New Hampshire
This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.
Medicaid Coverage Information Published
State Contact Information
Henry Lipman
Medicaid Director
Office of Medicaid Business and Policy
New Hampshire Department of Health and Human
Services
129 Pleasant Street
Concord, NH 03301-6521
Phone: (603) 271-4344
https://medicaiddirectors.org/wp-content/uploads/2023/06/Public_DirectorsList_June2023-1.pdf
General Genetic Testing Criteria
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
Licensure is required. You must complete the following requirements to be eligible to apply:
- Master’s Degree in Human Genetics
- American Board of Genetic Counseling (ABGC) Certified
The following link will direct you to a complete checklist for genetic counselor applicants:
https://www.oplc.nh.gov/sites/g/files/ehbemt441/files/inline-documents/sonh/genetic-counselor-checklist-for-initial-application.pdf
Metabolic Formula Coverage Legislation
NH Rev Stat § 415:6-c (2015)
Metabolic Formula Coverage & Criteria
415:6-c Coverage for Nonprescription Enteral Formulas. –
Each insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance who are residents of this state, coverage for the provision of nonprescription enteral formulas for the treatment of impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, or motility of the gastrointestinal tract. Such coverage shall be provided when the prescribing physician has issued a written order stating that the enteral formula is needed to sustain life, is medically necessary, and is the least restrictive and most cost effective means for meeting the needs of the patient.
Each insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance who are residents of this state, coverage for the provision of nonprescription enteral formulas and food products required for persons with inherited diseases of amino acids and organic acids. Such coverage shall be provided when the prescribing physician has issued a written order stating that the enteral formula or food product is medically necessary and is the least restrictive and most cost effective means for meeting the needs of the patient. Coverage for inherited diseases of amino acids and organic acids shall, in addition to the enteral formula, include food products modified to be low protein in an amount not to exceed $1,800 annually for any insured individual.
The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the service provided.
Prior Authorization Requirements
Instructions for Fee-for -Service Authorization Forms: https://nhmmis.nh.gov/portals/wps/wcm/connect/cfb10baa-0c2d-4ee3-9561-98800ef579ce/Instructions+Fee-for-Service+Authorization+Forms+07.2023.pdf?MOD=AJPERES&CVID=oDviiov
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Coverage is available, but criteria is unknown.
Requirements for BRCA
Cystic Fibrosis Screening
Coverage is available, but criteria is unknown.
Hereditary Cancer Testing Coverage
Lynch Syndrome Testing Coverage
Microarray Testing
Coverage is available, but criteria is unknown.
Newborn Screening
Panel Testing
Coverage is available for breast cancer gene panels and epilepsy genetic sequence panels.
Pharmacogenetic Testing
Prenatal Testing Offered
Coverage is available, but criteria is unknown.
Whole Exome Sequencing
Other Tests Covered
Coverage is available for Fragile X Syndrome.
Other Information
New Hampshire Medicaid will cover antisense oligonucleotide treatments for patients with Duchenne Muscular Dystrophy (DMD. Patient must have documentation of a confirmed diagnosis of DMD with genetic testing and meet all other criteria.
Medicaid will also cover treatment for patients with Spinal Muscular Atrophy. Patient must have documentation of a confirmed diagnosis of spinal muscular atrophy (SMA) and Genetic testing is required to demonstrate SMN1 homozygous gene deletion or mutation. Patients must meet all other criteria.
Resources
Newborn Screening Reimbursement
On this Page
Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.
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