CONCORD — Democratic state Sen. Cindy Rosenwald of Nashua has filed a bill that significantly rewrites the work requirement both parties agreed to last year for people in the state’s expanded Medicaid program, prompting a leading Republican senator to warn of a “donnybrook” if Democrats try to incorporate the changes in the new state budget.

Among other things, the bill would end the work requirement entirely if it resulted in more than 500 people losing their benefits out of 50,000 in the federally funded health insurance program for low-income households.

“There are several non-starters in the legislation that seem to deliberately undermine key components of the state’s expanded Medicaid program and reverse course on the broad, bipartisan agreement reached last year,” said Republican Gov. Chris Sununu. “These actions would put the healthcare of over 50,000 Granite Staters at risk.”

The expansion of Medicaid to a larger portion of the low-income population was approved in many states as part of the Affordable Care Act, with the federal government now bearing 93 percent of the cost. The federal share will decrease to 90 percent in 2020.

Republicans have been adamant that the state General Fund should not be tapped to fund the state share, and have come up with alternatives involving the private sector. Another change in Rosenwald’s bill would allow use of money from the General Fund for the program.

The federal government recently made some changes to the work requirement as it was originally designed, and Rosenwald’s bill was expected to address those changes, but it goes well beyond that objective.

“The goal of it is to help ensure the success of what I consider to be a really successful bipartisan program,” she said. “Some of what is in there is in reaction to the (work requirement) changes made by (the federal government), and some of it is not, but it’s all intended to contribute to the success of a program that the Legislature is very committed to.”

An essential element

More than 100,000 households were already on traditional Medicaid before the expansion in 2014 added another 50,000 to the rolls. Instituting a work requirement was essential in gaining Republican support for continuing the program beyond its original sunset date at the end of 2018.

Other measures in Rosenwald’s bill that would constrain the work requirement include applying it only to people 19 to 49 years of age, reducing required hours worked from 100 to 80, and basing it on an average of 20 hours per week instead of 25.

The bill also adds self-employment and participation in mental illness recovery programs as activities that would satisfy the work requirement.

An exemption from the work requirement for custodial parents or caretakers has been changed to apply in households with children up to the age of 16, as opposed to under the age of 6 in the existing statute.

Rosenwald’s bill also establishes exemptions from the work requirement for any beneficiary who is homeless, the caretaker of a grandchild, a full-time college or university student and anyone 50 or older.

Could be eliminated

If the Center for Medicare and Medicaid Services (CMS) does not approve the work requirement as designed in the bill, the requirement could be eliminated.

“If CMS has not approved the waiver amendment by April 1, 2020, the work and community engagement requirement shall be immediately terminated,” the bill states.

“This would take us from the strongest work requirement in the nation to the weakest work requirement in the nation. I can’t support that,” said Senate Minority Leader Chuck Morse, R-Salem. “I think the public will be extremely disappointed if we don’t have a work requirement.”

Senate Majority Leader Dan Feltes, D-Concord, who was a key negotiator in the Medicaid expansion compromise with then-Majority Leader Jeb Bradley, R-Wofleboro, said he believes the changes are within the spirit of that compromise.

“I’m proud to cosponsor Senator Rosenwald’s bill. I believe it’s standing up for New Hampshire’s health care system and the bipartisan deal we reached last session, making common-sense changes,” Feltes said. “Many of the changes are consistent with the spirit and purpose of what we negotiated.”

Bipartisanship threatened

Bradley, his chief counterpart in those negotiations, doesn’t agree.

“The work requirement is the glue that produced the bipartisan compromise,” he said, “and to undermine that at this point in time is really unfortunate. It’s just going to make bipartisan work on things like this that are necessary really difficult.”

Even if Rosenwald’s bill passes by majority vote in the House and Senate, it would likely face a veto from Sununu, which would leave existing law in place if Democrats could not muster the votes to override.

“Unless they put it in the budget,” said Bradley, which would significantly complicate the veto scenario.

“That was the first thing I thought when I saw this. It is very upsetting. It’s one thing to tweak around the edges, but this is a wholesale rewrite. If it goes into the budget, there will be a donnybrook.”

Sununu praised the work requirement in his inaugural speech last week, and urged the legislature not to mess with it.

“We have designed a New Hampshire solution that was the result of a bipartisan agreement,” he said. “This legislature should not obstruct its implementation.”