New Hampshire Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in New Hampshire's plan contracts, statutes and notices. For 11 of 21 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 11of 21
- Plans on record
- 5
- Directed payments
- 1
- Capitation cells
- 189$256.42–$37,283.92 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 9,324 | Plans must pay at least thisPaid by the state, outside plans |
| Hospital inpatient | Plans must pay at least thisPlans must pay at least the published rate | 7,179 | |
| Hospital outpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 3,480 | |
| Equipment & supplies | Not classified yet | 2,086 | |
| Lab & pathology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,370 | Plans must pay at least this |
| Pharmacy | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,037 | |
| Radiology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 635 | |
| Behavioral health | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 371 | Paid by the state, outside plansPlans must pay at least this |
| Dental | Paid by the state, outside plansPaid directly by the state, outside managed care | 358 | |
| Vision & hearing | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 141 | Paid by the state, outside plans |
| Nursing facility | Paid by the state, outside plansPaid directly by the state, outside managed care | 101 | Plans negotiate; applies out of network |
| Clinics (FQHC/RHC) | Plans must pay at least thisPlans must pay at least the published rate | 99 | Plans negotiate; applies out of network |
| Other home & community services | Paid by the state, outside plansPaid directly by the state, outside managed care | 82 | Plans negotiate; applies out of networkPlans must pay at least this |
| Other | Paid by the state, outside plansPaid directly by the state, outside managed care | 77 | Plans must pay at least thisState-directed payment |
| IDD services | Paid by the state, outside plansPaid directly by the state, outside managed care | 73 | Plans negotiate; applies out of networkPlans must pay at least this |
| Hospice | State sets the plan rateThe state sets the rate plans pay | 51 | |
| Therapy (PT/OT/speech) | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 49 | Paid by the state, outside plans |
| Transportation | Plans must pay at least thisPlans must pay at least the published rate | 23 | Paid by the state, outside plans |
| Home health | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 13 | Paid by the state, outside plans |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 12 | Plans negotiate; applies out of network |
| Private duty nursing | Plans must pay at least thisPlans must pay at least the published rate | 12 | Paid by the state, outside plans |
| ABA / autism services | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 8 | Paid by the state, outside plans |
State-directed payments
Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.
| Program | Amount | Effective |
|---|---|---|
| New Hampshire state directed payment: DME and supplies at a minimum 80% of the DHHS FFS State Plan fee schedule | 80% | 2026-07-01 |
Frequently asked questions
Do New Hampshire Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Hospital inpatient, Lab & pathology, Behavioral health, Clinics (FQHC/RHC), Other home & community services, Other, IDD services, Hospice, Transportation, Private duty nursing. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From New Hampshire's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.
← All New Hampshire Medicaid rates