As early as January 2014, states took advantage of the federal government’s offer in the Affordable Care Act to provide substantial support to expand Medicaid health coverage to the newly eligible low income adult population. Some states also considered seeking new restrictions on eligibility, including work requirements, with a focus on adults in the expansion population. New Hampshire was one of few states that passed legislation to require work and community engagement activities as a condition of eligibility for its Medicaid expansion population. Because such requirements are not otherwise allowed under federal rules, the NH Department of Health and Human Services (NH DHHS) applied for and received waiver approval from the Centers for Medicaid and Medicare Services (CMS) to implement Work and Community Engagement Requirements ("WACER”). In March 2019, when the WACER went into effect, NH Medicaid covered 50,411 beneficiaries in the Medicaid expansion program, making up almost 30 percent of the total Medicaid-covered population.