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In January 2027, new Medicaid eligibility requirements go into effect for certain Granite Advantage members. What do these changes mean for you and your family? 2027 Medicaid Changes Starting in January 2027, Granite Advantage members between the ages of 19 and 64 may need to participate in 80 hours of qualifying activities each month. You will need to show you meet these requirements for the 90 day period prior to your renewal date to keep Medicaid coverage. Requirements include a combination of: Work Community service Participation in an approved job training program School or technical education (at least half time) Click here to read more detail about the new requirements. New Eligibility Requirements Some members won’t need to meet the new requirements, including: People with certain disabilities Pregnant and postpartum women Certain caregivers Foster or former foster youth People meeting work requirements of SNAP or TANF People enrolled in a substance use disorder treatment program Please note: you will need to provide paperwork to the state of New Hampshire to prove exemption status. Keeping records now can help avoid problems later. Possible Exemptions from New Requirements It is important to update your contact info with your insurance provider, Amoskeag Health and other providers. Click here to update your info in our Patient Portal. Open all mail or e-mail from Department of Health and Human Services (DHHS). This correspondence may require a response to maintain coverage. You can also gather important medical or legal documents in case you need to show you qualify for an exemption. Having this documentation readily available will reduce confusion when it comes time to provide relevant information to DHHS. What You Can Do Now To Prepare f you receive your health insurance through NH Healthy Families, AmeriHealth Caritas NH, or WellSense Health Plan, you could be covered by NH Medicaid. Some of these plans cover other types of insurance besides Medicaid. Call the number on your card if you need more information about your plan. Not Sure If You Have Medicaid? Keep Reading: Additional Resources What You Need To Know DHHS Requirements Pay Your Bill Retroactive Coverage Medicaid Matters Medicaid Matters

MEDICAL PROVIDER BIOGRAPHY Nicolle Hyder FNP - C Nurse Practitioner Primary Office Location 145 Hollis St. Role/Year Joined Amoskeag Health Nurse Practitioner, 2023 Education Bachelor of Science in Nursing, Grand Canyon University Master of Science in Nursing (MSN), Family Nurse Practitioner (FNP), Rivier University Clinical Interests Pediatrics Family Practice Languages Spoken English Back to Medical Providers

BEHAVIORAL HEALTH CLINICIAN BIOGRAPHY Simone Bazile PMHNP-BC Psychiatric Nurse Practitioner Primary Office Location 145 Hollis Street Year Joined Amoskeag Health 2025 Treatments & Services Mental Health Education Rivier University, Nashua, NH Board Certifications ANCC (American Nurses Credentialing Center) Clinical Interests Adolescent and adults Languages Spoken English, French, Haitian Creole Back to Behavioral Health Clinicians

The first-of-its-kind program has connected more than 2,700 Manchester families to care In its 10-year history, the Manchester Adverse Childhood Experiences Response Team (ACERT) has responded to more than 8,000 incidents involving children. The multidisciplinary program has connected more than 2,700 children and families affected by domestic violence and other crimes to the care and support they need to heal. On Thursday, October 8, partners, local organizations, advocates, and elected officials gathered at SEE Science Center to celebrate ACERT’s 10th anniversary and reflect on the program’s impact over the past decade. The nation’s first program of its kind, ACERT has earned the support of Governor Kelly Ayotte, Senator Jeanne Shaheen, Senator Maggie Hassan, Congressman Chris Pappas, and Mayor Jay Ruais. At Thursday’s celebration, Ruais thanked the professionals and community partners who have sustained the program. “This milestone demonstrates the power of collaboration and of supporting children and families. The ACERT approach recognizes that trauma does not have to define a child's future, and that timely intervention, compassionate support, and strong community connections can help children heal and thrive.” The core ACERT team includes advocates from the Manchester Police Department, Amoskeag Health, and YWCA New Hampshire. Each partner delivers unique skills, resources, and services to link families to dedicated, trauma-informed care that addresses both the emotional and physical needs of children. Kris McCracken, President and CEO of Amoskeag Health, said, “I love that the success of ACERT doesn’t belong to any one organization. It is the result of the collaboration among all the core partners, first responders, and community partners who have said yes when a family needed help.” Once a family establishes a connection with the core team, they gain access to a close-knit network of a dozen Manchester-based organizations. These partners provide specialized services focused on the safety and healthy development of children and families. “That lasting impact is possible because of the extraordinary community partnerships that make ACERT what it is today,” said Caroline Knight, Executive Director of YWCA New Hampshire. “We may be the ones who connect families to services, but it's our community partners who open their doors, walk alongside them, and help them move forward. As we celebrate ten years of ACERT, we are deeply grateful for their commitment and look forward to building even stronger partnerships in the years ahead.” ACERT began in 2016 as a small effort to fill a gap in follow-up support for Manchester children. It has since grown into a robust referral network that has expanded to several New Hampshire cities and drawn interest from communities beyond the Granite State. The ACERT Technical Assistance Center (TAC) offers training, tools, coaching, convening, and monitoring and evaluation to communities interested in implementing the program. Manchester Police Chief Peter A. Marr credits ACERT as a contributor to the city’s declining crime rates over the last several years. “As just one piece in a larger puzzle, ACERT can’t take all the credit. But I absolutely believe it’s contributed to the more resilient community Manchester has become,” Marr said. “When we help one child, we help a family, and when we do it for thousands of children, we have an opportunity to change the community.”

About 1 in 8 women in the U.S. will develop breast cancer at some point in her life, and an estimated 382,640 women will receive a diagnosis this year alone. The numbers are sobering, but there is real reason for optimism. When breast cancer is caught early through screening, the 5-year relative survival rate is over 99%. Keep reading to learn how screening works, who is at higher risk, which symptoms to watch for, and what support is available. Why Screening Matters Advances in screening, research, and treatment methods have helped reduce breast cancer death rates by 44% since 1989. Women who get screened regularly are 26% less likely to die of the disease than those who do not receive screenings. Several tests can reveal abnormalities in the breast. Your health provider can perform a clinical breast exam during an office visit by physically examining your breasts. Mammograms are recommended for women 40 and older, as well as for those at higher risk. A mammogram uses low-dose X-rays to capture images of breast tissue and can often spot cancer before a lump can be seen or felt. If your provider finds an area that needs further attention during a screening, or if you have symptoms that align with breast cancer, you may be referred to a specialist to perform additional tests to confirm diagnosis. Who Is at Higher Risk? Breast cancer doesn’t always have a clear cause, but certain factors raise the odds. You’re considered high risk, and should be screened regularly, if any of the following apply: You’ve had breast cancer before Breast cancer runs in your family history You carry a genetic mutation linked to higher risk, such as a BRCA gene change You received chest radiation therapy before age 30 Symptoms to Watch For Although rare, men can get breast cancer as well since all people are born with some breast cells and tissue. Everyone should know the warning signs. The most frequent sign is a new lump or mass, although most lumps turn out to be noncancerous. A lump that is hard, painless, and irregular in shape is more suspicious, but cancerous lumps can also be soft, round, tender, or painful. Other signs include: Swelling in all or part of a breast, even without a lump Dimpled skin that resembles an orange peel Red, dry, flaky, or thickened skin on the breast or nipple Breast or nipple pain A nipple that turns inward Nipple discharge that isn’t breast milk Swollen lymph nodes under the arm or near the collarbone Having one of these symptoms doesn’t mean you have cancer. Hormonal changes and benign breast conditions can cause many of them. Try not to panic, and let your provider help you figure out what’s going on and what to do next. Life After a Diagnosis Breast cancer statistics can be frightening, but there is also hope in the numbers. Roughly 66% of breast cancers are found early, before spreading beyond the breast, when treatment is typically more successful. For cancers caught at this localized stage, the 5-year relative survival rate exceeds 99%. More than 4 million breast cancer survivors are living in the United States today. These figures highlight why proactive screening is so important: it gives you the best chance of finding and treating cancer at its earliest stage. How Amoskeag Health Can Help Amoskeag Health is a Breast and Cervical Cancer Program (BCCP) screening site for the State of NH providing free breast and cervical cancer screening to eligible patients. An Amoskeag Health Nurse provides education, support, and assistance to navigate through the program’s options. The cancer screening program is supported by funding from the State of NH’s Department of Health and Human Services BCCP Program and Dartmouth Hitchcock’s NH Colorectal Cancer Screening Program. Please talk to your Primary Care Provider for more information. If you’ve recently been diagnosed with breast cancer and want help coping with the stress and emotions of treatment, Amoskeag Health’s Behavioral Health Clinicians are also available to support your mental health. To learn more about Amoskeag Health’s screening services, click here.

Dr. Mary Cullen has achieved board certification in the subspecialty of addiction medicine through the American Osteopathic Association, a milestone she says reflects a personal commitment that began more than a decade ago. By 2013, Dr. Cullen had already spent three years providing primary care to Amoskeag Health patients and had grown deeply familiar with their needs and concerns. Recognizing how limited resources were for pregnant women with substance use disorders, she began offering medication treatment for this underserved population. What started as an effort to fill a gap in care soon grew into a major component of the community health center's services, as word spread and more patients sought help. After more than ten years of gaining knowledge about and treating substance use disorder, Dr. Cullen began pursuing her board certification. Among other program requirements, candidates must practice a minimum of 1,000 hours of addiction medicine in a two-year period and complete ongoing medical education. While the extensive certification exam required many hours of studying, Dr. Cullen says it was a welcome challenge because this preparation strengthened the care she provides her patients. "For me, this certification is not simply a professional accomplishment,” says Dr. Cullen. “It reflects my commitment to treating substance use disorders with the same compassion, evidence-based care, and medical expertise that I bring to every other aspect of my practice. I am proud to have pursued this path and grateful for the opportunity to continue helping patients and families affected by addiction." Today, about a third of Dr. Cullen’s practice at Amoskeag Health is devoted to addiction medicine and supporting patients on their recovery journey. In addition to this new certification, Dr. Cullen is board certified in Family Medicine. To learn more about Dr. Cullen, click here. To learn more about Amoskeag Health's Substance Use Treatment Program and Medication Assisted Treatment, click here.