency can turn these market disruptions into a competitive advantage. When the administrative heavy lifting is automated, your team can return to what they do best: providing high-quality, compassionate care to the people of New Hampshire.
Frequently Asked Questions:
What happens to my patients who were on Martin’s Point or Anthem?
Most have been moved to WellSense, Humana, or AmeriHealth. You must verify their new ID cards immediately and ensure your agency is credentialed with their new plan.
Are there new work requirements for NH Medicaid in 2026?
Yes, under the OBBBA and the state budget, many expansion adults are now required to engage in 80 hours of work or community service per month to maintain coverage.
How do I handle prior authorizations for transitioning patients?
New Hampshire has a “Transition of Care” policy that usually provides a 60–90 day grace period for existing authorizations, but you must submit new requests as soon as possible to avoid a hard denial later.
Is there more funding for nursing home care in 2026?
Yes, the SFY 2026 budget allocated an additional $4.5 million to adjust nursing facility per diem rates and address access-to-care concerns.
Can my software help me track these changes?
Yes. Modern home care platforms allow you to set custom alerts for “Payer Expiration” and “Eligibility Gaps,” which is essential for managing the 2026 transition.
