Federal, exists in every state
Help with a work-plan premium (premium assistance)
NH’s Health Insurance Premium Program can help with qualifying employer-plan premiums when a child has full Medicaid and DHHS finds the coverage cost effective.
What it is
NH’s Health Insurance Premium Program can help with qualifying employer-plan premiums when a child has full Medicaid and DHHS finds the coverage cost effective.
NH’s Health Insurance Premium Program can consider employer-plan premiums when a child has full Medicaid. DHHS checks the employer contribution, benefits, approved premium and whether keeping that coverage is cost effective; your answers here cannot decide those policy-specific tests.
Eligibility rules
- NH’s Health Insurance Premium Program can consider employer coverage for a person eligible for full Medicaid, including a child. The employer must contribute, the coverage must pass DHHS’s cost-effectiveness review, and the family must supply the premium, benefits, cost-sharing and other-insurance details. The rules exclude routes such as COBRA, coverage without an employer contribution, temporary coverage and In-and-Out-only Medicaid from this HIPP route. Medicaid eligibility continues to be determined separately. For an already enrolled employee, reimbursement begins the month after approval, not automatically for earlier premiums; a person not yet in the employer plan has a separate 15-day enrollment step after approval. DHHS HIPP can provide the current application and written explanation of the approved premiums and coverage arrangements.
- The cited He-W 511 rules took effect September 20, 2024. DHHS confirms the approved premium and reimbursement start date in writing.
What you get
- Payment of premiums approved by NH DHHS under its Health Insurance Premium Program.
What coverage includes
- The work plan stays the first payer. Medicaid coverage and premium help have separate rules.
If you decide to apply
- Ask the hospital enrollment specialist whether your child’s Medicaid and employer coverage meet NH’s Health Insurance Premium Program rules.
- Have ready your child’s Medicaid information and the employer’s premium breakdown.
NH DHHS Health Insurance Premium Program · 603-271-5218 · request the current application and a written explanation of reimbursement and treatment-coverage arrangements. · Official page ↗
Good to know
Premium help does not cover every family member or every work-plan bill. The enrollment specialist can check how treatment and billing would work before you choose.
Treatment and billing
- NH’s Health Insurance Premium Program is real, but approval of a premium does not mean every family member or every work-plan bill is covered. The employer plan pays first. NH rules provide fee-for-service Medicaid payment for covered Medicaid services the employer plan does not cover, so the enrollment specialist needs to confirm the Medicaid plan arrangement, provider enrollment and existing treatment approvals before a change. Family members who do not have Medicaid do not acquire Medicaid cost-sharing protection through this program. DHHS must explain which premium and cost-sharing amounts it approves and which remain yours. Existing premiums remain due until the reimbursement arrangement is confirmed.
Official sources
“Can New Hampshire help with our work-plan premium, and would that change our child’s Medicaid plan or treatment access?”
Why I’m asking: Premiums can remain a large bill even when Medicaid helps with treatment costs.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Get the employer rate sheet, file the state form the month Medicaid is approved, and keep the plan active.
Your social worker
The social worker finds the state HIPP contact and checks whether approval would change your child's Medicaid plan.
The care team
Records and letters when the application asks for them.
- Who decides
- The state HIPP unit, on cost-effectiveness
- Ask HR
- “Can you show what I pay each pay period for my child's medical coverage? Medicaid needs that amount to check help with the premium.”
How to apply
First step: Once Medicaid approves your child, ask the social worker for the state HIPP contact. Request the application and employer premium form.
- Ask HR for the premium rate sheet for medical-only dependent coverage.
- Apply the month Medicaid is approved.
- Ask first whether HIPP changes the child's Medicaid plan.
Where it starts: State form after Medicaid approval
What to gather
- Employer premium rate sheet showing the employee share for medical-only coverage
- The plan's summary of benefits
- The child's Medicaid ID
How long: A cost-effectiveness review by the state. Ask for the expected turnaround when you file.
What a yes looks like
A letter naming the reimbursed amount and how it is paid (to you or to the employer).
What a no looks like, and the next move
“Not cost-effective” or “no employer plan”. Ask what changed the math and whether a new plan year reopens it.
Watch out
- Ask first whether help paying the work-plan premium moves your child out of the Medicaid managed-care plan (California: yes, fee-for-service only. Texas: no rule found).
- The state needs the employer's premium breakdown for medical-only coverage per pay period. Ask human resources for the rate sheet before you apply.
- Approval usually requires you to keep the employer plan. Deductibles are not always reimbursed.
Dates that change this
2026-07-31: The federal employer notice listing premium-assistance states was reissued July 31, 2026 (Illinois added, 39 states). Louisiana and Minnesota phone numbers from the January 2026 edition stand until the new PDF is quoted. (not yet confirmed against the final rule)
The numbers and the rules
The arcane layer, kept on purpose. Checked September 7, 2026.
What it is worth
The family's employer premium reimbursed, often monthly, for as long as the state finds it cost-effective.
- Approved employee premium — Approved employee premium
Covers: Private plan stays primary. Medicaid coordinates behind it
Legal protection: A 60-day special-enrollment right in the employer plan follows premium-assistance eligibility or a Medicaid/CHIP loss
What it costs the family: State-specific.
The eligibility facts, as published
- Medicaid required
- yes
- Employer plan required
- enrolled or available
- Cost effectiveness
- yes
- Delivery system condition
- per state (CA fee-for-service only; TX none found)
Decisions this site cannot make: Cost-effectiveness review
Expect friction on: Employer rate sheet required · Periodic review
The trap: In some states help paying the work-plan premium moves the child out of the Medicaid managed-care plan (California: fee-for-service only. Texas: no rule found). Ask before you apply.
What changes by state: Whether it exists (38 states in the January 2026 federal list, Illinois added in July), the phone number, and the managed-care condition.
Where I read this
- Coordination of Benefits and Third Party Liability — Centers for Medicare & Medicaid Services, read August 27, 2026
- Model employer CHIP notice (premium assistance under Medicaid and CHIP) — U.S. Department of Labor, EBSA, read September 7, 2026