CONCORD — Continuing the expansion of Medicaid health insurance to more than 50,000 low-income New Hampshire residents was supposed to be last year’s legislative battle. But as 2019 dawns, the program now known as Granite Advantage Health Care is again atop the legislative agenda.

In one of her first acts as a state senator, former state Rep. Cindy Rosenwald, D-Nashua, will soon introduce legislation dealing with work requirements for Medicaid beneficiaries. The bill has been “filed confidentially” according to a state Senate spokesman, and its language is not yet ready for public release.

One bill that has been filed publicly by newly elected Concord state Rep. Rebecca McWilliams would remove the work requirement from the Granite Advantage program.

At issue is the question of whether able-bodied adults not involved in caring for a dependent child should be required to work or engage in community service or job training for at least 100 hours a month to qualify for the federally funded health insurance.

That work requirement was a key part of the deal struck between Republicans and Democrats in 2018 to extend the program, seen as essential in the fight against opioid addiction, for at least another five years. It was scheduled to sunset on Dec. 31.

The federal government, through the Centers for Medicaid and Medicare, approved the work requirement last week, but with some changes to the rules governing eligibility.

That set off a firestorm in Concord, where Democrats accused the Trump administration of tinkering with a carefully crafted compromise in the hope of dumping eligible recipients off their health insurance.

Fears of confusion

The changes will be “expensive to administer and cause confusion, chaos and loss of coverage for thousands of people,” according to Dawn McKinney, policy director at N.H. Legal Assistance, which advocates for low-income families.

Rosenwald’s bill will “codify New Hampshire-specific rules in state law,” according to a statement from the Senate Democrats, in an attempt to push back on the federal changes.

Republicans at the State House say the federal changes are minor and consistent with principles both parties agreed to in passing Senate Bill 313, the expanded Medicaid reauthorization. They want the state to accept the federal rules and move on, warning that any state challenge to the changes puts the federal approval at risk.

Department of Health and Human Services Commissioner Jeffrey Meyers also thinks the federal changes can be accommodated without violating the spirit of the SB 313 compromise.

Republican leaders in the State House in the days before Christmas suggested that Democrats never really liked the work requirement and were trying to use the rules process to upend it.

“This was negotiated in good faith, and compromises were reached on both sides,” said House Minority Leader Dick Hinch, R-Merrimack. “Clearly, this is an organized effort by Democrats to bypass the bipartisan agreements made just this year.”

The key question is, how onerous are the federal changes? Both sides are far apart on that analysis, and the details are incredibly complex.

Vote applauded

McKinney applauded the Dec. 20 vote by the Joint Legislative Committee on Administrative Rules to object to the federal changes.

“The rejected rule would subject some people who rely on Medicaid for their health coverage to harsh work reporting requirements,” she said. “Objecting to the proposed work requirement rule was a responsible decision, given the potential ramifications.”

According to McKinney, almost 17,000 people have lost their Medicaid coverage in Arkansas since September, due to that state’s work requirement.

“Kentucky has been mired in litigation over this issue for months with no resolution in sight,” she said. “New Hampshire Legal Assistance is working hard with our partners in other organizations to make sure the same thing doesn’t happen here.”

According to DHHS figures, about 45 percent of the population on expanded Medicaid is already working full- or part-time, and another group will qualify for one of several exemptions from the requirement, leaving as many as 15,000 recipients facing the work or community service mandate.

Despite warning alarms sounded by Republicans, McKinney, Meyers and others maintain the state’s pushback on the federal rule change will not jeopardize Medicaid coverage scheduled to take effect on Jan. 1.

“Our state leaders have time now to develop a common-sense, bipartisan New Hampshire solution,” says McKinney. “Hard-working New Hampshire families don’t need any more red tape. They need health care coverage so they can stay healthy and continue to provide for their families.”