CONCORD — The federal government has approved New Hampshire’s proposal to impose a work requirement on able-bodied adults enrolled in the expanded Medicaid program, now providing government-funded health insurance to an estimated 50,000 low-income residents.

The work requirement was added as lawmakers converted the New Hampshire Health Protection Program to the Granite Advantage Health Care Program, and extended approval for another five years.

New Hampshire is now one of five states that have a waiver from traditional Medicaid rules, issued by the federal Centers for Medicare and Medicaid Services (CMS), allowing the state to impose work requirements.

“Health insurance leads to better health outcomes for individuals, and extending this critical program will allow Granite Advantage members to continue to receive health insurance while also building long-term job training skills and pursuing work and educational opportunities,” said Gov. Chris Sununu.

“The community engagement and work requirement will help bring more people into the workforce, empowering individuals with the dignity of work, self-reliability and access to high quality health care.”

In June, Sununu signed Senate Bill 313 into law, establishing the Granite Advantage program, which reauthorized expanded Medicaid and added the work requirement for beneficiaries between the ages of 19 and 64 as a condition of continued Medicaid eligibility.

The incoming Democratic Majority Leader in the state Senate, Sen. Dan Feltes of Concord, said he was disappointed that the CMS under the administration of President Donald Trump made the work requirement more onerous than the state had proposed, and made other changes before granting the waiver.

“The Trump administration is drastically changing the policy in New Hampshire’s bipartisan work requirement, and that’s a big problem,” he said.

Opportunities for appeal that were in the original waiver request were changed in the CMS approval, as were various steps for implementation.

A Kentucky judge rejected CMS-approved work requirements for that state in June, ruling that the Trump administration did not adequately consider whether work requirements would violate the program’s purpose of providing health care to low-income Americans.

CMS has since approved a modified waiver for Kentucky.

New Hampshire Legal Assistance Policy Director Dawn McKinney said New Hampshire could find itself in a similar situation.

“Kentucky and Arkansas are currently tied up in litigation over this issue; meanwhile, 12,000 people have already lost access to their health insurance,” she said.

According to McKinney, the waiver is a solution in search of a problem that doesn’t exist.

“Seventy-seven percent of people on Medicaid in New Hampshire are in working families,” she said. “Those who aren’t working are sick, disabled or taking care of family.”

The new rules have to go before the Joint Legislative Committee on Administrative Rules on Dec. 20, when Republicans will still have a majority in the lame-duck session.

“We urge legislators to take a closer look at how a work requirement will negatively impact vulnerable New Hampshire residents and the state budget,” said McKinney.

“Do we want to wrap our state up in litigation like Kentucky? Do we want to risk health care coverage for thousands like they’ve seen in Arkansas? Do we want to spend the state’s limited state resources spinning new red tape for struggling families?”

Gregory Moore, policy director with the conservative advocacy group AFP-NH, applauded the CMS decision and urged the state to stay the course.

“The federal approval of Medicaid work requirements is a positive step for ensuring that Medicaid is a tool to transition people out of poverty and into a life of opportunity and self-sufficiency,” he said.

“Work is not a punishment. It is how people can advance their lives and give their families a chance of fulfilling the American dream.”

The Department of Health and Human Services is holding public information sessions around the state to explain the work requirement and other changes to the expanded Medicaid program.

The next one is scheduled for Wednesday, Dec. 5, from 6 to 7:30 p.m., at the Conway Public Library. Public forums in Claremont, Colebrook, Exeter and Keene will be announced on the DHHS website when dates have been set.

November forums were held in Rochester, Nashua and Manchester.