New Hampshire’s community health centers are on the frontlines of care, but right now we are confronting a crisis. With the passage of New Hampshire’s 2026-2027 State Budget and the federal budget reconciliation bill, new requirements and costs are coming to Medicaid programs that could impact thousands of community health center patients. We are already seeing the results of these sweeping policy changes in site closures.
New Hampshire’s community health centers are staples in their communities, often the only provider for miles around in small rural towns and neighborhoods. They offer a wide range of care to 93,000 Granite Staters, and nearly 23,000 of their patients are Medicaid recipients. They also provide much needed information about health insurance and supportive services for Granite State families such as nutrition education, Veteran services and childcare.
Medicaid makes up a major portion of community health centers’ operating revenue. In New Hampshire, about one quarter of their patients are Medicaid beneficiaries. As a result, Medicaid dollars represent a vital share of the funding that keeps these centers running. Patients on Medicaid who receive care at a community health center save 24% in total Medicaid expenses, thanks to reduced reliance on urgent care, fewer specialty visits and lower hospitalization rates. Community health centers deliver a strong public benefit and are proven stewards of scarce public resources.
The new state and federal policy changes introduce a maze of barriers — including work requirements, more frequent eligibility redeterminations, cost-sharing for individuals covered by the Granite Advantage (Medicaid Expansion) program and monthly premiums for Granite Advantage and CHIP enrollees . These are projected to cause an estimated 20,000 Granite Staters to lose coverage and strip $2.3 billion over the next decade from New Hampshire’s Medicaid budget.
One example of the disproportionate impact these policies will have on low-income families in the Granite State are families living paycheck to paycheck could be kicked off coverage because they cannot afford new monthly premiums. Seniors and people with disabilities might also be forced to re-prove their eligibility for Medicaid several times a year, risking paperwork delays that interrupt lifesaving medications.
Parents working multiple part-time jobs could lose coverage simply because their hours don’t add up neatly on paper. Adults enrolled in Granite Advantage with incomes above $15,650 a year will face new cost-sharing requirements — meaning out-of-pocket expenses for medical services — that could prevent them from seeking needed care.
Even when patients lose their insurance — whether because of increased costs, work requirements or missed paperwork — community health centers continue to provide care. It’s ingrained in our mission and commitment to our community.
This means when someone loses Medicaid, they still come through our doors for a check-up, asthma care or insulin refill. The difference is, instead of Medicaid covering the visit, the community health center absorbs the cost as uncompensated care. As uncompensated care rises, community health centers are faced with impossible choices: cutting staff, reducing services or even closing sites.
We’re already seeing the consequences on the ground: Ammonoosuc Community Health Services’ site in Franconia, which serves about 1,400 patients, is slated to close by the end of 2025 after losing roughly $524,000 in revenue due to Medicaid cuts. Additionally, HealthFirst Family Care Center will close its Canaan site, eliminating primary and behavioral health services in that area. It is fortunate that these patients have other community health center sites to visit, whose staff are eager to assist with any transportation needs. Yet, each closure isn’t just a building shutting down. It’s an indicator of what is yet to come: more visits to the emergency department and less prevention.
Preventive care today saves many times more tomorrow.
Ensuring access to health care is not partisan — it’s fundamental. Community health centers provide quality, cost-effective care in areas that lack access, and they uphold the very principle that your zip code or income shouldn’t determine your ability to stay healthy.
I urge both our federal and state leaders to pause the harmful cuts to Medicaid, protect the Granite Advantage (Medicaid Expansion) program, and reinforce — not undermine — the community health network that tens of thousands of Medicaid enrollees rely upon. The closures already underway serve as a warning: If we don’t act now, the health of countless Granite Staters is on the line.
Tess Stack Kuenning is president and chief executive officer of Bi-State Primary Care Association.