By Granite State Report Staff

New Hampshire’s health care access in 2025 is a tale of two realities. On paper, the Granite State ranks among the nation’s best for coverage and clinical capacity, buoyed by low uninsured rates, record Marketplace sign-ups, and a decade of Medicaid expansion. In practice, many residents still hit walls: finding an OB unit within an hour’s drive, a nursing home with staffed beds, a timely behavioral health bed, or an affordable bill even after insurance. This report synthesizes the latest state and federal releases, independent research, and local reporting to map where access stands today—and where focused policy could move the needle fastest.

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1) Coverage: Broad but Uneven—And at Risk of Policy Whiplash

Uninsured rate and coverage composition. New Hampshire remains one of the most insured states. America’s Health Rankings estimates the uninsured share at about 4.7%, well below national averages. That progress has held even as pandemic-era Medicaid protections unwound nationally. (America’s Health Rankings)

ACA Marketplace enrollment. Exchange take-up surged again: the New Hampshire Insurance Department reported a record 70,337 plan selections for 2025 coverage—an all-time high for the state—mirroring national enrollment gains linked to enhanced premium subsidies. (New Hampshire Department of Insurance)

Medicaid expansion (Granite Advantage). New Hampshire’s expansion program covers roughly 59,000 low-income adults (as of spring–summer 2025), with point-in-time DHHS enrollment rounding to ~59k in March–July. The program’s income thresholds and other details are summarized by state and advocacy sources. (New Futures)

Permanence? Not quite. Although the Senate backed making expansion permanent in 2023, the House declined in January 2024; the compromise in place keeps the program authorized for seven years rather than permanently. In other words, Granite Advantage is stabilized for now but not locked into statute forever. (AP News)

Post-pandemic churn and policy friction. As eligibility redeterminations resumed, analysts flagged modest declines in Medicaid coverage and warned that proposals such as work requirements or new premiums would push some adults off coverage—raising uncompensated care risks and access barriers. NHFPI’s 2025 analysis estimated about 1 in 8 residents were on Medicaid in 2024, with expansion adults about 1 in 13—and noted that new cost-sharing or administrative hurdles could depress enrollment further. (NHPR)

Bottom line. Coverage is broad—thanks to Marketplace uptake and expansion—but not immune to policy reversals. Keeping gains will require guarding against administrative friction, especially for near-poverty adults whose coverage hinges on small cost and paperwork barriers.

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2) Affordability & Transparency: The Bill (Still) Bites

Premiums and cost drivers. At the system level, New Hampshire’s Insurance Department reports that fully-insured premiums rose 3.3% in 2023, with small- and large-group rates up 5–6%, while particular service lines and pharmaceuticals continued to push claim trends. Though not catastrophic, these increases stack on earlier rises and high deductibles, keeping out-of-pocket exposure a persistent access barrier. (New Hampshire Department of Insurance)

Shopping tools. The state’s long-running NH HealthCost website lets consumers compare procedure prices by plan and provider, an unusually robust public tool in a fragmented market. Used well, transparency can steer some shoppable care—but it won’t solve workforce shortages or the math of hospital fixed costs. (NH Health Cost)

What it means for access. Insurance ≠ affordability. Even insured residents delay or skip care when copays and deductibles loom large. Rates have not spiraled, but they outpace many household budgets—especially in a high-cost state.

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3) Primary Care, Telehealth, and the Front Door to the System

Primary care capacity. The Northeast generally enjoys denser clinician supply, and recent workforce summaries show the region—including New Hampshire—well above national averages in primary care providers per capita. (The United Health Foundation reports ~358 primary care providers per 100,000 residents counting physicians, NPs, and PAs; AAMC’s 2024 national overview cites ~86 primary care physicians per 100k nationwide.) Still, pockets of shortage persist. (America’s Health Rankings)

Shortage designations. Federal shortage maps confirm HPSA designations across parts of New Hampshire for primary care, mental health, and dental, a reminder that statewide averages mask rural gaps. HRSA’s data tools and quarterly reports track where shortages are most acute and how many clinicians would be needed to lift them. (HRSA Data)

Telehealth as an access multiplier. New Hampshire is among the most telehealth-friendly states. Statute and rule changes now recognize audio-only telehealth and require broad reimbursement parity for medically necessary services in both Medicaid and commercial markets—keeping virtual care viable beyond the pandemic. Active legislative attention continues (e.g., a 2025 measure directing a new study on telehealth services). (CCHP)

Takeaway. New Hampshire’s “front door” generally works—especially with telehealth normalization—but workforce gaps in specific towns and specialties still mean the difference between a prompt appointment and a months-long wait.

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4) Behavioral Health: Progress, Deadlines, and Detours

The boarding crisis and “Mission Zero.” For years, patients in psychiatric crisis have been boarded in emergency departments for hours or days while awaiting inpatient beds. A federal court held aspects of the practice unlawful; deadlines to end boarding were set, then extended to March 2025 as the state worked to expand capacity and redesign intake. DHHS’s Mission Zero initiative anchors that push. (AP News)

Signals of improvement. By late 2024, DHHS reported no adults waiting for inpatient psychiatric placement on some days—an encouraging milestone, though not consistently sustained for all populations or times. Stakeholders continue to report periodic backlogs and variation by region. (WMUR)

Crisis system build-out. New Hampshire’s Rapid Response (call/text/chat) and mobile crisis teams now operate statewide, with 46,000+ contacts handled in 2024. Two 23-hour crisis stabilization centers (Derry and Laconia) offer short-stay alternatives to ERs. Continued investments in 988 staffing and marketing aim to keep the front end strong. (New Futures)

Forensic hospital delays. To relieve pressure on New Hampshire Hospital and end the practice of housing some civil or forensic patients in prison settings, the state began building a 24-bed forensic psychiatric hospital in Concord. Construction, initially slated for a 2025 completion, is now delayed amid foundation design problems and a 2025 construction halt; the project timeline has slipped into 2026 or later. (NHPR)

Bottom line. Crisis access and due-process safeguards are improving; inpatient bottlenecks are easing but not eliminated, and infrastructure delays complicate the final mile. Sustained operating funds for mobile teams and bed capacity (adolescent, adult, and forensic) remain essential.

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5) Maternal Health: Maternity Care Deserts, Unit Closures, and Long Drives

Unit closures and shrinking options. Over the last two decades, nearly half of New Hampshire hospitals have closed labor and delivery units, especially in rural regions, citing low volumes, staffing challenges, and reimbursement shortfalls. The Attorney General has approved several closures; independent birth centers have also shuttered (e.g., Concord Birth Center in 2023; Monadnock Birth Center in 2025), reducing choices further. Local reporting captures the lived consequences: longer travel times and fear of “car births.” (New Hampshire Bulletin)

Maternity care deserts. Nationally, 35% of counties lack adequate maternity care; New Hampshire’s rural counties feel the strain, with desert or low-access classifications in parts of the North Country. March of Dimes’ 2024 report card and desert maps frame the broader context of rising travel distances and delayed prenatal care. (The Guardian)

State response. DHHS’s State of Maternal Health (2024) outlines goals under the Maternal Health Blueprint (e.g., access, safety, equity), but the structural realities—shrinking birth volumes, staffing shortages, and payer mix—make unit sustainability hard without targeted supports. Research from the Urban Institute underscores how rural L&D closures intertwine with low volume and Medicaid reimbursement dependence. (NHDHHS)

Access takeaway. Maternal care is the most visible access fracture in New Hampshire. Tele-OB consults can mitigate risk, but safe delivery often hinges on proximity. Policymakers face a hard tradeoff: subsidize low-volume units, regionalize and fund transport, or accept longer drives with stronger contingency planning.

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6) Oral Health: A Big Gap Finally Addressed—Now Comes the Network Challenge

Adult Medicaid dental coverage arrives. After years of advocacy, New Hampshire launched comprehensive adult dental benefits for Medicaid on April 1, 2023 (New Hampshire Smiles Adult Program), building on 2022 legislation. A 2025 independent assessment details implementation and utilization to date. (NHDHHS)

Access vs. acceptance. As other states have found, adding a benefit does not guarantee provider participation; low reimbursement can limit dentist acceptance of Medicaid, leaving travel and wait times high. National reporting that included New Hampshire highlighted these participation barriers and the scale of new spending. (AP News)

Why it matters. Unmet dental needs drive ER visits and complicate chronic disease management. Coverage was the prerequisite; ensuring adequate networks and timely appointments is the real access test for 2025–2027.

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7) Hospitals, Capacity, and Workforce: The Back-End Constraints

Hospital operating pressures. After pandemic operating losses, New Hampshire’s systems have slowly regained footing. Dartmouth Health, for example, reported a return to positive operating margins in late 2024 and subsequently secured a stable bond outlook in 2025—markers of improving, if fragile, finances. (Becker’s Hospital Review)

Workforce shortages. A 2024–2025 snapshot from the NH Hospital Association flagged high bed occupancy (≈89%) and persistent vacancy rates (≈11% overall; 14% for RNs)—clear constraints on throughput and elective capacity. The downstream effect is felt everywhere from ED waits to surgical scheduling and discharge planning. (New Hampshire Hospital Association)

Post-acute bottlenecks. Staffing shortages in nursing homes have forced facilities to limit admissions, keeping hospital beds occupied with patients waiting for long-term care placement. New federal staffing mandates (now partially blocked in court) underscored the tension: quality and safety goals vs. an already thin workforce. New Hampshire facilities say only about a quarter could meet the proposed standard with current staffing. (NHPR)

Home health and hospice. Surveyed providers report high vacancy and turnover; when agencies decline services due to staffing, hospital discharge delays ripple outward. (Healthforce NH)

Implication. Workforce is the dominant rate-limiting step. Recruiting and retaining nurses, aides, and behavioral health clinicians matters as much as brick-and-mortar capacity.

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8) Substance Use & Overdose: Signs of Progress, Vigilance Required

Overdose trends. Preliminary 2024 data show sharp declines in New Hampshire overdose deaths—roughly 282 confirmed deaths, down about 35% year-over-year—though potent synthetic opioids (including carfentanil) remain a serious threat regionally and nationally. DHHS’s Drug Monitoring Initiative and CDC surveillance both emphasize volatility in the illicit drug supply. (BostonGlobe.com)

System response. Local cross-agency response teams, expanded medication-assisted treatment access, and stronger 988/rapid response integration with SUD services likely contributed to gains—but the situation can reverse quickly with supply shifts. Continued data sharing and community-level outreach remain essential. (AP News)

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9) Where Access Is Strong—and Where It Breaks

Strengths

• Coverage: Low uninsured rate, strong Marketplace and Medicaid take-up. (America’s Health Rankings)
• Telehealth parity: Permanent coverage for audio-only and video services across payers preserves virtual access. (CCHP)
• Transparency: A mature price-comparison portal (NH HealthCost) helps consumers shop shoppable services. (NH Health Cost)
• Crisis continuum: Statewide Rapid Response, mobile teams, and stabilization sites reduce ER dependence. (New Futures)

Pressure points

• Maternal care deserts: Unit closures leave long travel times in rural counties. (NHPR)
• Behavioral health beds: Progress but periodic backlogs; forensic facility delays. (NHPR)
• Post-acute care: Nursing home staffing shortfalls block hospital throughput. (New Hampshire Bulletin)
• Affordability: Premiums and deductibles still lead many to delay care. (New Hampshire Department of Insurance)

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10) What’s Working Elsewhere—and Practical Moves for New Hampshire

A. Stabilize rural maternity access (and transport)

• Targeted subsidies or global budgets for low-volume OB units (piloted in some states) to preserve essential services where regionalization isn’t realistic.
• Tele-OB hubs linking rural L&D to tertiary centers, with funded maternal transport (including weather-resilient ambulance capacity) as a defined benefit.
• Birth center viability grants tied to Medicaid rates and quality metrics to prevent further closures.
  Rationale: Peer-reviewed work shows travel time to obstetric hospitals is a central risk factor; deserts correlate with worse outcomes. (PMC)

B. Finish the behavioral health “last mile”

• Complete the forensic hospital and expand step-down/short-stay capacity; publish quarterly boarding metrics tied to Mission Zero targets.
• Lock in 988 staffing and mobile team sustainability with multi-year contracts.
  Rationale: Court deadlines, clinical safety, and hospital relief all hinge on bed capacity and rapid alternatives to ER boarding. (NHPR)

C. Prevent workforce from becoming destiny

• Loan repayment and housing stipends for nurses, behavioral health clinicians, and dentists in HPSAs; align state incentives with HRSA shortage maps.
• Scale clinical ladders and paid preceptorships (LNA→LPN→RN) with rural premiums.
• Create a “placement concierge” linking hospitals to nursing homes with real-time staffed-bed visibility to speed discharges.
  Rationale: HPSA designations quantify the gap; targeted incentives move the needle faster than generic wage bumps. (HRSA Data)

D. Make adult Medicaid dental real, not theoretical

• Raise targeted dental rates for key codes (endo, dentures, extractions) and simplify credentialing to expand participation; seed mobile dental in care deserts.
• Integrate dental with primary care/SUD through co-location grants.
  Rationale: Benefit launch was step one; network adequacy determines access. (NHDHHS)

E. Keep care affordable at the point of use

• Expand cost-sharing reduction wrap programs for Marketplace enrollees up to 250%–300% FPL; strengthen navigators to reduce churn.
• Use HealthCost data to push bundled, fixed-price electives (imaging, colonoscopy) with employer steering incentives.
  Rationale: Even small copays deter use; predictable consumer prices improve adherence for shoppable care. (NH Health Cost)

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11) The Outlook: High Coverage, Targeted Friction

New Hampshire has done the hardest part: keep people insured. With uninsured rates among the lowest in the country and record Marketplace selections, the coverage floor is solid. But “access” depends on distance, delay, and price—and on whether there’s a staffed bed or an accepting provider at journey’s end.

In 2025, the decisive plays are not universal reforms but surgical, sector-specific fixes:

• Fund and finish behavioral health infrastructure while locking in mobile crisis staffing.
• Backstop rural maternity with operating support, tele-OB, and transport.
• Staff the back end—nursing homes and home health—so hospitals can flow.
• Pay dentists and mid-level oral providers enough to grow Medicaid networks.
• Protect expansion coverage from new friction that would turn paperwork into a wall.

Do those things, and the state’s enviable coverage can translate into care on time, close to home, and within reach—the true definition of access.

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Sources

• Uninsured and coverage rankings: America’s Health Rankings, uninsured and provider measures; AAMC workforce overviews (2023–2024). (America’s Health Rankings)
• Marketplace enrollment: NH Insurance Department press release on record 2025 enrollment. (New Hampshire Department of Insurance)
• Medicaid enrollment and policy: DHHS point-in-time enrollment (July 2025); NHFPI analyses on 2024–2025 coverage; New Futures expansion briefs. (NHDHHS)
• Medicaid expansion authorization: AP report on Senate permanence vote (Mar. 2023); NH Bulletin on House declining permanence (Jan. 2024). (AP News)
• Premiums and cost drivers: NH Insurance Department 2024 Annual Hearing fact sheet and materials. (New Hampshire Department of Insurance)
• Price transparency: NH HealthCost portal and documentation. (NH Health Cost)
• HPSA/shortage mapping: HRSA quarterly HPSA report (Apr. 2025) and HPSA-Find tool. (HRSA Data)
• Telehealth parity: CCHP state summary; NH emergency order history; 2025 telehealth study legislation. (CCHP)
• Behavioral health boarding & reforms: Federal ruling coverage and deadlines; DHHS Mission Zero; NHPR and stakeholder roundtables. (AP News)
• Forensic hospital timeline and delays: NHPR ground-breaking (2023); Concord Monitor status (2024); InDepthNH updates (May 2025). (NHPR)
• Crisis system metrics: New Futures 988 snapshot (contacts, MCTs, stabilization). (New Futures)
• Maternal access: NH Bulletin on maternity closures; NHPR/Boston Globe features; March of Dimes report card/desert maps; Urban Institute research; AHR maternity desert measure. (New Hampshire Bulletin)
• Adult Medicaid dental: DHHS press release (Apr. 2023) and 2025 assessment; AP national context on dentist participation. (NHDHHS)
• Hospitals & workforce: Dartmouth Health operating/bond outlook; NHHA “Hospitals at a Glance” (Dec. 2024) with vacancy/occupancy data. (Becker’s Hospital Review)
• Nursing home staffing: NH Bulletin and NHBR on CMS rule feasibility; court ruling halting staffing rule; NHPR survey history. (New Hampshire Bulletin)
• Overdose trends: Boston Globe (Mar. 2025) on 2024 death declines; DHHS Drug Monitoring Initiative; CDC reports on fentanyl analogs. (BostonGlobe.com)
• Aging & demographic pressure: Census profile and press release (2025) showing NH among states where older adults now outnumber children; NHFPI demographic briefs. (Census Data)

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Editor’s note: Data current as of September 15, 2025. Where sources differ (e.g., varying provider counts by methodology), we present ranges or specify series and years to keep comparisons fair and transparent.