State health and human service officials have started to consider what organization will land the biggest contract in state history — a five-year deal to create and run a managed care system for Medicaid in New Hampshire.

In mid-December, a deadline for submissions passed, and a team of officials and consultants has started to pore over voluminous proposals, said Nicholas Toumpas, commissioner of health and human services.

Toumpas said he expects the team to settle on three companies by the middle of next month, and negotiations will begin soon after that.

The prize will be contracts to manage Medicaid, which consumed $1.42 billion in state and federal expenditures in the 2010 budget year.

Medicaid is a jointly funded, federal-state program that provides health care for the poor. With the stakes so high, speculation has run rampant about which companies applied.

Toumpas said state law keeps the submissions confidential until he brings a proposed contract to the governor and Executive Council for approval. That’s expected to take place in mid-March.

“We are pleased with the response that we received,” Toumpas said, adding he would go no further. He would not say how many companies submitted proposals.

Toumpas said that under federal law he must provide Medicaid clients with a choice of managed care companies, which means the state will contract with at least two companies. His goal is three.

Insiders, including interest groups, patient advocacy organizations and managed-care companies themselves have speculated about what companies submitted proposals.

Anthem or its affiliate Wellpoint is on several lists. Chris Dugan, the Anthem Blue Cross Blue Shield spokesman for New Hampshire, would not comment when contacted by a reporter.

Speculation is also rife about Centene, Aetna, Coventry Health Care, Network Health, which is affiliated with Tufts University, and Harvard Pilgrim.

The number could be even higher. A year ago, the state asked the insurance industry for advice about a managed care program for Medicaid; it received nine responses, according to the Health and Human Services Department website.

Six were national for-profit firms. Three were New England-based non-profit companies.

John Stephen, a former Republican candidate for governor who has helped fashion managed care for other states’ Medicaid programs, said there are fewer than 10 companies across the country capable of winning the New Hampshire contract.

With their bids under review, the companies have started to approach providers.

Doug Dean, president and chief executive of Elliot Hospital, said managed care companies have contacted the hospital to ask about becoming part of their Medicaid network.

“We would consider anything, but the details are what needs to be discussed,” Dean said. He is skeptical. The average Medicaid payment amounts to less than half the hospital’s cost of providing the service, Dean said.

“It’s an underfunded program,” Dean said about Medicaid, “and if it’s an underfunded program, it becomes difficult for me to understand how an insurance company inserts itself and makes it better,” Dean said. But he added he is not an expert on managed care for Medicaid and he is willing to speak to the companies and work out details.

Stephen has high expectations for managed care. “You’re not just saving money, you’re promoting quality of care,” he said.

The key to success, Stephen said, will be for state officials to create a contract that will specify outcomes, performance guarantees, quality controls, access guarantees and other quantitative measures.

Many states have enacted Medicaid managed care, so New Hampshire will be able to benefit from their experience and ramp up quickly, Stephen said.

The state anticipates a minimal savings of $16 million the first year, but Stephen thinks a potential exists for $50 million.

In later years, savings could amount to 10 to 15 percent, he said. Stephen said he has discussed the matter with Toumpas, but has no consulting relationship with the state.

Toumpas said the consulting group Deloitte Consulting is working with his department. The Legislature has earmarked $1 million for consulting work on the contract, he said.

For Toumpas, the system is one of the reasons he asked Gov. John Lynch to reappoint him. In doing so, Toumpas became the first commissioner of health and human services to win reappointment since the department was created in the 1969. “It is the most significant public policy initiative this department has done,” he said. “I can’t think of any other that is as significant since we’ve been here.”