The New Hampshire Granite Advantage Health Care Program represents a significant initiative in the state’s healthcare landscape. Established under New Hampshire RSA 126-AA, this program is designed to provide health care coverage and is supported by assessments collected on behalf of the State of New Hampshire. It effectively replaced the Marketplace Premium Assistance Program, previously operating under New Hampshire RSA 126-A:5(:XXV).
The program’s financial structure is outlined in the 2018 Statutory Amendments, which amended RSA 404-G and other statutes. These amendments mandate the Association—likely referring to an insurance or healthcare association within New Hampshire—to continuously collect assessments from its members. These funds are then deposited into the Granite Advantage Health Care Trust Fund. The amount collected is capped, not exceeding the “remainder amount” as defined in RSA 126-AA:1(V) or the revenue transferred from the alcohol abuse prevention and treatment fund (RSA 176-A:1(IV)), alongside taxes from premiums and medical services for the newly Medicaid-eligible population.
To adapt to these statutory changes, the Association adopted a First Amendment to its Restated Plan. This amendment, approved by both the Commissioner of the New Hampshire Department of Health and Human Services and the Insurance Commissioner, authorizes the Association to redirect funds no longer needed for the Marketplace Premium Assistance program. These funds can be moved to a reserve fund, specifically for potential needs arising from supporting the Granite Advantage Program.
However, the 2018 Statutory Amendments also set a termination date for the Granite Advantage Program. Unless future legislation extends it, the program is scheduled to end on December 31, 2023. Consequently, the Association is expected to make its final distribution of assessment proceeds to the Granite Advantage Health Care Trust Fund by February 15, 2024. Following this, the Commissioner of the Department of Health and Human Services will determine the final remainder amount by February 15, 2025, and report it to the Association. This report will initiate a “true-up” process. If assessments have underpaid the final remainder, the Association will cover the deficit from its reserves or through a special assessment on its members if reserves are insufficient. Conversely, any overpayment will be returned to the Association within 45 days of the Commissioner’s report.
