It looks like DHHS Commissioner Jeffrey Meyers and his staff have come up with rules governing the new work requirement for certain Medicaid recipients that will enable the requirement to be implemented as planned, at least for now.

The expansion of Medicaid to another 50,000 low-income New Hampshire residents was a key part of the Affordable Care Act, but the expansion was not adopted in many states with Republican controlled legislatures.

Republicans in New Hampshire agreed to extend the program beyond its sunset in December of last year, but only if a work, training or community service requirement was added for able-bodied adults not taking care of children.

The rules governing the work requirement had to be approved by the federal agency in charge of Medicaid, which not only approved the work requirement but made it tougher, according to Democrats.

At the time, Meyers expressed confidence that his agency could implement the work requirement in a way that addressed the concerns raised by Democrats in December, when the legislative committee on rules unanimously rejected the federal changes.

On Friday, the same committee unanimously accepted the rules needed to implement the work requirement.

“While I am happy that we’ve gotten to the point where the work requirements will be implemented I hope my Democratic colleagues understand that any attempt to weaken the work requirements will make bipartisan compromise much more difficult to achieve in the future,” said state Sen. Jeb Bradley, R-Wolfeboro.

As Bradley suggests, this battle is far from over. The rules in place are “interim rules,” meaning final rules have yet to be developed and approved, while Democrats are moving ahead with a bill filed by Sen. Cindy Rosenwald of Nashua that Republicans say they can’t support.

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.

“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 when Rosenwald’s bill was first filed.

Majority Leader Dan Feltes, a JLCAR member, said the committee “successfully fought back in a bipartisan way against the Trump administration’s drastic changes to our bipartisan Medicaid plan.”

Gov. Chris Sununu and Republican legislative leaders didn’t’ think the federal changes amounted to much more than minor tinkering.

A hearing on Rosenwald’s bill, SB 290, has been scheduled for 1:30 p.m. Tuesday, Feb. 19, in Room 101 of the LOB.

Big contracts coming

Speaking of Medicaid, the state subcontracts the program to health care companies that take state and federal Medicaid funds, administer the nearly $1 billion program, pay claims and pocket a portion of what’s left as profit.

These contracts worth hundreds of millions of dollars will be presented to the Executive Council on Wednesday as a “late item,” meaning none of the detail was attached to the council agenda posted on Friday.

“It was always the department’s intention to have the council table the contracts when they were brought forward in order to provide the council with time to consider them and potentially hold an information session,” Meyers wrote in an email when asked about the scheduling. “The agreements will be presented on Wednesday with a request to table them.”

The DHHS scoring sheet for the bidding on the contracts shows the two incumbent contractors — Wellsense and Centene — were bidders, along with newcomers WellCare Health Plans, based in Tampa, Fla., and Amerihealth Caritas, based in Philadelphia.

Out of a possible score of 1,000, Amerihealth had the highest score at 846; Centene is second and Wellsense is third. Contracts have been proposed for each.

Councilors might want to ask about an investigation into Amerihealth Caritas last year by the Des Moines Register, regarding the denial of care to disabled Iowans.

Amerihealth Caritas “has yet to pay as much as $14.6 million for medical care provided to disabled, poor and elderly Iowans,” the Register reported in August.

“Before AmeriHealth terminated its work with the state last year, Iowa’s Human Services had assessed more than $1 million in penalties against the company.”

AmeriHealth spokesman Joshua Brett responded to the newspaper with a written statement that said the company is complying with its Iowa contract.