New Hampshire’s Medicaid program began its transition to managed care on December 1, 2013. This shift to the managed care model of Medicaid represents an attempt to control costs and improve the coordination of health care. The shift to managed care is part of a national trend, as many states are looking at ways to control costs and establish predictability in their Medicaid budget. While Medicaid managed care has been in practice for several decades, it has primarily focused on low-cost patient populations such as young women and children. There is a very short track record of managed care plans that include disabled and long-term care populations. New Hampshire’s Medicaid managed care plan has unique characteristics that include patient populations in the model that few other states have attempted to incorporate into capitated managed care programs. It is uncertain that the shift to managed care will produce any savings, especially in the short-term. If savings are found, they will likely be achieved in the long- term. The transition to managed care will present challenges, such as managing the needs of Medicaid patients without compromising access to care. Factors that may present challenges to New Hampshire’s implementation of managed care include its rural demographics and its small Medicaid enrollment, which may make it difficult to maintain provider networks, as well as other policy challenges, such as setting appropriate capitation rates for patients with complex health conditions and its method of allocating federal funding for uncompensated care. To ensure that New Hampshire’s transition to managed care is smooth and successful; the state should be cognizant of the concerns of all stakeholders involved in providing long-term care. Finally, careful, continuous statistical analysis will be important in tracking the effectiveness of this new program to address weaknesses early on in the implementation process.